Notice of Privacy Practices

Purpose of the Notice

As an essential part of our commitment to you, Peters Township Ambulance Service maintains the privacy of certain confidential health care information about you, known as Protected Health Information (PHI). We are required by law to protect your health care information and provide you with this Notice of Privacy Practices.

This notice outlines our legal duties and privacy practices respect to your PHI. It not only describes our privacy practices and your legal rights, but lets you know, among other things, how Peters Township Ambulance Service is permitted to use and disclose PHI about you, how you can access and copy that information, how you may request amendment of that information, and how you may request restrictions on our use and disclosure of your PHI.

Peters Township Ambulance Service is also required to abide by the terms of the version of this Notice currently in effect. In most situations we may use this information as described in this Notice without your permission, but there are some situations where we may use it only after we obtain your written authorization, if we are required by law to do so.

We respect your privacy, and treat all health care information about our patients with care under strict policies of confidentiality that all of our staff are committed to follow at all times.

Uses & Disclosures of PHI

• For Treatment: for the care and treatment of you by our staff, doctors and nurses and hospitals.
• For Payment: any activities that we undertake in order to get reimbursed for the services we provide to you.
• For Health Care Operations: quality assurance activities, licensing and training programs, obtaining legal and financial services, conducting business planning, processing complaints, and creating reports.
• For Fundraising: we may contact you when we are in the process of raising funds for the Peters Township Ambulance Service.
• Reminders for Scheduled Transports and Other Information: we may also contact you to provide you with a reminder of any scheduled appointments for non-emergency ambulance and medical transportation.

Use & Disclosure of Phi Without Your Authorization

Peters Township Ambulance Service is permitted to use PHI without your written authorization, or opportunity to object in certain situations, including the following examples:

• For use in treating you or in obtaining payment for services provided to you or in other health care operations.
• To a family member, relative, or close friend involved in your health care with your verbal agreement or without agreement when you are not capable of giving verbal consent if doing so would be in your best interest.
• For judicial and administrative proceedings as required by court or administrative order.

Patient Rights

As a patient, you have a number of rights with respect to the protection of your PHI, including:

• The right to access, copy or inspect your PHI
• The right to amend your PHI
• The right to request an accounting of our use and disclosure of your PHI
• The right to obtain a copy of paper notice on request
• The right to request that we restrict the uses and disclosures of your PHI
• Your legal rights and complaints

Revisions to the Notice

Peters Township Ambulance Service reserves the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all protected health information that we maintain. Any material changes to the notice will be promptly posted in our facility. You can get a copy of the latest version of the Notice by contacting a privacy officer.