Privacy Notice
NOTICE OF PRIVACY PRACTICES
Effective Date Wednesday,
February 05, 2003:
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.
If you have any
questions about this notice, please contact BestCare Ambulance Services Inc. at
603.527.3553
WHO MUST FOLLOW THIS NOTICE:
This notice describes the
privacy practices of BestCare Ambulance Services, Inc..
OUR OBLIGATIONS:
We are required by law to:
- Maintain the
privacy of protected health information;
- Give you this
notice of our legal duties and privacy practices regarding health information
about you; and
- Follow the terms
of our notice that is currently in effect.
- For Treatment. We may use Health Information
to treat you or provide you with health care services. We may disclose Health Information to
doctors, nurses, technicians, or other personnel, including people outside our
facility who may be involved in your medical care. For example, we may tell your primary
physician about the care we provided you or give Health Information to a
specialist to provide you with additional services.
- For Payment. We may use and disclose Health Information so
that we or others may bill or receive payment from you, an insurance company or
a third party for the treatment and services you received. For example, we may give your health plan
information about your treatment so that they will pay for such treatment. We also may tell your health plan about a
treatment you are going to receive to obtain prior approval or to determine
whether your plan will cover the treatment.
- For Health Care Operations. We may use and
disclose Health Information for health care operations purposes. These uses and disclosures are necessary to
make sure that all of our patients receive quality care and for our operation
and management purposes. For example, we
may use Health Information to review the treatment and services we provide to
ensure that the care you receive is of the highest quality.
- Fundraising Activities. We may use
Health Information to contact you in an effort to raise money. We may disclose Health Information to a
related foundation or to our business associate so that they may contact you to
raise money for us.
- Individuals Involved in Your Care or Payment for Your
Care. We may release Health Information to a person
who is involved in your medical care or helps pay for your care, such as a
family member or friend. We also may
notify your family about your location or general condition or disclose such
information to an entity assisting in a disaster relief effort.
- Research. Under certain circumstances, we may use and
disclose Health Information for research purposes. For example, a research project may involve
comparing the health and recovery of all patients who received one medication
or treatment to those who received another, for the same condition. Before we use or disclose Health Information
for research, though, the project will go through a special approval process. This process evaluates a proposed research project
and its use of Health Information to balance the benefits of research with the
need for privacy of Health Information.
Even without special approval, we may permit researchers to look at
records to help them identify patients who may be included in their research
project or for other similar purposes, so long as they do not remove or take a
copy of any Health Information.
- As Required by Law. We will
disclose Health Information when required to do so by international, federal,
state or local law.
- To Avert a Serious Threat to Health or Safety. We may use and
disclose Health Information when necessary to prevent or lessen a serious
threat to your health and safety or the health and safety of the public or
another person. Any disclosure, however,
will be to someone who may be able to help prevent the threat.
- Business Associates. We may
disclose Health Information to our business associates that perform functions
on our behalf or provide us with services if the information is necessary for
such functions or services. For example,
we may use another company to perform billing services on our behalf. All of our business associates are obligated,
under contract with us, to protect the privacy of your information and are not
allowed to use or disclose any information other than as specified in our
contract.
- Organ and Tissue Donation. 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 or tissue donation and
transplantation.
- Military and Veterans. If you are a
member of the armed forces, we may release Health Information as required by
military command authorities. We also
may release Health Information to the appropriate foreign military authority if
you are a member of a foreign military.
- Workers’ Compensation. We may release
Health Information for workers’ compensation or similar programs. These programs provide benefits for
work-related injuries or illness.
- Public Health Risks. We may
disclose Health Information for public health activities. These activities generally include
disclosures to prevent or control disease, injury or disability; report births
and deaths; report child abuse or neglect; report reactions to medications or
problems with products; notify people of recalls of products they may be using;
track certain products and monitor their use and effectiveness; notify a person
who may have been exposed to a disease or may be at risk for contracting or
spreading a disease or condition; and conduct medical surveillance of the
hospital in certain limited circumstances concerning workplace illness or
injury. We also may release Health
Information to an appropriate government authority if we believe a patient has
been the victim of abuse, neglect or domestic violence; however, we will only
release this information if you agree or when we are required or authorized by
law.
- Health Oversight Activities. We may disclose
Health Information to a health oversight agency for activities authorized by
law. These oversight activities include,
for example, audits, investigations, inspections, and licensure. These activities are necessary for the
government to monitor the health care system, government programs, and
compliance with civil rights laws. Your
protected private information will be provided to LRGHealthcare, 80 Highland Street, Laconia, NH 03246 whether or not any of your care
was provided by LRGHealthcare, and with or without your permission. Best Care Ambulance Services, Inc. has no
control over this, and this is disclosure is a requirement mandated by
LRGHealthcare and the State of New
Hampshire.
BestCare Ambulance Services, Inc. has no control over what LRGHealthcare
or the State of New Hampshire
does with your private information or whether or not we disclose your private
information to them, it’s compulsory.
- Lawsuits and Disputes. If you are
involved in a lawsuit or a dispute, we may disclose Health Information in
response to a court or administrative order.
We also may disclose Health Information in response to a subpoena,
discovery request, or other lawful process by someone else involved in the
dispute, but only if efforts have been made to tell you about the request or to
obtain an order protecting the information requested.
- Law Enforcement. We may release Health
Information if asked by a law enforcement official for the following reasons:
(1) in response to a court order, subpoena, warrant, summons or similar
process; (2) limited information to identify or locate a suspect, fugitive,
material witness, or missing person; (3) about the victim of a crime if, under
certain limited circumstances, we are unable to obtain the person’s agreement;
(4) about a death we believe may be the result of criminal conduct; (5) about
criminal conduct on our premises; and (6) in emergency circumstances to report
a crime, the location of the crime or victims, or the identity, description, or
location of the person who committed the crime.
- Coroners, Medical Examiners and Funeral Directors. We may release
Health Information to a coroner or medical examiner. This may be necessary, for example, to
identify a deceased person or determine the cause of death. We also may release Health Information to
funeral directors as necessary for their duties.
- National Security and Intelligence Activities. We may release
Health Information to authorized federal officials for intelligence,
counter-intelligence, and other national security activities authorized by
law.
- Protective Services for the President and Others. We may
disclose Health Information to authorized federal officials so they may provide
protection to the President, other authorized persons or foreign heads of state
or conduct special investigations.
- Inmates or Individuals in Custody. If you are an
inmate of a correctional institution or under the custody of a law enforcement
official, we may release Health Information to the appropriate correctional
institution or law enforcement official.
This release would be made only if necessary (1) for the institution to
provide you with health care; (2) to protect your health and safety or the
health and safety of others; or (3) for the safety and security of the
correctional institution.
- Right to Inspect and Copy. You have the
right to inspect and copy Health Information that may be used to make decisions
about your care or payment for your care.
To inspect and copy this Health Information, you must make your request,
in writing, to BestCare Ambulance Services, Inc. 35 Bedford Ave. Gilford, NH 03249-2204.
- Right to Amend. If you feel that Health
Information we have is incorrect or incomplete, you may ask us to amend the
information. You have the right to
request an amendment for as long as the information is kept by or for us. To request an amendment, you must make your
request, in writing, to BestCare Ambulance Services, Inc. 35 Bedford Ave. Gilford, NH 03249-2204.
- Right to an Accounting of Disclosures. You have the
right to request an accounting of certain disclosures of Health Information we
made. To request an accounting of
disclosures, you must make your request, in writing, to BestCare Ambulance
Services, Inc. 35 Bedford
Ave. Gilford, NH 03249-2204.
- Right to Request Restrictions. You have the
right to request a restriction or limitation on the Health Information we use
or disclose for treatment, payment, or health care operations. In addition, you have the right to request a
limit on the Health Information we disclose about you to someone who is
involved in your care or the payment for your care, like a family member or
friend. For example, you could ask that
we not share information about your surgery with your spouse. To request a restriction, you must make your
request, in writing, to BestCare Ambulance Services, Inc. 35 Bedford Ave. Gilford, NH 03249-2204. We are
not required to agree to your request. If we agree, we will comply with your request
unless we need to use the information in certain emergency treatment
situations.
- Right to Request Confidential Communications. You have the
right to request that we communicate with you about medical matters in a certain
way or at a certain location. For
example, you can ask that we contact you only by mail or at work. To request confidential communications, you
must make your request, in writing, to BestCare Ambulance Services, Inc. 35 Bedford Ave. Gilford, NH
03249-2204. Your request must specify
how or where you wish to be contacted.
We will accommodate reasonable requests.
- Right to a Paper Copy of This Notice. You have the
right to a paper copy of this notice.
You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this
notice electronically, you are still entitled to a paper copy of this
notice.
HOW WE MAY
USE AND DISCLOSE HEALTH INFORMATION:
The
following categories describe ways that we may use and disclose health
information that identifies you (“Health Information”). Some of the categories include examples, but
every type of use or disclosure of Health Information in a category is not
listed. Except for the purposes
described below, we will use and disclose Health Information only with your
written permission. If you give us
permission to use or disclose Health Information for a purpose not discussed in
this notice, you may revoke that permission, in writing, at any time by writing
to BestCare Ambulance Services, Inc. 35 Bedford
Ave. Gilford, NH 03249-2204.
SPECIAL
CIRCUMSTANCES
YOUR RIGHTS:
You have the following rights regarding Health
Information we maintain about you:
To obtain a paper copy of this notice, by writing to
BestCare Ambulance Services, Inc. 35 Bedford
Ave. Gilford, NH 03249-2204..
CHANGES TO THIS NOTICE:
We reserve the
right to change this notice. We reserve
the right to make the revised or changed notice effective for Health
Information we already have as well as any information we receive in the
future. We will post a copy of the
current notice at the hospital. The
notice will contain the effective date on the first page, in the top right-hand
corner.
COMPLAINTS:
If you believe your privacy rights have been violated,
you may file a complaint with us or the Secretary of the Department of Health
and Human Services. To file a complaint
with us, contact us in writing at BestCare Ambulance Services, Inc. 35 Bedford Ave. Gilford, NH
03249-2204. All complaints must be made
in writing. You will not be penalized for filing a complaint.
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