| Lyons
Ambulance Service LLC("Lyons") is required by law to maintain
the privacy of certain confidential health care information, known
as Protected Health Information or PHI, and to provide you with
a notice of our legal duties and privacy practices with respect
to your PHI. Lyons is also required to abide by the terms of the
version of this Notice currently in effect.
Uses
and Disclosures of PHI: Lyons may use PHI for the purposes
of treatment, payment, and health care operations, in most cases
without your written permission. Examples of our use of your PHI:
For
treatment.This includes such things as obtaining verbal
and written information about your medical condition and treatment
from you as well as from others, such as doctors and nurses who
give orders to allow us to provide treatment to you. We may give
your PHI to other health care providers involved in your treatment,
and may transfer your PHI via radio or telephone to the hospital
or dispatch center.
For
payment. This includes any activities we must undertake
in order to get reimbursed for the services we provide to you,
including such things as submitting bills to insurance companies,
making medical necessity determinations and collecting outstanding
accounts.
For
health care operations. This includes quality assurance
activities, licensing, and training programs to ensure that our
personnel meet our standards of care and follow established policies
and procedures, as well as certain other management functions.
Reminders for Scheduled Transports and Information on Other
Services. We may also contact you to provide you with
a reminder of any scheduled appointments for non-emergency ambulance
and medical transportation, or to provide information about other
services we provide.
Use
and Disclosure of PHI Without Your Authorization. Lyons
is permitted to use PHI without your written authorization, or
opportunity to object, in certain situations, and unless prohibited
by a more stringent state law, including:
- For
the treatment, payment or health care operations activities
of another health care provider who treats you;
- For
health care and legal compliance activities;
- To
a family member, other relative, or close personal friend or
other individual involved in your care if we obtain your verbal
agreement to do so or if we give you an opportunity to object
to such a disclosure and you do not raise an objection, and
in certain other circumstances where we are unable to obtain
your agreement and believe the disclosure is in your best interests;
- To
a public health authority in certain situations as required
by law (such as to report abuse, neglect or domestic violence;
- For
health oversight activities including audits or government investigations,
inspections, disciplinary proceedings, and other administrative
or judicial actions undertaken by the government (or their contractors)
by law to oversee the health care system;
- For
judicial and administrative proceedings as required by a court
or administrative order, or in some cases in response to a subpoena
or other legal process;
- For
law enforcement activities in limited situations, such as when
responding to a warrant;
- For
military, national defense and security and other special government
functions;
- To
avert a serious threat to the health and safety of a person
or the public at large;
- For
workers' compensation purposes, and in compliance with workers'
compensation laws;
- To
coroners, medical examiners, and funeral directors for identifying
a deceased person, determining cause of death, or carrying on
their duties as authorized by law;
- If
you are an organ donor, we may release health information to
organizations that handle organ procurement or organ, eye or
tissue transplantation or to an organ donation bank, as necessary
to facilitate organ donation and transplantation;
- For
research projects, but this will be subject to strict oversight
and
approvals;
- We
may also use or disclose health information about you in a way
that does not personally identify you or reveal who you are.
Any
other use or disclosure of PHI, other than those listed above
will only be made with your written authorization. You may revoke
your authorization at any time, in writing, except to the extent
that we have already used or disclosed medical information in
reliance on that authorization.
Patient
Rights: As a patient, you have a number of rights with
respect to your PHI, including:
The
right to access, copy or inspect your PHI.
This means you may inspect and copy most of the medical information
about you that we maintain. We will normally provide you with
access to this information within 30 days of your request. We
may also charge you a reasonable fee for you to copy any medical
information that you have the right to access. In limited circumstances,
we may deny you access to your medical information, and you may
appeal certain types of denials. We have available forms to request
access to your PHI and we will provide a written response if we
deny you access and let you know your appeal rights. You also
have the right to receive confidential communications of your
PHI. If you wish to inspect and copy your medical information,
you should contact our privacy officer.
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 will generally amend your information
within 60 days of your request and will notify you when we have
amended the information. We are permitted by law to deny your
request to amend your medical information only in certain circumstances,
like when we believe the information you have asked us to amend
is correct. If you wish to request that we amend the medical information
that we have about you, you should contact our privacy officer.
The
right to request an accounting.
You may request an accounting from us of certain disclosures of
your medical information that we have made in the six years prior
to the date of your request. We are not required to give you an
accounting of information we have used or disclosed for purposes
of treatment, payment or health care operations, or when we share
your health information with our business associates, like our
billing company or a medical facility from/to which we have transported
you. We are also not required to give you an accounting of our
uses of protected health information for which you have already
given us written authorization. If you wish to request an accounting,
contact our privacy officer.
The
right to request that we restrict the uses and disclosures of
your PHI.
You have the right to request that we restrict how we use and
disclose your medical information that we have about you. Lyons
is not required to agree to any restrictions you request, but
any restrictions agreed to by Lyons in writing are binding on
Lyons.
Internet,
Electronic Mail, and the Right to Obtain Copy of Paper Notice
on Request.
If we maintain a web site, we will prominently post a copy of
this Notice on our web site. If you allow us, we will forward
you this Notice by electronic mail instead of on paper and you
may always request a paper copy of the Notice.
Revisions
to the Notice:
Lyons reserves the right to change the terms of this Notice at
any time, and the changes will be effective immediately and will
apply to all protected health information that we maintain. Any
material changes to the Notice will be promptly posted in our
facilities and posted to our web site, if we maintain one. You
can get a copy of the latest version of this Notice by contacting
our privacy officer.
Your
Legal Rights and Complaints:
You also have the right to complain to us, or to the Secretary
of the United States Department of Health and Human Services if
you believe your privacy rights have been violated. You will not
be retaliated against in any way for filing a complaint with us
or to the government. Should you have any questions, comments
or complaints you may direct all inquiries to our privacy officer.
Privacy
Officer Contact Information:
Donna Moore
Lyons Ambulance Service LLC
135 Maple Street
Danvers, MA 01923-2060
(978) 774-1133
Effective
Date of the Notice: April 14, 2003
Back
to the top
|
