IMPORTANT: THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU
MAYBE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
AAA Ambulance Service is dedicated to protecting
your medical information. We are required by law to maintain the privacy
of protected health information (PHI) and to provide you with this Notice
of our legal duties and privacy practices with respect to protected
health information (PHI). AAA Ambulance Service is required by law to
abide by the terms of this Notice, but we reserve the right to change the
terms of this Notice, making any new notice provisions effect for all the PHI that we maintain. If AAA Ambulance Service
revises the terms of this Notice, it will make paper copies of this
Notice of Privacy Practices available upon request.
Patient's Individual Rights:
In addition to your right to receive
communications of your PHI from us in a confidential manner, you have the
- The right to inspect
and copy your medical information. This right is subject to certain
specific exceptions, and you may be charged a reasonable fee for any
copies of your records.
- The right to request restrictions on certain
uses and disclosures of your PHI, but in some instances we are not
required to agree to your requested restriction.
- The right to request an amendment of your
medical information. In certain instances, we may deny your request, but,
if denied, we will provide you with a written explanation for the denial.
- The right to receive an accounting of the
disclosures of your medical information for six years prior to your
- The right to complain to AAA Ambulance Service
and/or to the United States Department of Health and Human Services if
you believe that we have violated your privacy rights. To complain to us,
please call our Privacy Officer, at (601 )
264-0175. If you choose to file a complaint, you will not be retaliated
against in any way.
Uses and Disclosures of PHI:
AAA Ambulance Service may use and disclose
your PHI without your written authorization:
- For treatment purposes, examples include: using
your PHI to facilitate your proper care or disclosing your PHI in writing
or via radio or telephone to a hospital or dispatch center when proper
for your treatment.
- For payment purposes, examples include: billing
and seeking reimbursement, managing accounts, determining and reviewing
medical necessity, and collecting outstanding accounts.
- For purposes of health care operations,
examples include: quality assurance activities, licensing, training
programs, obtaining legal and financial services, conducting
business planning, processing grievances and complaints, and creating reports
for data collection purposes.
- For the treatment activities, payment
activities, or health care operations of another health care provider
(such as a hospital).
- To remind you of any scheduled appointments for
non-emergency transportation or to inform you about other services.
- For other purposes permitted by law and for
activities related to AAA Ambulance Service's compliance with the law.
- Unless you object, to inform family members or
other concerned individuals involved in your care about your general
condition, where you are being taken, and other general information.
- To report certain situations as required by law
to public health authorities and law enforcement agencies (such as
reporting a birth, death, or communicable disease, child or adult abuse
or neglect, domestic violence, a knifing or shooting, a threat of
violence being made, etc.).
- For health oversight activities such as audits
or government investigations, inspections, disciplinary proceedings, etc.
- In judicial and administrative proceedings as
required by a court or administrative order, or in response to a subpoena
or other legal process compliant with HIPAA.
- To law enforcement in limited situations, such
as when properly subpoenaed 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 workers' compensation purposes.
- To coroners, medical examiners, and funeral
directors as authorized by law.
- If you are an organ donor, to 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, subject to strict
oversight and only when there is a minimal risk to your privacy and
adequate safeguards are in place in accordance with the law.
- We may further use or disclose health
information about you in a way that does not personally identify you or
reveal who you are.
Any other uses or disclosures of PHI, other than
those listed above, will be made only 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.
If you would like further information regarding
your rights or regarding the uses and disclosures of your medical
information, you may contact AAA Ambulance Service, P .0. Box 17889,
Hattiesburg, MS 39404- 7888, telephone (601) 264-0175.
of Privacy Practices
Effective Date of this Notice: April 1 , 2003