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THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Purpose of This Notice: verihealth Inc. 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.
This Notice describes your legal rights, advises you of our privacy practices,
and lets you know how veriHealth Inc. is permitted to use and disclose
PHI about you.
verihealth Inc. is also required to abide by the terms of the version of
this Notice currently in effect. In most situations we may use this information
as described in this Notice without your permission, but there are some
situations where we may use it only after we obtain your written authorization,
if we are required by law to do so.
Uses and Disclosures of PHI: verihealth Inc. 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 verbal and written information
that we obtain about you and use pertaining to your medical condition and
treatment provided to you by us and other medical personnel (including
doctors and nurses who give orders to allow us to provide treatment to
you). It also includes information we give to other health care personnel
to whom we transfer your care and treatment, and includes transfer of PHI
via radio or telephone to the hospital or dispatch center as well as providing
the hospital with a copy of the written record we create in the course
of providing you with treatment and transport.
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 organizing your PHI and submitting bills to insurance companies (either
directly or through a third party billing company), management of billed
claims for services rendered, medical necessity determinations and reviews,
utilization review, and collection of 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, obtaining
legal and financial services, conducting business planning, processing
grievances and complaints, creating reports that do not individually identify
you for data collection purposes, fundraising, and certain marketing activities.
Fundraising. We may contact you when we are in the process
of raising funds for verihealth or to provide you with information about
our annual subscription program.
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 for other information
about alternative services we provide or other health-related benefits
and services that may be of interest to you.
Use and Disclosure of PHI Without Your Authorization. veriHealth
Inc. is permitted to use PHI without your written authorization,
or opportunity to object in certain situations, including:
- For verihealth Inc. use in treating you or in obtaining payment for
services provided to you or in other health care operations;
- For the treatment activities of another health care provider;
- To another health care provider or entity for the payment activities
of the provider or entity that receives the information (such as your
hospital or insurance company);
- To another health care provider (such as the hospital to which you
are transported) for the health care operations activities of the entity
that receives the information as long as the entity receiving the information
has or has had a relationship with you and the PHI pertains to that
relationship;
- For health care fraud and abuse detection or for activities related
to compliance with the law;
- 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. We may also disclose health information
to your family, relatives, or friends if we infer from the circumstances
that you would not object. For example, we may assume you agree to
our disclosure of your personal health information to your spouse when
your spouse has called the ambulance for you. In situations where you
are not capable of objecting (because you are not present or due to
your incapacity or medical emergency), we may, in our professional
judgment, determine that a disclosure to your family member, relative,
or friend is in your best interest. In that situation, we will disclose
only health information relevant to that person's involvement in your
care. For example, we may inform the person who accompanied you in
the ambulance that you have certain symptoms and we may give that person
an update on your vital signs and treatment that is being administered
by our ambulance crew;
- To a public health authority in certain situations (such as reporting
a birth, death or disease as required by law, as part of a public health
investigation, to report child or adult abuse or neglect or domestic
violence, to report adverse events such as product defects, or to notify
a person about exposure to a possible communicable disease as required
by law;
- 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
there is a warrant for the request, or when the information is needed
to locate a suspect or stop a crime;
- 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 workersí compensation purposes, and in compliance with workersí 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 and health information will be released only when there
is a minimal risk to your privacy and adequate safeguards are in place
in accordance with the law;
- We may 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, (the authorization must specifically
identify the information we seek to use or disclose, as well as when and
how we seek to use or disclose it). 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 the protection of your PHI, including:
The right to access, copy or inspect your PHI. This means you may
come to our offices and 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.
If you wish to inspect and copy your medical information, you should contact
the privacy officer listed at the end of this Notice.
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,
such as 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 the privacy officer listed at the end of
this Notice.
The right to request an accounting of our use and disclosure of your
PHI. You may request an accounting from us of certain disclosures of
your medical information that we have made in the last 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 of the medical information
about you that we have used or disclosed that is not exempted from the
accounting requirement, you should contact the privacy officer listed at
the end of this Notice.
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 for treatment,
payment or health care operations, or to restrict the information that
is provided to family, friends and other individuals involved in your health
care. But if you request a restriction and the information you asked us
to restrict is needed to provide you with emergency treatment, then we
may use the PHI or disclose the PHI to a health care provider to provide
you with emergency treatment. veriHealth Inc. is not required to agree
to any restrictions you request, but any restrictions agreed to by veriHealth
Inc. are binding on veriHealth Inc.
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 and make the Notice available electronically
through the 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: veriHealth Inc. 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 the Privacy
Officer identified below.
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 the privacy officer listed
at the end of this Notice. Individuals will not be retaliated against for
filing a complaint.
If you have any questions or if you wish to file a complaint or exercise
any rights listed in this Notice, please contact:
Privacy Officer
verihealth Inc.
PO Box 750416
Petaluma, CA 94975
(707) 766-2400 |
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