HIPAA Notice Of Privacy Practices (Effective 4/14/04)
YOUR PERSONAL MEDICAL INFORMATION IS PRIVATE:
International Medevac Services Inc.. understands how important your personal medical information is to you. We know you are concerned with how that information might be used, the way in which it is disclosed and how you can access that information. That is why we've put this document together. It's the "Privacy Practices" outlined here that is so important and why we want to pledge our commitment, at the onset, to respect your personal medical information.
OUR PLEDGE TO YOU: We understand that your medical information is personal and confidential. We create a medical record of the care you receive because it is our legal obligation, but more importantly because we want to provide you with quality care. Please know we are committed to protecting your personal medical information from any use for which it was not intended.
IN SHORT, THE LAW REQUIRES US TO:
Keep your medical information private. Notify you of our legal duties and privacy practices with respect to your medical information. Follow the terms of the most current notice.
WHAT THIS NOTICE IS ALL ABOUT:
The information in this document applies to all your medical records whether created by your facility staff or your personal doctor. Please understand that your personal doctor may have different policies or notices regarding the use and disclosure of the medical information created in his or her office. This notice will tell you about the specific way International Medevac Services, Inc. and our facilities may use and disclose your medical information. This notice also describes your rights and the duties we have regarding the use and disclosure of your medical information. ENTITIES ADHERING TO THESE PRIVACY PRACTICES:
The Department of Health and Human Services sponsored the Health Insurance Portability Accountability Act (HIPAA). HIPAA dictates the medical information privacy practices that health care organizations and their partners are obligated to follow. International Medevac Services Inc. provides health care to our patients and clients in partnership with many physicians and other professionals and organizations. We want you to know that all of these entities will be following the same privacy practices we do, and that these practices are specifically designed to keep your medical information confidential. The medical information privacy practices in this notice will be adhered to by: Any health care professional or staff that treats you at any of our locations. All departments and units of our organization. Any business associate or partner with whom we share health information. Be assured that all of these individuals and organizations understand that the privacy of your medical information is important, and will be following HIPAA guidelines to ensure that your information is used only as it is intended.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.International Medevac Services Inc . Hereinafter referred to as Jet Rescue Air Ambulance may use your health information, that is, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Jet Rescue Air Ambulance has established a policy to guard against unnecessary disclosure of your health information.Each time you visit a hospital, physician, utilize an ambulance service or utilize services of any type of healthcare provider, they document information about you. Typically, this record is referred to as your medical record and contains your name, symptoms, health history, test results, diagnoses, treatment given and plan for future care or treatment ("Health Information"). This medical record is used to plan your care and treatment and be a source of your health information as described below.The Following is a Summary of the Circumstances under Which and Purposes for Which Your Health Information May Be Used and Disclosed:RENDERING TREATMENT
Jet Rescue Air Ambulance may use your health information to provide care to you and disclose your health information to others who provide care to you. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications or provide appropriate medical treatments. Jet Rescue Air Ambulance also may disclose your health care information to individuals outside of Jet Rescue Air Ambulance involved in your care including family members, pharmacists, suppliers of medical equipment or other health care professionals.
OBTAINING PAYMENT
Jet Rescue Air Ambulance may include your health information in invoices to collect payment from third parties for the care you may receive from us. For example, Jet Rescue Air Ambulance may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Jet Rescue Air Ambulance. Jet Rescue Air Ambulance also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for health care and the services that will be provided to you.
HEALTH CARE OPERATIONS
Jet Rescue Air Ambulance may use and disclose health information for its own operations in order to provide quality care to all of Jet Rescue’s patients. Health care operations include activities such as: Quality assessment and improvement activities, protocol development, case management and care coordination, contacting health care providers and patients with information about treatment alternatives and other related functions that do not include treatment, professional review and performance evaluation, training programs including those in which students, trainees or practitioners in health care learn under supervision, training of non-health care professionals, accreditation, certification, licensing or credentialing activities, review and auditing, including compliance reviews, medical reviews, legal services and compliance programs, business planning and development including cost management and planning related analyses and formulary development, fundraising for the benefit of Jet Rescue Air Ambulance and certain marketing activities, business management and general administrative activities of Jet Rescue Air Ambulance.For example, Jet Rescue Air Ambulance may use your health information to evaluate its staff performance, combine your health information with other Jet Rescue Air Ambulance patients in evaluating how to more effectively serve all of Jet Rescue Air Ambulance patients, disclose your health information to Jet Rescue Air Ambulance staff and contracted personnel for training purposes, use your health information to contact you or your family as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).
HEALTH OVERSIGHT ACTIVITIES AND SPECIALIZED GOVERNMENT FUNCTIONS
We may disclose your health information to an agency that oversees healthcare systems and ensures compliance with the rules of government health programs such as: Medicare or Medicaid, and under certain circumstances to the U.S. Military or the U.S. Department of State.
LAW ENFORCEMENT OFFICIALS, MEDICAL EXAMINERS AND CORONERS AND COURT OR ADMINISTRATIVE ORDERS
We may disclose your health information to the police, other law enforcement officials, medical examiners and coroners, and to courts or administrative proceedings as allowed or required by law, a court order or other legal process.
IN THE EVENT OF A SERIOUS THREAT TO HEALTH OR SAFETY
Jet Rescue Air Ambulance may, consistent with applicable law and ethical standards of conduct, disclose your health information if Jet Rescue Air Ambulance, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
TO CORONERS AND MEDICAL EXAMINERS
Jet Rescue Air Ambulance may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
TO FUNERAL DIRECTORS
Jet Rescue Air Ambulance may disclose your health information to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, Jet Rescue Air Ambulance may disclose your health information prior to, and in reasonable anticipation of, your death.
FOR ORGAN, EYE, OR TISSUE DONATION Jet Rescue Air Ambulance may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.
PUBLIC HEALTH ACTIVITIES
We may report your identity and other health information as follows: to public health authorities for the purpose of controlling disease, injury or disability; to the U.S. Food and Drug Administration for regulating certain products or activities; to governmental authorities about suspected or known child abuse and neglect, elder adult abuse and neglect, or domestic violence; to a person exposed to a contagious disease or who has the risk of contracting or spreading a disease; to your employer and governmental agencies as required by federal and state laws regarding work-related illness or injury; to prevent or lessen a serious or imminent threat to a person’s or the public’s health or safety; or to a public or private entity that is authorized to assist in disaster relief efforts.
RESEARCHWe may use or disclose your health information to identify you as a potential candidate for a research study that has been approved by an Institutional Review Board or for governmental research studies in which your identifiable information will not be released.
WORKER'S COMPENSATION
We may disclose your health information as allowed or required by California law relating to workers’ compensation or to other similar programs.
OTHER COMMUNICATIONS WITH YOU
We may contact you to follow up on services that you received. We may leave messages via telephone or with a person who answers the phone, unless you notify us that you object.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFOMATION
You have the following rights regarding your health information that Jet Rescue Air Ambulance maintains:
RIGHT TO REQUEST RESTRICTIONS
You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on Jet Rescue Air Ambulance’s disclosure of your health information to someone who is involved in your care or the payment of your care. However, Jet Rescue Air Ambulance is not required to agree to your request. If you wish to make a request for restrictions, please contact the Compliance Officer at 480-522-1080.
RIGHT TO RECIVE CONFIDENTIAL COMMUNICATIONS
You have the right to request that Jet Rescue Air Ambulance communicate with you in a certain way. For example, you may ask that Jet Rescue Air Ambulance only conduct communications pertaining to your health information with you privately with no other family members present. If you wish to receive confidential communications, please contact the Compliance Officer at 480-522-1080. Jet Rescue Air Ambulance will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.
RIGHT TO INSPECT AND COPY YOUR HEALTH INFORMATION
You have the right to inspect and copy your health information, including billing records. A request to inspect and copy records containing your health information may be made to the Compliance Officer at 480-522-1080. If you request a copy of your health information, Jet Rescue Air Ambulance may charge a reasonable fee for copying and assembling costs associated with your request.
RIGHT TO AMMEND YOUR HEALTH INFORMATION
You or your representative have the right to request that Jet Rescue Air Ambulance amend your records, if you believe your health information records are incorrect or incomplete. That request may be made as long as the information is maintained by Jet Rescue Air Ambulance. A request for an amendment of records must be made in writing to: Jet Rescue Air Ambulance - Compliance Officer Jet Rescue Air Ambulance may deny the request if it is not in writing or does not include a reason for the amendment. The request also may be denied if your health information records were not created by Jet Rescue Air Ambulance, if the records you are requesting are not part of Jet Rescue Air Ambulance’s records, if the health information you wish to amend is not part of the health information you or your representative are permitted to inspect and copy, or if, in the opinion of Jet Rescue Air Ambulance, the records containing your health information are accurate and complete.
RIGHT TO AN ACCOUNTING You or your representative, have the right to request an accounting of disclosures of your health information made by Jet Rescue Air Ambulance for certain purposes, which may include disclosures required by law and disclosures for certain public health activities. The request for an accounting must be made in writing to: Jet Rescue Air Ambulance - Compliance Officer 7633 E. Acoma Dr. Suite 102 Scottsdale, AZ 85260 The request should specify the time period for the accounting starting on April 14, 2004. Accounting requests may not be made for periods of time in excess of six (6) years. Jet Rescue Air Ambulance will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
RIGHT TO A PAPER COPY OF THIS NOTICE
You or your representative, have a right to a separate paper copy of this Notice at any time even if you or your representative, have received this Notice previously. To obtain a separate paper copy, please contact the Jet Rescue Air Ambulance Compliance Officer at 480-522-1080. A patient or a patient's representative may also obtain a copy of the current version of Jet Rescue Air Ambulance's Notice at its Web site, www.jet-rescue.com DUTIES OF JET RESCUE Air Ambulance
Jet Rescue Air Ambulance is required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of its duties and privacy practices. Jet Rescue Air Ambulance is required to abide by the terms of this Notice as may be amended from time to time. Jet Rescue Air Ambulance reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all health information that it maintains. If Jet Rescue Air Ambulance makes a material change to this Notice, Jet Rescue Air Ambulance will distribute a copy of the revised Notice.
RIGHT TO FILE A COMPLAINT
If you would like to report a Privacy Problem of want further information, please contact Jet Rescue Air Ambulance Compliance Officer at 480-522-1080.If you believe your privacy rights have been violated, you may file a complaint with Jet Rescue Air Ambulance Compliance Officer or the U.S. Secretary of Health and Human Services (HHS). We will not retaliate against you if you file a complaint.
CONTACT PERSON
Jet Rescue Air Ambulance has designated a Compliance Officer as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at: Jet Rescue Air Ambulance 7633 E. Acoma Dr. Suite 102 Scottsdale, Az 85260 or 480-522-1080
EFFECTIVE DATE: This Notice is effective April 14, 2003.
DISCLAIMER:THIS NOTICE OF PRIVACY PRACTICES HAS BEEN ADOPTED AS THE ONLY APPROVED NOTICE FORM FOR USE THROUGHOUT JET RESCUE AIR AMBULACE. ANY CHANGES ARE UNAUTHORIZED AND INVALID.