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.

Your health information is personal and Penn Mahoning Ambulance Association is committed to protecting it. We are required by law to maintain the privacy of health information that could be used to identify you, known as protected health information (PHI). The law requires us to provide you with a copy of this Notice of Privacy Practice, which describes our privacy practices and our legal duties with respect to PHI. Under certain circumstances, we may also be required to notify you following a breach of unsecured PHI.

HOW WE MAY USE OR DISLCOSURE YOUR PHI

Treatment. We may use or disclose your PHI in connection with our treatment or transportation of you. For example, we may disclose your PHI to doctors, nurses, technicians, medical students, and any other healthcare professional involved in taking care of you. We may also provide information about you to a hospital or dispatch center via radio, telephone, or other electronic means. We may provide a hospital or other healthcare facility with a copy of the medical records created by us in the course of treating or transporting you.

Payment. We may use and disclose your medical information to obtain payment from you, an insurance company, and other third parties. For example, we may provide PHI to your health insurance plan in order to receive payment for our services.

Health care operations. We may use and disclose your PHI for quality assurance activities, licensing, and training programs to ensure that our personnel meets our standards for care and to ensure that our personnel follows our established policies and procedures. We may also use your information for obtaining legal, financial, or accounting services, conducting business planning, processing complaints, and creating reports that do not individually identify you.

Other uses or disclosures that do not require authorization. The law permits us to use or disclose your PHI without your authorization in the following circumstances:

• When required by law, but only to the extent required by law.
• For public health activities, including disclosures to public health authorities authorized by law to collect information for the purpose of preventing or controlling disease, injury, or disability, reporting births and deaths, and the conduct of public health investigations. We may also be required by law to disclose information related to possible child abuse or neglect.
• To a social service or other protective services agency authorized by law to receive reports about victims of abuse, neglect, or domestic violence. We will make every effort to obtain your permission before releasing this information, but in some cases, we may be required or authorized by law to act without your permission.
• For health oversight activities.
• For judicial and administrative proceedings, in response to a court order, subpoena, discovery request, or other lawful processes.
• For law enforcement purposes, including disclosures: (1) to comply with laws requiring reporting of certain types of injuries, (2) made pursuant to a court order, warrant, subpoena, grand jury subpoena, or other lawful processes, (3) to assist law enforcement in identifying or locating a suspect, fugitive, material witness, or missing person, ( 4) about the victim of a crime, if, under the circumstances, we are unable to obtain your permission, (5) about a death we reasonably believe may be the result of a crime, ( 6) about a crime committed on our premises, or (7) to notify law enforcement of the commission of a crime, the location of a victim, or to identify the perpetrator of a crime, but only in emergency situations.
• To coroners, medical examiners, and funeral directors.
• To organ procurement organizations.
• For approved medical research projects.
• To avert a serious threat to health or safety.
• For military and veteran’s activities, national security, and other specialized government functions.
• To comply with laws relating to workers’ compensation or similar programs.

USES OR DISCLOSURES WHERE YOU HAVE THE RIGHT TO OBJECT

Unless you object, we may provide relevant portions of your PHI to a family member, friend, or another person that you indicate is involved in making decisions about your health care or in paying for your health care. We may use or disclose PHI to notify your family member, friends, or personal representative about your condition. In an emergency or when you are not capable of agreeing or objecting to these disclosures, we will disclose your PHI only to the extent we reasonably believe such disclosure to be in your best interest, and we will tell you about such disclosure after the emergency has passed, and give you the opportunity to object to future disclosures to family, friends, or personal representatives. Unless you object, we may also disclose your PHI to people involved in providing disaster relief, for example, the American Red Cross.

USES OR DISCLOSURES THAT REQUIRE YOUR WRITTEN CONSENT

Any other use or disclosure of PHI, other than those listed above, will only be made with your written authorization. The law also requires your written authorization before we may use or disclose: (1) psychotherapy notes, other than for the purpose of carrying out our treatment, payment, or health care operations purposes, (2) any PHI for our marketing purposes or (3) any PHI as part of a sale of PHI. You may revoke a previous written authorization in writing at any time. If you elect to revoke a prior written authorization, we will immediately stop any further uses or disclosures of your PHI for the purposes set out in the written authorizations to the extent we have not already acted in reliance on your authorization; however, we will be unable to retract any disclosures previously made with your permission.

YOUR RIGHTS WITH RESPECT TO YOUR PHI

You have the following rights with respect to your PHI:

• The right to request restrictions on the use and disclosure of your PHI. To exercise this right, you must submit a written request to our privacy officer. We are not required to agree to your request; however, if we do agree, we will put our agreement in writing and will abide by that agreement except to the extent the use or disclosure of such PHI is necessary to provide you treatment in an emergency. Notwithstanding the foregoing, we must agree to a restriction on the use or disclosure of your PHI if: (1) the disclosure is for our payment or health care operations purposes and is not otherwise required by law and (2) you or another person acting on your behalf have paid for our services in full.
• The right to request to receive your PHI in a specific location (for example, at your work address rather than your home) or in a specific manner (for example, by email rather than regular mail). We will comply with all reasonable requests. Any such request should be made in writing to our privacy officer.
• The right to inspect and copy your PHI, except in limited circumstances. Any such request should be made in writing to our privacy officer. We will respond to your request within 30 days. The law gives us the right to deny your request in certain instances; in which case, we will notify you in writing of the reasons for the denial and explain your rights with regard to having the denial reviewed. A reasonable fee may be charged for making copies.
• The right to request that we amend your PHI to the extent you think it is inaccurate or incomplete. Any such request should be made in writing to our privacy officer and should include the reasons you think your information is inaccurate or incomplete. We will respond to your request within 60 days. We are not required to change your information, but if we do not agree to change your information, we will notify you of the reasons for our decision and will explain your right to submit a written statement of disagreement, file a complaint, or request that your requested change be included in future disclosures of your PHI. If we agree to a change, we will ask you who else you would like us to notify of the change.
• The right to receive an accounting of any disclosures of your PHI made within the six years immediately preceding your request. We are not required to provide you an accounting of disclosures: (1) made for our treatment, payment, or health care operations purposes, (2) made directly to you, your family, or friends, (3) made for national security purposes to law enforcement or certain other government purposes. We are also not required to provide an accounting of disclosures made before April 14, 2003. If you request more than one accounting within a 12-month period, we may charge you a reasonable fee for each additional accounting.
• The right to receive a paper copy of this notice.

CHANGES TO THIS NOTICE

Penn Mahoning Ambulance Association is required to comply with the terms of this notice as currently in effect. We reserve the right to change or amend our privacy practices at any time in the future and to make any changes applicable to PHI already m our possession. This notice will be revised to reflect any changes in our privacy practices. You may obtain a copy of our revised notice by contacting our privacy officer. We will also make any revised notice available on our website at: (www.pmaaems.org).

CONTACT

If you have questions or comments about our privacy practices or you would like to obtain additional information about your privacy rights, please contact our privacy officer at 1748 W Penn Pike, New Ringgold, PA 17960 You may also contact our privacy officer by phone at: (570) 386-2233

COMPLAINT

If you think your privacy rights have been violated, you may file a complaint with Penn Mahoning Ambulance Association. or the secretary of the Department of Health and Human Services (DHHS). To file a complaint with us, please put your complaint in writing and mail: It to: Privacy Officer, Penn Mahoning Ambulance Association 1748 W Penn Pike, New Ringgold, PA 17960. You may also contact our privacy officer by phone at: (570) 386-2233. To file a complaint with the DHHS, you must put your complaint in writing and mail it to the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201. You will not be retaliated against or denied any health services if you elect to file a complaint.