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Jewett EMS Inc.
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Jewett EMS Inc.
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Notice of Privacy Practice of Jewett Emergency Medical Services, Inc. Effective January 01, 2009 This Notice describes how medical information may be used and disclosed about you. This Notice also informs you on how you may gain access to this information. Please review carefully. 1. Legal requirements: Jewett E.M.S., Inc. is legally required to maintain privacy of certain confidential information about your health under H.I.P.A.A. regulations and to provide you with the notice of our legal duties and privacy practice with respect to protected health information. Jewett E.M.S., Inc. reserves the right to amend this notice and to make amended provisions effective for all protected health information we maintain. Any changes of this notice will be available at our facility. You may obtain the latest copy of this notice from our web page or the home office at the address listed below. 2. Use and Disclosure of protected health information: Jewett E.M.S. maintains your protected health information in a confidential manner in accordance with legal requirements. However Jewett E.M.S. may use protected health information as necessary, without your consent for the purpose of treatment, payment, and health care operations, some examples are: •Treatment: This involves oral and written information we will obtain and share among health care providers involved in your care and transportation you received. •Payment: This involves obtaining payment for the transportation and care rendered to you. For example, we will provide information about your transportation and care to insurance companies and entities and agencies involved in reimbursement and medical necessity or utilization review. •Healthcare operations: This involves the use of information about you to improve the quality of care. For example, we may use the information about your care for training, quality control, and licensure purposes. In addition, Jewett E.M.S. is permitted to use and disclose protected health care information without your consent in these ways that may be disclosed authorized or required by federal, state or local law: •To your parent or guardian, if you are a minor. •To your legal guardian or power of attorney. •Any use or disclosure related to public health activities. •Use or disclosure in connection with judicial or administrative proceedings, lawsuits, subpoenas and disputes. • Law enforcement purposes. •In health care fraud and abuse investigations •For health oversight activities, investigations by a governmental entity or its contractor, and disciplinary or licensure proceedings •For military, national defense and security, or law enforcement purposes •To coroners, medical examiners, and funeral directors. •Uses and disclosures that do not identify you 3. Other uses of protected health information: Protected health information will only be used for other purposes that are listed below, unless you ask for restrictions on a specific use of disclosure in writing. •To provide you with reminders of scheduled transportation. •To provide you with information about the services we provide and the benefits that may be available to you. •To contact you to raise funds for our activities. Any other use or disclosure of protected health information (besides those described in paragraphs 2 and 3) will occur only with your written authorization. If you give us such an authorization, you may revoke it in writing at any time. Once you revoke such authorization no further use of disclosure by virtue of that revoked authorization will occur. 4. Your rights: You have the following rights regarding your protected health information, provided you make a written request to exercise these rights to Jewett E.M.S. privacy officer identified below: • Rights to request restrictions: You may request limitations of the information we use or disclose for health care treatment, payment, or operations but we are not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment. • Rights to confidential communication: You may request that we communicate with you in a certain manner or at a certain location, but you must specify how or where you wish to be contacted. •Right to inspect and copy: You have a right to inspect and copy most of the information we will maintain about you. We will normally provide access to information within 30 days and charge a reasonable fee for a copy. Under limited circumstances, we can deny your request for information. You may appeal certain denials. • Right to request and amendment: If you believe that the information we have about you is incorrect or incomplete, you may request an amendment. We will generally amend your information within 60 days of receiving a written request specifying the specific amendment you request. We can deny your request only in certain situations, for example if we believe the information you have asked us to amend is correct and therefore should not be amended. •Right to accounting of disclosure of protected health information: You may request an accounting of certain disclosures of your protected health information we have made in the six years prior to the date of the request, but not prior to April 15, 2004. We are not required to provide an accounting of disclosures or uses that occurred for treatment, payment, or health care operations or our sharing of information with our business associates. • Right to receive a copy of this notice: You may request an additional paper copy of this notice from our privacy officer at any time. If we maintain a web site we will post a copy of our current notice on our site. 5. Exercising your rights: To exercise any of the rights described in this notice, contact our Privacy Officer listed below. 6. Complaints: If you believe that your privacy rights have been violated, you may file a complaint with Jewett E.M.S. or with the Secretary of the United States Department of Health and Human Services. You will not be penalized or retaliated against in any way for making a complaint to Jewett E.M.S. or the Department of Health and Human Services. 7. Contacting Jewett E.M.S.: You contact Jewett E.M.S. Privacy Officer, Steven Robinson at 903-626-4958 or 201 S. Main / P.O. Box 491, Jewett, TX 75846 to file a complaint if you have any questions about this notice, if you wish to request restrictions on uses and disclosures for health treatment, payment, or operations or if you wish to exercise your rights described above.
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