Ambulance USA LLC d/b/a/ Air Medical Transport, from here on referred to as “AMT.”
As a patient, you have several rights concerning your “PHI” (Protected Health Information), including:
The right to access, copy, or inspect your PHI.
It means you may inspect and copy most of the medical information about you that we maintain. We will provide you with access to this information within 30 days of your request. We may also charge you a reasonable fee to copy any medical information that you have the right to access. We may deny you access to your medical information in limited circumstances, and you may appeal certain types of denials. We have forms available 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 also have the right to receive confidential communications of your PHI. If you wish to inspect and copy your medical information, you can contact our privacy officer at +1-832-872-2222
The right to update your PHI.
You have the right to ask to change the written medical information we may have about you. We will amend your information within approximately 60 days of your request. We will notify you when we have amended the information. We are permitted by law to deny your request to change your medical information only in certain circumstances, for instance, when we believe the information, you have asked us to amend is correct. If you wish to request that we change the medical information that we have about you, you should contact our privacy officer indicated above.
The right to request an accounting.
You have the right to request an accounting from us for certain disclosures of your medical information that we have made within up to six years from the date of your transport. We are not required to give an accounting of our uses of protected health information for which you have already provided authorization. If you wish to request an accounting, contact our privacy officer indicated above.
The right to restrict the uses and disclosures of your PHI.
You have the right to request to limit how we use and disclose the medical information that we have about you. AMT is not required to agree to any restrictions you request, but any conditions agreed to by AMT in writing are binding on AMT.
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 Privacy Notice on our site. If you allow us, we will forward you this Notice by email instead of paper, and you can also request a paper copy of this Notice.
Revisions to the Privacy Notice.
AMT reserves the right to change the terms of this Notice at any time, and the changes will be effective immediately. Those changes will apply to all protected health information that we maintain. We will promptly post any material changes to the Notice in our records and our website if we keep one. You can get a copy of the latest version by contacting our privacy officer.
Your Legal Rights and Complaints.
You also have the right to complain to us or the United States Department of Health and Human Services Secretary. If you believe your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with the government or us. Should you have any questions, comments, or complaints, you may direct all inquiries to our privacy officer.
PHI Uses & Disclosures
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.
AMT 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 concerning your PHI. AMT is also required to abide by the terms of the version of this Notice currently in effect.
Uses and Disclosures of PHI
AMT may use PHI for treatment, payment, and health care operations, in most cases, without your written permission.
This includes obtaining verbal or 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 arrange treatment for you. We may provide your PHI to other health care providers involved in your treatment. AMT of our provider or operator may transfer your PHI via radio or telephone to the hospital or dispatch center.
It includes any activities we must undertake to be 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 Healthcare Operations
It includes quality assurance activities, licensing, and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures and other management functions.
Reminders for Scheduled Transports and Information on Other Services.
We may also contact you to provide a reminder of any scheduled transports for non-emergency air medical transportation and air ambulance or to provide information about other services we provide.
Use and Disclosure of PHI Without Your Authorization.
AMT is permitted to use PHI without your written authorization, or opportunity to object, in certain situations, and unless prohibited by 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, another relative, or close personal friend or other individual involved in your care. If we obtain your verbal agreement to do so or if we allow you 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 interest;
- 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 investigation, 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 domestic or international flights to the Transportation Security Agency (TSA), Immigration, Customs, and Border Protection. Federal regulations require the identification of each passenger and a security check with customs (e.g., passport, driver’s license number, and state of issuance).
- For judicial and administrative proceedings as required by a court or executive 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.