NOTICE OF PRIVACY PRACTICES MANVEL EMERGENCY MEDICAL SERVICESPurpose of this Notice:
The pre-hospital care provider is required by law to maintain the privacy of your health care information, known as protected health information (PHI), and to provide you with a notice as to how we may use this information and to whom it may be disclosed. We ask you to acknowledge your receipt of this notice and to consent to the release of this information for the purposes set forth in this notice, but we may nonetheless use and disclose your PHI for any purposes authorized by law.Uses and Disclosures of PHI:
We may use and disclose your PHI for the purposes of treatment, payment and other health care operations, including providing a copy of your pre-hospital care report to the hospital to which you are transported; to obtain payment for the pre-hospital care and treatment that we provide to you; to monitor the quality of patient care provided by pre-hospital care personnel; and to respond to complaints about the pre-hospital care provided to you. We may disclose your PHI to a relative, friend or other individual involved in your care. We may also use your PHI in connection with required public health reporting; for workers' compensation purposes; in connection with a legal claim or proceeding; to comply with a subpoena or other compulsory legal process, and for military, national defense, security and certain law enforcement purposes.Patient Access to PHI: You may obtain a copy of your pre-hospital care report from the pre-hospital care provider for a reasonable fee. Please be sure to include the patient's full name and date of service in written correspondence requesting a copy of the report. The patient's notarized authorization will be required. Send such requests to:
|Prior to 4/1/2012||After 4/1/2012|
|Manvel EMS||Helath Claims Plus|
|P.O. Box 341||P.O. Box 9032|
|Manvel, TX 77578||Liberty, TX 77575|
Amending your PHI:
You may request that we amend any PHI that appears on this pre-hospital care report if you believe that the information is incorrect. We will consider, but may not be required to comply with your request.Accounting of PHI use and disclosure:
You may request an accounting from us of our use and disclosure of your PHI excluding the use and disclosure of your PHI for treatment, payment and health care operations and as otherwise provided by law.Restricting PHI use and disclosure:
You may request that we restrict our use and disclosure of your PHI. We will consider, but may not be required to comply with your request.Changes in privacy practices:
Our privacy practices are subject to change without further notice, including changes affecting our use and disclosure of any PHI previously created or received. You may obtain a copy of our current or more comprehensive notice of privacy practices by writing the Privacy Officer of the pre-hospital care provider.
Complaints: All complaints regarding the use and disclosure of PHI may be made to the United States Department of Health and Human Services and/or to the pre-hospital care provider's Privacy Officer.