IMPORTANT: 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 REGARDING YOUR MEDICAL INFORMATION:
IMPORTANT: 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. This sheet is designed to provide you with an overview the rights of patients as provided by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) regarding the protected health information that Hamilton County EMS gathers about patients in the course of its daily operations. This may not be a complete discussion of such rights, and is not intended to be legal advice. If you have questions, please refer to the Code of Federal Regulations (“C.F.R.”) generally, as well as 45 C.F.R. §§ 160.102-103; 164.522, and seek legal advice.
Protected Health Information (PHI): This is defined as “individually identifiable health information” that is held or transmitted by a covered entity or its business associates in any form or media, whether printed, electronic, or oral. Individually identifiable health information, is information including demographic data that relates to: the individual’s past, present or future physical or mental health condition; the provision of health care to the individual; or the past, present or future payment for the provision of health care to an individual, and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. Individually identifiable health information includes identifiers such as name, address, birth date, and Social Security Number.
You have the following rights regarding your health information: The Right to Inspect and Copy your PHI: You may review and copy your medical records and information. You should make such a request to us at 317 Oak St, Chattanooga, TN 37403.
The Right to Amend your PHI: You may ask that we amend your PHI if you believe that your information is incomplete or incorrect. A request for an amendment should be made in writing and should be sent to us at the above address. Your request must be accompanied by a statement from you regarding why you feel the amendment is proper. We may deny your request if it is not written or if you fail to state a reason for the proposed amendment. We may deny your request if the information is not part of the information we keep, was not created by us (unless the entity responsible is no longer available), is not part of the information available for you to inspect and copy or is accurate and complete.
The Right to Know about Disclosures of your PHI: You have the right to request an accounting of who we have disclosed your health information to. The request should be made in writing and sent to us at the above address. You must state a time period for your request, which cannot be longer than 6 years.
The Right to Request Restrictions of your PHI: You may request a restriction or limitation on our use or disclosure of your PHI with respect to the following categories: (1) treatment, (2) billing and payment, or (3) health operations or to your family or caregivers. Because the use or disclosure of PHI is often necessary to ensure quality patient care and efficient payment for such care, we do not have to agree to your request. However, even if we do agree to your request, we may override your request in the event of a medical emergency where sharing your PHI is necessary to ensure your treatment. In such a case, we are required to inform the emergency treatment provider of your request, and ask that such provider not disclose the information other than for the purpose pf providing emergency treatment.
You have a right to restrict who may receive information about your health care, including restricting the disclosures to notify family members or other about your general conditional, location or death. Additionally, if you object, we are prohibited from releasing your PHI to a family member or other person involved in your health care or in payment for your health care.
Requests for restrictions must be made in writing and sent to us at the address above. Your request must include a statement of what information you want to limit, whether you want to limit its use, disclosure, or both, and to whom you want the limits to apply.
The Right to Confidential Communications: You may request that we communicate with you about medical matters in a certain format or at a specific location. You must request such a confidential communication or specific type or place of communication in writing submitted to us at the address above. No reason for this request is necessary and we will honor all reasonable requests.
PLEASE NOTE that we retain the right to alter, amend or change this Notice at any time. Any such revision may be effective on any information we obtain about you in the future or any information that we already have regarding you. A copy of our most current Notice will be on display in our offices.
COMPLAINTS regarding the use of your PHI should be made to us at the address above and/or with the Department of Health and Human Services. All complaints must be submitted in writing. There is no cost or penalty to you for filing a complaint.
You also have the right to request that we restrict the method in which we use or disclose your PHI for purposes of treatment, payment or health care operations. We have the right to refuse to comply with your request.
We will keep and record information about your medical condition. We may use this information or disclose this information to others as follows:
We may use or disclose your PHI in order to treat you. For example, we may advise the health care provider which we are transporting you to of your medical condition, including your vital signs and medications we have administered to you. We may also disclose your condition to family or caregivers who are involved in your medical care.
We may use or disclose your PHI in order to receive payment for the services we provide to you. For example, we may disclose your condition in order for your insurance company to understand why you received treatment so that they will pay your claim. We may also disclose your information to our billing department/attorney/collection agencies in order to seek payment for the services we provide to you. We may use to disclose your PHI for our operations. For example, we may review your information in order to evaluate your treatment and our services in order to insure that our care for you now and in the future is the best that it can be.
We may use your PHI to contact you in the future. We may also disclose your information as required by law. If you have questions about this brochure, your rights, or the care you have received, please contact one of the following phone numbers with your requests:
E.M.S. Administrative Office (423) 209-6900