| NorthStar EMS 1701 E. Beebe-Capps Expy Searcy, Arkansas 72143 Business Office Phone 501-305-2287 Toll Free Phone 1-866-305-2287 Searcy * Beebe * Heber Springs * Bald Knob * Quitman |
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NorthStar EMS, Inc. is required by law to maintain the privacy of certain confidential health
notice of our legal duties and privacy practices with respect to your PHI. NorthStar EMS is
also required to abide by the terms of the version of this Notice currently in effect.
OUR OBLIGATIONS
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.
Uses and Disclosures of PHI:
NorthStar EMS 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 Treatment:
This includes such things as obtaining verbal and written information about your medical
condition and treatment from you as well as from others, such as doctors and nurses who
give orders to allow us to provide treatment to you. We may give your PHI to other health
care providers involved in your treatment, and may transfer your PHI via radio or telephone
to the hospital or dispatch center.
•For Payment:
This includes any activities we must undertake in order to get reimbursed for the services we
provide to you, including such things as submitting bills to insurance companies, making
medical necessity determinations and collecting outstanding accounts.
•For Health Care Operations:
This includes quality assurance activities, licensing, and training programs to ensure that
our personnel meet our standards of care and follow established policies and procedures,
as well as certain other management functions.
•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 provider information about
other services we provide.
Uses and Disclosure of PHI Without Your Authorization:
NorthStar EMS is permitted to use PHI without your written consent, or opportunity to object,
in certain situations, and unless prohibited by a more stringent state law, including:
• For the treatment, payment, or health care operations activities of another health care
provider who treats you;
• For health care 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 an 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;
• For judicial and administrative 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 out 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 or transplantation;
• For research projects, but this will be subject to strict oversight and approvals;
• We may release Health Information is 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 certain 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; and (6) 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.
• If you are an inmate of a correctional institution or under the custody of law enforcement,
we may release Health Information to the appropriate correctional institution or law
enforcement official. This release would be made only 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.
• 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 consent. You may revoke your authorization at any time, in writing, except to the
extent that we have already use 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: This means you may inspect and copy most of the medical
information about you that we maintain. We will normally provide you with the access to this
information within 30 days of your request. We may also charge you a reasonable fee for
you to copy any medical information that you have the right to access. In limited
circumstances, we may deny you access to your medical information, any 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. You
may also have the right to receive confidential communications of your PHI. If you wish to
inspect and copy your medical information, you should contact or privacy officer.
•The right to amend you PHI: You have the right to ask us to amend written medical
information that we may have about you. We will generally amend the information within 60
days of your request and will notify you when we have amended this information. We are
permitted by law to deny your request to amend your medical information only in certain
circumstances, like when we believe the information you have asked to amend is correct. If
you wish to request that we amend the medical information that we have about you, you
should contact our privacy officer.
•The Right to Request an Accounting:
You may request an accounting from us of certain disclosures of your medical information
that we have made in the six years prior to the date of your request. We are not required to
give you an accounting of information we have used or disclosed for purposes of treatment,
payment, or health care operations, or when we share your health information with our
business associates, like or billing company or medical facility from/to which we have
transported you. We are also not required to give you an accounting of our uses of
protected health information for which you have already given us written authorization. If you
wish to request an accounting, contact our privacy officer.
•The right to request that we restrict the uses and disclosures of your PHI: You have the
right to request that we restrict how we use or disclose your medical information that we
have about you. NorthStar EMS is not required to agree to any restrictions you request, but
any restrictions agreed to by NorthStar EMS in writing are binding on NorthStar EMS.
•Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request: If we
maintain a website, we will prominently post a copy of this Notice on a 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:
NorthStar EMS 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
on the web site. You can get a copy of the latest version of this notice by contacting the
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 the
government. Should you have any questions, comments or complaints you may direct all
inquiries to our Complaint officer.
HIPPA officer contacts:
Privacy Officer:
Tonia Hale
NorthStar EMS
1115 S. Benton St.
Searcy, AR 72143
Phone:501-305-2287
Fax: 501-268-7026
Email: tonia@northstarems.us
Complaince Officer:
Tonia Hale
NorthStar EMS
1115 S. Benton St.
Searcy, AR 72143
Phone: 501-305-2287
Fax: 501-268-7026
Email: tonia@northstarems.us
Training Officer:
Tonia Hale
NorthStar EMS
1115 S. Benton St
Searcy, AR 72143
Phone:501-305-2287
Fax: 501-268-7026
Email: tonia@northstarems.us
This notice is effective as of March 11, 2011
