HIPAA NOTICE OF PRIVACY PRACTICES
This Notice describes how medical information about you may be used and disclosed by Ambulnz Holdings, LLC and its affiliates and subsidiaries and/or Rapid Reliable Testing, LLC and its affiliates and subsidiaries (“We”), and how you can get access to this information. Please review it carefully.
WHAT IS THE NOTICE OF PRIVACY PRACTICES?
The Notice of Privacy Practices (NOPP) explains how we fulfill our commitment to respect the privacy and confidentiality of your Protected Health Information (PHI). This NOPP explains how we may use and share your PHI, as well as the legal obligations we have regarding your PHI, and about your rights under federal and state laws. The NOPP applies to all records maintained by us, regardless of whether the record is written, computerized or in any other form. We are required by law to make sure that information that identifies you is kept private and to make this NOPP available to you. In this NOPP, the term Protected Health Information (PHI) refers to individually identifiable information about you, which may include:
Information about your health condition (such as medical conditions and test results you may have)
Information about healthcare services you have received or may receive in the future (such as a trip or test)
Information about your healthcare benefits under an insurance plan (such as whether a service is covered)
Geographic information (such as where you live or work)
Demographic information (such as your race, gender, ethnicity or marital status)
Unique numbers that may identify you (such as Social Security number, phone numbers or driver’s license number)
WHO WILL FOLLOW THIS NOTICE?
The privacy practices described in this NOPP will be followed by all of our healthcare professionals, employees, staff, students, volunteers and Business Associates.
Uses and Disclosures of Your PHI We Can Make Without Your Authorization
We may use or disclose your PHI without your authorization, or without providing you with an opportunity to object, for the following purposes:
Treatment: This includes such things as verbal and written information that we obtain about you, and use pertaining to your medical condition and treatment provided to you by us and other medical personnel including doctors and nurses, EMTs, Paramedics, technicians, and others who are involved in taking care of you. It also includes information we give to other healthcare personnel to whom we transfer your care and treatment, and includes transfer of PHI via radio or telephone to the hospital or dispatch center as well as providing the hospital with a copy of the written record we create in the course of providing you with treatment and transport.
Payment: This includes any activities we must undertake in order to get reimbursed for the services that we provide to you, including such things as organizing your PHI, submitting bills to insurance companies (either directly or through a third party billing company), managing billed claims for services rendered, performing medical necessity determinations and reviews, performing utilization reviews, and collecting outstanding accounts. You may restrict disclosures by us of medical information to your health plan regarding services you paid for yourself in full.
Healthcare Operations: This includes activities such as quality assurance activities, licensing, and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints, creating reports that do not individually identify you for data collection purposes, fundraising, and certain marketing activities.
Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for transport, testing, or medical care.
Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Fundraising: We may contact you for fundraising activities or to provide you with information about our annual subscription program. We may use medical information about you to contact you in an effort to raise money. We may disclose medical information to a related foundation so that the foundation may contact you. We would only release contact information, such as your name, address and phone number and the dates you received treatment or services. If you do not want to be contacted for fundraising efforts, you may opt out of such efforts by following the procedures described in the communications you may receive.
Business Associates: In certain cases, we will provide your information to contractors, agents and other parties who need the information in order to perform a service for us, such as obtaining payment for health care services or carrying out business operations. Another example is that we may share your information with an insurance company, law firm or risk management organization in order to maintain professional advice about how to manage risk and legal liability, including insurance or legal claims. However, you should know that in these situations, we require third parties to provide us with assurances that they will safeguard your information.
Public Health Risks: We may disclose medical information about you for public health activities. These activities generally include the following:
to prevent or control disease, injury or disability;
to report births and deaths;
to report child abuse or neglect;
to report reactions to medications or problems with products;
to notify people of recalls of products they may be using;
to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities 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 a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you 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 medical information if asked to do so by a law enforcement official:
In response to a court order, subpoena, warrant, summons or similar process;
To identify or locate a suspect, fugitive, material witness, or missing person;
About a suspected victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
About a death suspected to be the result of criminal conduct;
About criminal conduct; and
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.
National Security and Intelligence Activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others: We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be 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 are permitted to use or disclose your PHI without your written authorization in situations including:
For the treatment activities of another healthcare provider;
To another healthcare provider or entity for the payment activities of the provider or entity that receives the information (such as your hospital or insurance company);
To another healthcare provider (such as the hospital to which you are transported) for the healthcare operations activities of the entity that receives the information as long as the entity receiving the information has or has had a relationship with you and the PHI pertains to that relationship;
For healthcare fraud and abuse detection or for activities related to compliance with the law;
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. We may also disclose health information to your family, relatives, or friends if we infer from the circumstances that you would not object. For example, we may assume that you agree to our disclosure of your personal health information to your spouse when your spouse has called the ambulance for you. In situations where you are incapable of objecting (because you are not present or due to your incapacity or medical emergency), we may, in our professional judgment, determine that a disclosure to your family member, relative, or friend is in your best interest. In that situation, we will disclose only health information relevant to that person’s involvement in your care. For example, we may inform the person who accompanied you in the ambulance that you have certain symptoms and we may give that person an update on your vital signs and treatment that is being administered by our ambulance crew;
For law enforcement activities in limited situations, such as when there is a warrant for the request, or when the information is needed to locate a suspect or stop a crime;
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 on 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 and transplantation; and
For research projects, but this will be subject to strict oversight and approvals and health information will be released only when there is a minimal risk to your privacy and adequate safeguards are in place in accordance with the law.
Uses and Disclosures of Your PHI That Require Your Written Consent:
Any other use or disclosure of PHI, other than those listed above, will only be made with your written authorization (the authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to use or disclose it). Specifically, we must obtain your written authorization before using or disclosing your: (a) psychotherapy notes, other than for the purpose of carrying out our own treatment, payment or health care operations purposes, (b) PHI for marketing when we receive payment to make a marketing communication; or (c) PHI when engaging in a sale of your PHI. You may revoke your authorization at any time, in writing, except to the extent that we have already used or disclosed medical information in reliance on that authorization.
Your Rights Regarding Your PHI:
As a patient, you have a number of rights with respect to your PHI, including:
Right to access, copy or inspect your PHI: You have the right to inspect and copy most of the medical information that we collect and maintain about you. Requests for access to your PHI should be made in writing to our HIPAA Privacy Officer. In limited circumstances, we may deny you access to your medical information, and 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. If you wish to inspect and copy your medical information, you should contact our HIPAA Privacy Officer: Ambulnz Holdings, LLC & Rapid Reliable Testing, LLC 35 West 35th St. 6th Floor New York, NY 10001 Attn: HIPAA Privacy Officer
We will normally provide you with access to this information within 30 days of your written request. If we maintain your medical information in electronic format, then you have a right to obtain a copy of that information in an electronic format. In addition, if you request that we transmit a copy of your PHI directly to another person, we will do so provided your request is in writing, signed by you (or your representative), and you clearly identify the designated person and where to send the copy of your PHI.
We may also charge you a reasonable cost-based fee for providing you access to your PHI, subject to the limits of applicable state law.
Right to request an amendment of your PHI: You have the right to ask us to amend protected health information that we maintain about you. Requests for amendments to your PHI should be made in writing to the HIPAA Privacy Officer you wish to make a request for amendment and fill out an amendment request form.
When required by law to do so, we will amend your information within 60 days of your request and will notify you when we have amended the information. We are permitted by law to deny your request to amend your medical information in certain circumstances, such as when we believe that the information you have asked us to amend is correct.
Right to request an accounting of uses and disclosures of your PHI: You may request an accounting from us of disclosures of your medical information. If you wish to request an accounting of disclosures of your PHI that are subject to the accounting requirement, you should contact our HIPAA Privacy Officer and make a request in writing.
You have the right to receive an accounting of certain disclosures of your PHI made within six (6) years immediately preceding your request. But, we are not required to provide you with an accounting of disclosures of your PHI: (a) for purposes of treatment, payment, or healthcare operations; (b) for disclosures that you expressly authorized; (c) disclosures made to you, your family or friends, or (d) for disclosures made for law enforcement or certain other governmental purposes.
Right to request restrictions on uses and disclosures of your PHI: You have the right to request that we restrict how we use and disclose your medical information for treatment, payment or healthcare operations purposes, or to restrict the information that is provided to family, friends and other individuals involved in your healthcare. However, we are only required to abide by a requested restriction under limited circumstances, and it is generally our policy that we will not agree to any restrictions unless required by law to do so. If you wish to request a restriction on the use or disclosure of your PHI, you should contact our HIPAA Privacy Officer and make a request in writing.
We are required to abide by a requested restriction when you ask that we not release PHI to your health plan (insurer) about a service for which you (or someone on your behalf) have paid us in full. We are also required to abide by any restrictions that we agree to. Notwithstanding, if you request a restriction that we agree to, and the information you asked us to restrict is needed to provide you with emergency treatment, then we may disclose the PHI to a healthcare provider to provide you with emergency treatment.
A restriction may be terminated if you agree to or request the termination. Most current restrictions may also be terminated by us as long we notify you. If so, PHI that is created or received after the restriction is terminated is no longer subject to the restriction. But, PHI that was restricted prior to the notice to you voiding the restriction must continue to be treated as restricted PHI.
Right to notice of a breach of unsecured protected health information: If we discover that there has been a breach of your unsecured PHI, we will notify you about that breach by first-class mail dispatched to the most recent address that we have on file.
Right to request confidential communications: You have the right to request that we send your PHI to an alternate location (e.g., somewhere other than your home address) or in a specific manner (e.g., by email rather than regular mail). However, we will only comply with reasonable requests when required by law to do so. If you wish to request that we communicate PHI to a specific location or in a specific format, you should contact our HIPAA Privacy Officer and make a request in writing.
Internet, Email and the Right to Obtain Copy of Paper Notice:
If we maintain a web site, we will post a copy of this Notice on our web site and make the Notice available electronically through the 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:
We reserve the right to change this notice and the privacy practices without first notifying you. We reserve the right to make the revised or changed NOPP effective for PHI we already have about you as well as any information we receive in the future. We will post a copy of the current notice on our website. To request a copy of the most recent NOPP, please contact our HIPAA 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 that your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with us or to the government.
Should you have any questions, comments or complaints, you may direct all inquiries to Compliance Name, our HIPAA Compliance Officer. Individuals will not be retaliated against for filing a complaint.
If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact:
Ambulnz Holdings LLC, and Rapid Reliable Holdings, LLC
35 West 35th Street, 6th Floor
New York, NY 10001
Attn: HIPAA Privacy Officer