STAMFORD EMS, INC.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Stamford Emergency Medical Services, Inc. ("SEMS") 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. SEMS is also required to abide by the terms of the version of this Notice currently in effect.
Uses and Disclosures of PHI: SEMS 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 healthcare operations
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 provide information about other services we provide.
Use and Disclosure of PHI without Your Authorization. SEMS is permitted to use PHI without your written authorization, or opportunity to object, in certain situations, and unless prohibited by a more stringent state law, including:
For the treatment, payment or healthcare operations activities of another health care provider who treats you;
For healthcare 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 on 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; 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 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;
For research projects, but this will be subject to strict oversight and approvals;
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 authorization. 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.
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.
The right to amend your PHI
The right to request an accounting
The right to request that we restrict the uses and disclosures of your PHI
Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request.
If we maintain a web site, we will prominently post a copy of this Notice on our 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: SEMS 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 posted to our web site, if we maintain one. You can get a copy of the latest version of this Notice by contacting our 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 to the government. Should you have any questions, comments or complaints you may direct all inquiries to our privacy officer.
Privacy Officer Contact Information:
Stamford EMS, Inc.
684 Long Ridge Rd.
Stamford, CT 06902
(203) 968-1118 - Office
(203)-322-0658 - Facsimile
Effective Date of the Notice: April 14, 2003