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Privacy Notice

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Notice of Privacy Practices

Dove Creek Ambulance District
222 S Guyrene 
PO Box 825
Dove Creek, CO  81324

DCAD Privacy Board: 970-394-6266

Your Information Your Rights Our Responsibilities

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.

YOUR RIGHTS

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of your health and claims records

  • You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your Patient Care Reports and facilitate requests for claims records, usually within 30 days of your request. We reserve the right to charge a reasonable, cost-based fee.

Ask us to correct health and claims records

  • You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.
  • We may refuse your request, but we'll tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will consider all reasonable requests and must say yes if you tell us you would be in danger if we do not.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations.
  • We are not required to agree to your request, and we may say no if it would affect your care.

Get a list of those with whom we've shared information

  • You can ask for a list (accounting) of the times we've shared your health information for six years before the date you ask, who we shared it with, and why.
  • We will include all the disclosures except those about treatment, payment, health care operations, and certain other disclosures (such as any you asked us to make). We'll provide one accounting a year for free but charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will promptly provide you with a paper copy.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we act.

File a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting us using the information on page 1.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.
     


YOUR CHOICES

You can tell us your choices about what we share for specific health information. Talk to us if you have a clear preference for how we share your information in the situations described below. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in payment for your care
  • Share information in a disaster relief situation
  • Contact you for fundraising efforts

If you cannot tell us your preference, for example, if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information

 

OUR USES AND DISCLOSURE

How do we typically use or share your health information?
We typically use or share your health information in the following ways.

Help manage the health care treatment you receive

  • We can use your health information and share it with professionals treating you.
    Example: The hospital or receiving facility treating you after transport requests pre-hospital care information 

Run our organization

  • We can use and disclose your information to run our organization and contact you when necessary.
  • We are not allowed to nor use genetic information to decide whether we will provide you care.
    Example: We use your health information to develop better services for you.

Pay for your health services

  • We can use and disclose your health information as we request reimbursement for your health services.
    Example: We share information about you with your insurance plan to coordinate reimbursement for your pre-hospital care.

Administer your plan

  • We may disclose your health information to your plan sponsor for plan administration.
    Example: Your company contracts with us to provide a health plan, and we provide your company with specific statistics to explain the premiums we charge.

How else can we use or share your health information?

We are allowed or required to share your information in other ways - usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before sharing your information for these purposes. For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

  • We can share health information about you for certain situations, such as:
  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone's health or safety

Comply with the law

  • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.

Respond to organ and tissue donation requests and work with a medical examiner or funeral director

  • We can share health information about you with organ procurement organizations.
  • We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers' compensation, law enforcement and other government requests
We can use or share health information about you:

  • For workers' compensation claims
  • For law enforcement purposes or with a law enforcement official with health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

  • We can share health information about you in response to a court or administrative order, or in response to a subpoena.

There are federal and state laws that may protect or restrict certain types of health information from use or disclosure, such as information regarding HIV/AIDS, mental health, genetic tests, alcohol and drug abuse, sexually-transmitted diseases and reproductive health, and child or adult abuse or neglect.

OUR RESPONSIBILITIES

  • We are required by law to maintain the privacy and security of your protected health information and personally identifiable information.
  • We will let you know promptly if a breach may have compromised your information's privacy or security.
  • We must follow the duties and privacy practices described in this notice and give you a copy.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind anytime. Let us know in writing if you change your mind.

For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of This Notice
We can change the terms of this notice, which will apply to all information we have about you. The new notice will be available upon request and we will mail a copy to you. This notice applies to the Dove Creek Ambulance District and pre-hospital medical care.