UPPER LAUREL AMBULANCE SERVICE

IMPORTANT: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY ACCESS THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

 

Upper Laurel Ambulance maintains the privacy of confidential health care information about you, known as “Protected Health Information” or “PHI”. Upper Laurel Ambulance is required by law to protect your health care information and to provide you with this “NOTICE OF PRIVACY PRACTICES”.

 

Upper Laurel Ambulance respects your privacy, and we treat all information about our patients under strict confidentiality policies that our staff is committed to following at all times.

 

PLEASE READ THIS DETAILED NOTICE. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT OUR PRIVACY OFFICER AT UPPER LAUREL AMBULANCE AT (304) 294-4400 OR STOP BY OUR CENTRAL OFFICE AT THE UPPER LAUREL VOLUNTEER FIRE DEPARTMENT IN SABINE.

 

This notice describes your legal rights, advises you of our privacy practices and lets you know how Upper Laurel Ambulance is permitted by law to use and disclose PHI about you.

 

Upper Laurel Ambulance may use PHI for the purpose of treatment, payment and health care operations, in most cases without your permission.

 

TREATMENT: Includes verbal and/or written information that we obtain about you and use pertaining to your medical condition and treatment provided to you by Upper Laurel Ambulance and other healthcare providers (including doctors and nurses who give us orders to allow us to treat you). It also includes information we give to nurses and doctors when we transfer care and treatment, which also includes a copy of the West Virginia Prehospital Care Record or “PCR” we complete detailing the reason(s) for transport and also the treatment provided.

 

PAYMENT: Includes any activities we must initiate in order to be reimbursed for transport and services rendered, including but not limited to: submitting bills to insurance companies; management of those bills; medical necessity determination and reviews; utilization reviews; and collection of outstanding accounts.

 

HEALTH CARE OPERATIONS: Includes Quality Assurance/Quality Improvement (QA/QI) activities, licensing and educational programs to ensure our personnel meet training requirements set forth by the State of West Virginia as well as Upper Laurel Ambulance’s internal requirements.

 

Upper Laurel Ambulance may also contact you for an appointment reminder for non-emergency transports that have been pre-scheduled.

 

Any other use or disclosure of PHI, other than payment, treatment or operations will be made only with your written authorization. You make revoke your authorization in writing at any time.

 

As a patient you have a number of rights with respect to the protection of your PHI, including:

 

1.       The right to access, copy and inspect your PHI.

2.       The right to amend your PHI. You have the right to ask us to amend written medical information that we may have about you. We are permitted by law to deny your request to amend your medical information when we believe the information you have asked us to amend is correct.

3.       The right to request an accounting of our use and disclosure of your PHI in the last six (6) years. We are not required to give you an account of information we have used for purposes of treatment, payment and healthcare operations.

4.       The right to request that we restrict the use and disclosure of your PHI. You can also restrict the information that is provided to family, friends and other individuals involved in your health care.

5.       Upper Laurel Ambulance reserves the right to change the terms of this Privacy Notice at any time. The changes will be effective immediately and will apply to all PHI that Upper Laurel Ambulance maintains. You can receive a copy of the current Upper Laurel Ambulance Notice of Privacy by contacting us at the above telephone number.

6.       You have the right to file any complaint with Upper Laurel Ambulance or to the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated.

 

If you have any questions/concerns about this Privacy Notice or with any Upper Laurel Ambulance situation or want to exercise your right to complain, please do not hesitate to contact our Privacy Officer at (304) 294-4400.                                                                    

 

 

 

 

 

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