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.

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 purposes as 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 contacting the Mohawk Valley Ambulance Corp at the address above.

For Treatment: We may use health information to treat you or provide you with health 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 to you or give Health Information to a specialist to provide you with additional services, if asked.

 

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 service you received.  For example, we may give your health plan information about your treatment so that they will pay for such treatment.  We may also tell you 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 Car 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.

 

Individuals Involved in Your Care of Payment for Your care: We may use and disclose 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, if you so designate.  We may also notify your family about you 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 the 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.

SPECIAL CIRCUMSTANCES:

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 computer repair services on our behalf. While Health Information is not needed for the repairs, they might need to test the program.  All of our business associates are obligated, under contract to us, to protect the privacy of your information and are not allowed to use or disclose any information other than is 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 may also release Health Information to an appropriate foreign military authority if you are a member of a foreign military.

 

Workman’s Compensation: We may release Health Information for worker’s compensation or similar programs. These programs provide benefits for work-related injuries and illnesses.

 

Public Health Risks: We may disclose Health Information for public 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 medication 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 may also release Health Information to an appropriate government authority if we believe the patient has been the victim of abuse, neglect or domestic violence; however, we will release this information only 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 as authorized by law.  These oversights 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.

 

Lawsuits and Disputes: If you are involved in a lawsuit or dispute, we may disclose Health Information in response to a court or administrative order.  We may also 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 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 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; (6) in emergency circumstances to report a crime, the location of crime victims, or the identity, description or location of a 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 may also release Health Information to funeral activities authorized by law.

 

National Security and Intelligence Activities: We may release Health Information to authorized federal officers for intelligence, couterintelligence and other nation security activities authorized by law.

 

Protective Services for the President and Others: We may disclose Health Information to authorized federal officials so they might provide protection to the President, other authorized person 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 correction institution or law enforcement official.  This release would only be made 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.

YOUR RIGHTS:

You have the following rights regarding Health Information we maintain about you:

Right to Inspect and Copy: You have the right to inspect and copy Health Information that may be used to make decisions about you care or payment, in writing, to the Privacy Officer at Mohawk Valley Ambulance at the address above.

 

Right to Amend: If you feel that the 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 us or for us. To request an amendment, you must make your request, in writing, to the Privacy Officer at Mohawk Valley Ambulance at the address above.

 

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 the Privacy Officer at Mohawk Valley Ambulance at the above address.

 

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 payment for you care, like a family member or friend.  For example, you could request that we not share information about your surgery with your spouse. To request a restriction, you must make your request, in writing, to the Privacy Officer at Mohawk Valley Ambulance at the above address. We are not required to agree with your request.  If we agree, we will comply with your request unless we need to use the information in certain emergency situations.

 

Right to Request Confidential Communications: You have the right to request that we communicate with you about matters in a certain way or at a certain location.  For example, you may ask that we contact you only by mail or at work. To request confidential communications, you must make your request, in writing, to the Privacy Officer at Mohawk Valley Ambulance at the above address. You must specify how, where and when 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 at any time. To obtain a paper copy of this notice, call the Privacy Officer at Mohawk Valley Ambulance at (315) 866-2336.  You may also print a copy using the link at the top of this page.

CHANGES TO THIS NOTICE:

We reserve the right to change this notice at any time.  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 and in our offices at 15 State Route 5S, Mohawk, New York.  This 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 the Privacy Officer at Mohawk Valley Ambulance at the above address. All complaints must be made in writing. You will not be penalized for filing a complaint.