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HIPAA Notice of Privacy Practices

Your personal medical information is private:

Balboa Ambulance Service, Inc. understands how important your personal medical information is to you. We know you are concerned with how that information might be used, the way in which it is disclosed and how you can access that information. That is why we've put this document together. It's the "Privacy Practices" outlined here that is so important and why we want to pledge our commitment, at the onset, to respect your personal medical information.

Our pledge to you:

We understand that your medical information is personal and confidential. We create a medical record of the care you receive because it is our legal obligation, but more importantly because we want to provide you with quality care. Please know we are committed to protecting your personal medical information from any use for which it was not intended.

In short, the law requires us to:

  • Keep your medical information private.
  • Notify you of our legal duties and privacy practices with respect to your medical information.
  • Follow the terms of the most current notice.

What this notice is all about:

The information in this document applies to all your medical records whether created by our facility staff or your personal doctor. Please understand that your personal doctor may have different policies or notices regarding the use and disclosure of the medical information created in his or her office. This notice will tell you about the specific way Balboa Ambulance Service, Inc. and our facilities may use and disclose your medical information. This notice also describes your rights and the duties we have regarding the use and disclosure of your medical information.

Entities adhering to these privacy practices:

The Department of Health and Human Services sponsored the Health Insurance Portability Accountability Act (HIPAA). HIPAA dictates the medical information privacy practices that health care organizations and their partners are obligated to follow. Balboa Ambulance Service, Inc. provides health care to our patients and clients in partnership with many physicians and other professionals and organizations. We want you to know that all of these entities will be following the same privacy practices we do, and that these practices are specifically designed to keep your medical information confidential.

The medical information privacy practices in this notice will be adhered to by:

Any health care professional or staff that treats you at any of our locations.

  • All departments and units of our organization.
  • Any business associate or partner with whom we share health information.
  • Be assured that all of these individuals and organizations understand that the privacy of your medical information is important, and will be following HIPAA guidelines to ensure that your information is used only as it is intended

How your personal medical information may be used and disclosed:

The following is a list of ways in which your personal medical information may be used and disclosed as allowed under HIPAA provisions. Be assured that we will use your information in the most discreet manner.

Disclosure for health care related purposes:

We may use and disclose your medical information to a specialist for health care related purposes including:

  • Treatment, such as sending your medical information to a specialist as part of a referral.
  • Obtaining payment for treatment, such as sending billing information to your insurance company or Medicare.
  • Supporting our health care operations, such as comparing patient data to improve treatment methods.

Communication with business partners so they may help us to do our jobs. These business partners are required by contract and by law to comply with the provisions of HIPAA and protect your rights as we do.

Disclosure to other organizations:

Subject to certain requirements, we may give out your medical information to other organizations without prior authorization for:

  • Public health purposes
  • Abuse or neglect reporting
  • Research studies
  • Funeral Arrangements
  • Organ Donation
  • Worker Compensation purposes
  • Emergencies
  • Health oversight audits or inspections

Disclosure to legal agencies:

We also disclose medical information when required by law in response to:

  • Requests from Law enforcement agencies in specific circumstances.
  • Valid judicial or administrative orders.
  • The government, if you are in the military or a veteran.
  • National security or intelligence activities.
  • Protective services for the President and others.

Disclosure for contacting you:

We also may use your medical information for contact with you, for:

  • Appointment reminders.
  • Possible treatment options and alternatives.
  • Health-related benefits or services that may be of interest to you.

Disclosure to friends, family and others:

We may disclose medical information about you to:

  • A friend or family member who is involved in your medical care.
  • Someone who helps pay for your care.
  • Disaster relief authorities to notify your family of your location and condition.

Disclosure in special circumstances:

In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing your medical information. If you choose to authorize use or disclose you can later revoke that authorization by notifying us in writing of your decision.

Your Rights:

Can you see a copy of your medical information?

In most cases, you have the right to review and obtain a copy of the medical information we use to make decisions about your care by submitting a written request. If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy you may submit a written request for a review of that decision.

What if your medical records are inaccurate?

If you believe that information in your record is incorrect or if important information is missing, you have the right to request correction of the records by submitting a request in writing along with your reason for requesting the amendment. We could deny your request to amend a record if the information was not created by us; if it is not a part of the medical information we maintained; if it is not part of the information you would be permitted to review or copy; or if we determine that the record is accurate, you may appeal, in writing, a decision by us not to amend a record.

Can you know with whom we've shared your records?

Your have the right to a list of those instances where we have disclosed your medical information, other than for treatment, payment, health care operations or where you specifically authorized a disclosure, by submitting a written request. The request must state the time period desired for the accounting, which must be less than a 6-year period and start after April 14, 2003. You may receive the list in paper or electronic form. The first disclosure list request in a 12-month period is free; other requests will be charged according to our production cost. We will inform you of the cost before you incur any expenses.

Can you specify the way in which we communicate your medical records to you?

You have the right to request that your medical information be communicated to you in a confidential manner, such as sending mail to an address other than your home. Your request must specify how or where you wish to be contacted. We will attempt to honor all reasonable requests.

Can you request your medical information only to be released with your permission?

You may request in writing that we not use or disclose your medical information for treatment, payment and health care operations, or to persons involved in your care except when specifically authorized by you, when required by law or in an emergency. We will consider your request but are not legally required to accept it. We will inform you of our decision on your request. All written requests must tell us (1) what information you want to limit; (2) whether you want to limit our use or disclose; and (3) to whom you want the limits to apply.

Where can you express a concern?

If you are concerned that your privacy rights may have been violated or disagree with a decision made about access to your records, you may contact the Balboa Ambulance Service, Inc. office at 1-619-295-1919. You also may send a written complaint to the U S Department of Health and Human Services Office of Civil Rights. Under no circumstances will you be penalized or retaliated against for filing a complaint.

Will the policies in the notice change?

We may change our policies at any time. Changes will apply to medical information we have already hold, as well as new information after the change occurs. When we make a significant change to our policies, we will change our notice and post the new notice in our corporate offices. You can receive a copy of the current notice at any time. The effective date is listed. You will not be offered a copy of the current notice when you are under our treatment, however, you may request one at any time.