We are required by law to maintain the privacy of Protected
Health Information and to provide you with this Notice of our
legal duties and privacy practices with respect to Protected
Health Information. Protected Health Information is information
maintained in any form that identifies an individual and relates
to the physical or mental condition of an individual, the
provision of health care or the payment for health care for that
individual.
With your prior written consent, we are permitted to disclose
your Protected Health Information for purposes of treatment,
payment and health care operations. For example, we may disclose:
(a) information to the hospital where you are transported about
your medical status; (b) information including medical reasons for
your transport to obtain payment from your insurance company or
other third party payer; (c) information to our billing company to
process your claim for payment; (d) information to an auditor
about services we rendered to you for purposes of quality
assurance.
We also may use the information we obtain about you to contact
you to provide information concerning health-related services that
may be of interest to you and to remind you about transports that
have been scheduled for you.
We also may use your Protected Health Information to contact
you to raise funds for this organization or to ask you to become a
member of our organization.
We also may use or disclose your Protected Health Information
without your written consent or authorization, in accordance with
and as otherwise restricted or limited by law or regulation, in
the following circumstances:
If we inform you in advance verbally and you have the
opportunity to agree, prohibit or restrict verbally, we may make
disclosures to your family member, other relative, close
personal friend or other person identified by you directly
relevant to such person’s involvement with your care or
payment for your care, or we may disclose Protected Health
Information to notify a family member, personal representative
or other person responsible for your care, general condition or
death. If you are unavailable or incapacitated, we may exercise
our professional judgment and disclose your Protected Health
Information to the above named individual(s), if we determine it
to be in you best interest. We may similarly make disclosures to
entities involved in disaster relief activities who are involved
in notification of family members;
To your personal representative, i.e. the person who under
state law has authority to act on your behalf in making
decisions related to health care;
To the extent required by law;
For public health and oversight activities;
For certain law enforcement activities;
For judicial and administrative proceedings;
To the coroner, medical examiner, or funeral director
consistent with applicable law or as authorized by law;
To prevent or lessen a serious and imminent threat to the
health or safety of a person or the public;
For specialized government functions including but not
limited to national security;
To comply with laws relating workers’ compensation or other
similar programs;
For research in certain limited circumstances.
Any other uses and disclosures of your Protected Health
Information will be made only with written authorization. You may
revoke any such authorization that you give, provided your
revocation is in writing and we have not already taken any action
in reliance on the authorization.
To the extent Pennsylvania law may have more stringent
requirements as to the use or disclosure of information that a
patient has Acquired Immune Deficiency Syndrome (AIDS), about a
patient’s HIV status, information regarding drug and alcohol use
or dependency, or mental health records, it is our policy to abide
by the more stringent requirements of the State law.
You have the right to request restrictions to certain uses and
disclosures of your Protected Health Information that are for
purposes of carrying out treatment, payment or health care
operations. You also have the right to request restrictions or
certain permitted disclosures to family members, other relatives,
close personal friends or individuals identified by you. We are
not required to agree to such restrictions, but will advise you of
the decision. We may nevertheless release restricted information
in certain emergency situations.
You have the right to request receipt of confidential
communications of Protected Health Information by alternative
means or at an alternative location. We will accommodate
reasonable requests made by you. Your request must be made in
writing.
You have the right to inspect and copy your Protected Health
Information except as otherwise restricted by law and regulation.
You must make your request in writing. We may charge a reasonable
fee for the copies that you request.
You have the right to request that we amend your Protected
Health Information. Your request must be made in writing and you
must provide a reason to support your requested change. We must
respond to your request no later than sixty (60) days after
receipt of your request.
You have the right to receive an accounting from us of
certain disclosures of your Protected Health Information upon
your written request without charge in any twelve-month period.
We may charge for a subsequent request within the twelve-month
period. We must respond to your request no later than sixty (60)
days after receipt of your request.
If you received this Notice electronically you have the right
to obtain a paper copy of this Notice upon request.
We are required to abide by the terms of this Notice as it is
currently in effect.
We reserve the right to change the terms of this Notice and
to make the new Notice provisions effective for all Protected
Health Information that we maintain. We will provide a revised
Notice to you upon your request by mail.
You may complain to us and to the Secretary of the Department
of Health and Human Services of the United States of America if
you believe that your privacy rights have been violated. You may
file your complaint with us by sending a written complaint to:
South Central Emergency Medical Services, Inc. at 8065 Allentown
Boulevard, Harrisburg, PA 17112. We will not retaliate against
you for filing a complaint.
To exercise your rights referenced in this Notice; or if you
have any questions concerning the information contained in this
Notice you should contact our Privacy Officer by phone at (717)
671-4020, or by mail at 8065 Allentown Boulevard, Harrisburg, PA
17112.
The effective date of this Notice is April 1, 2003.