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| Business Office 1701 E. Beebe-Capps Expy. Searcy, Arkansas 72143 501-305-2287 Local 866-305-2287 Toll-free 501-268-7026 Fax 501-268-2353 Administration |
NorthStar EMS, Inc. is required by law to maintain the privacy of certain confidential health care information, known as Protected
Health Information or PHI, and to provide you with a notice of our legal duties and privacy practices with respect to your PHI. NorthStar
EMS is also required to abide by the terms of the version of this Notice currently in effect.
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.
Uses and Disclosures of PHI: NorthStar EMS may use PHI for the purposes of treatment, payment, and health care operations, in most
cases without your written permission. Examples of our use of your PHI:
- For Treatment: This includes such things as obtaining verbal and written information about your medical condition and
treatment from you as well as from others, such as doctors and nurses who give orders to allow us to provide treatment to you.
We may give your PHI to other health care providers involved in your treatment, and may transfer your PHI via radio or
telephone to the hospital or dispatch center.
- For Payment: This includes any activities we must undertake in order to get reimbursed for the services we provide to you,
including such things as submitting bills to insurance companies, making medical necessity determinations and collecting
outstanding accounts.
- For Health Care Operations: This includes quality assurance activities, licensing, and training programs to ensure that our
personnel meet our standards of care and follow established policies and procedures, as well as certain other management
functions.
- Reminders for Scheduled Transports and Information on Other Services: We may also contact you to provide you with a
reminder of any scheduled appointments for non-emergency ambulance and medical transportation, or to provider information
about other services we provide.
Uses and Disclosure of PHI Without Your Authorization: NorthStar EMS is permitted to use PHI without your written consent, or
opportunity to object, in certain situations, and unless prohibited by a more stringent state law, including:
- For the treatment, payment, or health care operations activities of another health care provider who treats you;
- For health care and legal compliance activities;
- To a family member, other relative, or close personal friend or other individual involved in your care if we obtain your verbal
agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection, and in
certain other circumstances where we are unable to obtain your agreement and believe the disclosure is in your best interests; - To a public health authority in certain situations as required by law (such as to report abuse, neglect, or domestic violence);
- For health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and other
administrative or judicial actions undertaken by the government (or their contractors) by law to oversee the health care system; - For judicial and administrative proceedings as required by a court or administrative order, or in some cases in response to a
subpoena or other legal process; - For law enforcement activities in limited situations, such as when responding to a warrant;
- 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, and in compliance with workers’ compensation laws;
- To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of death, or
carrying out their duties as authorized by law; - 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 donation or transplantation; - For research projects, but this will be subject to strict oversight and approvals;
- We may release Health Information is asked by 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. - If you are an inmate of a correctional institution or under the custody of law enforcement, 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. - We may also use or disclose health information about you in a way that does not personally identify you or reveal who you are.
Any other use or disclosure of PHI, other than those listed above will only be made with your written consent. You may revoke your
authorization at any time, in writing, except to the extent that we have already use or disclosed medical information in reliance on that
authorization.
Patient Rights: As a patient, you have a number of rights with respect to your PHI, including:
The right to access, copy or inspect your PHI: This means you may inspect and copy most of the medical information about you that we
maintain. We will normally provide you with the access to this information within 30 days of your request. We may also charge you a
reasonable fee for you to copy any medical information that you have the right to access. In limited circumstances, we may deny you
access to your medical information, any you may appeal certain types of denials. We have available forms to request access to your
PHI and we will provide a written response if we deny you access and let you know your appeal rights. You may also have the right to
receive confidential communications of your PHI. If you wish to inspect and copy your medical information, you should contact or
privacy officer.
The right to amend you PHI: You have the right to ask us to amend written medical information that we may have about you. We will
generally amend the information within 60 days of your request and will notify you when we have amended this information. We are
permitted by law to deny your request to amend your medical information only in certain circumstances, like when we believe the
information you have asked to amend is correct. If you wish to request that we amend the medical information that we have about you,
you should contact our privacy officer.
The Right to Request an Accounting: You may request an accounting from us of certain disclosures of your medical information that
we have made in the six years prior to the date of your request. We are not required to give you an accounting of information we have
used or disclosed for purposes of treatment, payment, or health care operations, or when we share your health information with our
business associates, like or billing company or medical facility from/to which we have transported you. We are also not required to give
you an accounting of our uses of protected health information for which you have already given us written authorization. If you wish to
request an accounting, contact our privacy officer.
The right to request that we restrict the uses and disclosures of your PHI: You have the right to request that we restrict how we use or
disclose your medical information that we have about you. NorthStar EMS is not required to agree to any restrictions you request, but
any restrictions agreed to by NorthStar EMS in writing are binding on NorthStar EMS.
Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request: If we maintain a website, we will prominently post
a copy of this Notice on a web site. If you allow us, we will forward you this Notice by electronic mail instead of on paper and you may
always request a paper copy of the Notice.
Revisions to the Notice: NorthStar EMS 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 facilities and on the web site. You can get a copy of the latest version of this notice by contacting the privacy
officer.
Your Legal Rights and Complaints: You also have the right to complain to us, or to the Secretary of the United States Department of
Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against in any way for filing
a complaint with us or the government. Should you have any questions, comments or complaints you may direct all inquiries to our
Complaint officer.
HIPPA officer contacts:
Privacy Officer:
Tonia Hale
NorthStar EMS
1115 S. Benton St.
Searcy, AR 72143
Phone:501-305-2287
Fax: 501-268-7026
Email: tonia@northstarems.us
Complaince Officer:
Tonia Hale
NorthStar EMS
1115 S. Benton St.
Searcy, AR 72143
Phone: 501-305-2287
Fax: 501-268-7026
Email: tonia@northstarems.us
Training Officer:
Tonia Hale
NorthStar EMS
1115 S. Benton St
Searcy, AR 72143
Phone:501-305-2287
Fax: 501-268-7026
Email: tonia@northstarems.us
This notice is effective as of March 11, 2011
| HIPAA Privacy Notice |