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:Berlin Area Ambulance Assoc. Inc. is required by law to maintain
the privacy of certain confidential healthcare information, known as protected health
information of 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 Berlin Area Ambulance Assoc.
Inc. is permitted to use and disclose PHI about you. Berlin Area Ambulance Assoc.
Inc. is also required to abide by the terms of the version of this Notice currently
in effect. We may use this information after we obtain your consent, and in an emergency
and other situations without your immediate consent.
Uses and Disclosure of PHI: Berlin Area Ambulance Assoc. Inc. may use PHI for the
purposes of treatment, payment, and other health care operations. 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 as well as providing the hospital
with a copy of the written medical 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
Berlin Area Ambulance Assoc. Inc., or to provide you with information about our annual
Reminders for Scheduled Transports and Information on Other Services. We may also
contact you to provide you with a reminder or 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.
Uses and Disclosure of PHI Without Your Consent: Berlin Area Ambulance Assoc. Inc.
is authorized to use PHI without your consent, authorization, or written permission
in certain situations, including:
Emergency situations (in these situations, in accordance with the law we will attempt
to get your written consent after the emergency service is provided and we would
appreciate your cooperation when we do so);
To a relative, friend or individual involved in your care;
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 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
For military, national defense and security and other special government functions;
To avert a serious threat to the health and safety to a person or the public at large;
For workers’ compensation purposes, in compliance with workers’ compensation laws.
Any other use or disclosure of PHI, other than those listed above will only be made
with your written consent or an authorization (an authorization specifically identifies
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 consent or authorization at any time, in writing,
except to the extent that we have already used or disclosed medical information in
reliance on that consent or 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 certain types of denials may be appealed. We have
available forms to request PHI and 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
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. You can appeal our denial of your request to amend the information.
If you wish to 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 of uses or disclosures
made prior to August 21, 2007. If you wish to request and accounting of the medical
information about you that we have used or disclosed, you should contact the privacy
officer listed at the end of this Notice.
The right to request we restrict the uses and disclosure of your PHI. You have the
right to 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 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 PHI or disclose the
PHI to a health care provider to provide you with emergency treatment. Berlin Area
Ambulance Assoc. Inc. is not required to agree to any restrictions you request, but
any restrictions agreed to by Berlin Area Ambulance Assoc. Inc. are binding on Berlin
Area Ambulance Assoc. Inc.
Legal Rights and Complaints: Notice of any changes in Berlin Area Ambulance Assoc.
be updated when any significant changes in our policy practices occur. Berlin Area
Ambulance Assoc. Inc. reserves the right to change the terms of this Notice at any
time, and the changes will be effective immediately. We also reserve the right to
make any changes effective for PHI that we have created or received prior to the
effective date of the Notice provision that was changed. You also have the right
to complain to us, or the the Secretary of the federal 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.
If you have any questions or if you wish to file a complaint or exercise any rights
listed in this Notice, please contact: