Arlington Ambulance Service has always been a leader in protecting patients' medical information. Maintaining patient privacy is part of our mission to serve the needs of the patient first. Controlled use of medical information by staff at Arlington Ambulance Service is essential to providing optimum patient care.

The United States government created new rules for the use and protection of medical and health information by hospitals, clinics and other medical practices, including medical transportation services. The rules are a result of the 1996 Health Insurance Portability and Accountability Act (HIPAA). They are meant to provide all patients in the United States with standard privacy protections. One new rule requires healthcare organizations to provide all patients with a Notice of Privacy Practices to explain how patient medical information is used. The same rule requires providers keep records showing that patients have received the notice.

We are pleased to provide you with this copy of Arlington Ambulance Service's Notice of Privacy Practices. We hope it will answer any questions you may have about how patient medical information is used. In accordance with the federal government HIPAA rules, please sign in receipt of this form demonstrating that you have received the notice; it will in no way affect the care you receive by Arlington Ambulance Service.

Sincerely,

Arlington Ambulance Service

This notice applies to the following entities which are collectively referenced as Arlington Ambulance Service.

By law, Arlington Ambulance Service must keep protected health information private. The federal government defines protected health information as any information, whether oral, electronic or paper, which is created or received by Arlington Ambulance Service and relates to a patient’s health care or payment for the provision of health care.

Arlington Ambulance Service will follow the rules of its privacy notice currently in effect.

Arlington Ambulance Service makes every effort to maintain the confidentiality of medical information. However, to provide appropriate and consistent treatment, it is often necessary to share your information with other medical facilities. When Arlington Ambulance Service transports you to a medical facility for treatment, Arlington Ambulance Service will share your medical information with that facility to ensure you receive the best possible care. Arlington Ambulance Service will take every precaution against inappropriate use or disclosure of your medical information.

Federal and state laws require Arlington Ambulance Service to protect your medical information, and federal law requires Arlington Ambulance Service to describe to you how we handle that information. When state and federal privacy laws differ, and state law is more protective of your information or provides you with greater access to your information, then state law will override federal law.

This section describes the most common uses of protected health information. These apply to virtually all Arlington Ambulance Service patients.

There are three common ways Arlington Ambulance Service will use medical information: They include treatment, billing and health-care operations. Arlington Ambulance Service may also release information, where appropriate, to other medical facilities involved in your care.

"Protected health information" means any information, whether oral, electronic or paper, which is created or received by Arlington Ambulance Service and relates to a patient’s health care or payment for the provision of health care. This includes not only the documentation generated by your caregiver during the course of treatment, but also certain demographic information (such as your name, address and telephone number) that is related to your health records.

Arlington Ambulance Service will use and disclose protected health information to provide, coordinate or manage your care. This includes communication and consultation between health-care providers—doctors, nurses, technicians and other members of your medical team. For example, when Arlington Ambulance Service transports you to a hospital, your caregiver will provide the staff at the hospital a summary of your condition, as well as any treatments or procedures provided to you.

Oregon law requires Arlington Ambulance Service to obtain your written consent to disclose your medical information outside of Arlington Ambulance Service or related entities for treatment. You would not need to provide consent in cases of medical emergency, within related health care entities when necessary for current treatment, or to third parties who requested or paid for independent medical exams.

Arlington Ambulance Service uses protected health information to create bills and collect from insurance companies, Medicare and other payers. This includes providing information such as dates of service, symptoms and diagnosis to your insurance company to show that Arlington Ambulance Service provided medical services to you.

Oregon law requires your written consent to disclose information outside of Arlington Ambulance Service for payment. This consent will continue to be collected from you before submitting any claim for service.

• To provide quality improvement education, the Medical Director will share unique case summaries with staff.

• The ambulance licensing authority in our state may review run records to ensure that records are complete and accurate.

Under federal regulations, Arlington Ambulance Service may disclose relevant protected health information to a family member or friend involved with your care, or handling your bills. If family or friends are present while care is being provided, Arlington Ambulance Service will assume your companions may hear the discussion, unless you state otherwise. Federal regulations allow Arlington Ambulance Service to share limited protected health information to notify a family member or legal representative of your location, condition or death.

Oregon law requires your written consent to share health information in most situations to family members or friends except in the case of an emergency.

Medical research is vital to the advancement of medical science. Federal regulations permit use of protected health information in medical research, with either your authorization or when the research study at Arlington Ambulance Service is reviewed and approved by an Institutional Review Board before any medical research study begins. In some situations, limited information may be used before approval of the research study to allow a researcher to determine whether enough patients exist to make a study scientifically valid.

Oregon law generally requires a written consent before Arlington Ambulance Service can disclose any medical information about you for medical research to an outside researcher. Arlington Ambulance Service will obtain your consent or refusal to participate in any research study, or will make a good faith effort to obtain your consent or refusal, before releasing any identifiable information about you for research purposes.

Part II - Other Potential External Disclosures

This section outlines less common circumstances that apply to some patients. Federal and/or state law requires or permits Arlington Ambulance Service to provide protected health information outside the organization in the following situations:

Arlington Ambulance Service uses and discloses protected health information to alert those able to lessen or prevent the threat of a serious threat to the health or safety of a patient, another person or the public.

Oregon law allows disclosures under limited circumstances in which Arlington Ambulance Service professionals have a "duty to warn."

Under federal regulations, if a patient is a member of the United States Armed Forces, Arlington Ambulance Service is permitted to release protected health information as required by military authorities. Arlington Ambulance Service also may release protected health information about foreign military personnel to the appropriate foreign military authority. When the military organization is sponsoring the medical evaluation, the patient’s medical information is shared with both the patient and the sponsoring organization. Patients being evaluated on behalf of the military are aware of these arrangements.

Oregon law generally requires your consent in order to make such disclosures unless another federal law requires the disclosure.

If you are seen for a workers’ compensation claim, federal rules permit the release of information related to your claim, as permitted or required by state law.

Oregon law permits disclosure of information related to a workers’ compensation claim without consent to those parties that are involved in the claim.

Arlington Ambulance Service may disclose protected health information for public health purposes. The following are some examples of releases that are allowed for public health purposes:

Arlington Ambulance Service must disclose protected health information to health-care oversight agencies, where required by law. Oversight activities can include licensure, accreditation, audits and investigations. It is standard practice for regulatory agencies such as the state ambulance licensing authority to review a sample of medical records to assure the quality of care provided.

Arlington Ambulance Service must disclose protected health information in response to a valid court or administrative order.

Oregon law permits disclosures in response to a valid Oregon court order, but requires written consent from the patient to release information in response to court orders from other states, subpoenas (except grand jury subpoenas) and discovery requests. In these cases, if the patient does not consent to the release Arlington Ambulance Service will not release the information unless the person requesting the information provides a court order that is valid in Oregon.

Arlington Ambulance Service may disclose protected health information to law enforcement officials:

Oregon law generally does not allow the release of information from the health record without a valid court order or warrant. Oregon allows the release of information to law enforcement in limited situations when a serious, specific threat of harm has been communicated to certain types of health care professionals. Arlington Ambulance Service may disclose information that is not in the health record when a crime has occurred on Arlington Ambulance Service property or in certain types of emergencies.

Arlington Ambulance Service may release protected health information to a coroner or medical examiner when necessary to identify the deceased or determine the cause of death, or as otherwise authorized by law. Release of information to a funeral director may occur when necessary to handle arrangements after death.

Oregon law requires written authorization signed by a family or legal representative to release medical information to funeral directors. Oregon law requires reports of certain types of deaths to a coroner or medical examiner, and in those cases must disclose health records upon the request of the coroner or medical examiner. Funeral directors are required to collect fact of death and certain demographic information. Arlington Ambulance Service will disclose this information to those in charge of the disposition of a body. Any additional disclosures from the health record will require consent from a surviving spouse, parent, person appointed by the patient in writing, or the patient’s legally authorized representative.

Arlington Ambulance Service may release protected health information to authorized federal officials for intelligence, counterintelligence or other national security activities authorized by law. Arlington Ambulance Service may disclose protected health information to authorized federal officials so they may provide protection to the President or other authorized individuals.

Oregon law generally does not permit this type of disclosure without written consent, or unless otherwise required by federal law.

Part III - Patients’ Rights With Respect to Protected Health Information

You have the right to inspect and to request a copy of information maintained in Arlington Ambulance Service’s records about you. This includes medical and billing records maintained and used by Arlington Ambulance Service to make decisions about your care. In certain situations, where providing access may be detrimental to your health, Arlington Ambulance Service is permitted by state and federal law to withhold access.

To obtain or inspect a copy of your medical information, submit a written request to the Privacy Officer at Arlington Ambulance Service. Arlington Ambulance Service may charge a reasonable, cost-based fee to cover the expense of providing the copies.

Most patients have full access to inspect and receive a copy of the full medical record. On rare occasions, Arlington Ambulance Service may deny a request to inspect and receive a copy of some information in the medical record. This may occur if, in the professional judgment of your physician, the information could cause a threat to you or others. In these cases, Arlington Ambulance Service may supply the information to an appropriate third party who may then release the information to the patient.

If you are denied access to information, you may request a review of the denial. Another health-care professional who was not involved in the original decision within Arlington Ambulance Service will independently review both the original request and denial. Arlington Ambulance Service will comply with the outcome of the independent review. Contact the Privacy Officer at Arlington Ambulance Service for more information.

Right to request amendment

You have the right to request that protected health information or information in Arlington Ambulance Service’s record be amended. To request an amendment, submit a written request to the Privacy Officer at Arlington Ambulance Service. The request must include a reason to support the amendment. Arlington Ambulance Service may deny a request for amendment based upon any of the following circumstances:

• The request is not in writing or does not include a supporting reason;
• The information you want to change was not created by Arlington Ambulance Service, and the originator of the information is available to make the amendment;
• The information is not part of the designated medical record; or
• The information in the record is accurate and complete

If Arlington Ambulance Service denies your request for an amendment, Arlington Ambulance Service will give you a written explanation of the denial. If you still disagree with the explanation provided, you can submit your written disagreement to the privacy officer at Arlington Ambulance Service, or you can ask that your request for amendment and explanation of the denial be included in any future disclosure of the pertinent protected health information. If you submit a statement of disagreement, Arlington Ambulance Service may write a rebuttal to your statement of disagreement that will be included in your record.

Right to a list of certain disclosures

You can ask Arlington Ambulance Service for a list of where Arlington Ambulance Service has shared your protected health information. This list would provide you with a summary of all disclosures Arlington Ambulance Service has made that you would not otherwise expect or know about. The list would not include any of the following disclosures:

You can ask Arlington Ambulance Service to restrict the use or disclosure of protected health information about you. Your request must be in writing and submitted to the Privacy Officer at Arlington Ambulance Service.

Arlington Ambulance Service will carefully consider all request. However, because of the integrated nature of Arlington Ambulance Service’s medical record, Arlington Ambulance Service is not generally able to honor most requests, nor is Arlington Ambulance Service legally required to do so.

You have a right to request that Arlington Ambulance Service communicate with you in various ways (such as a letter or phone) or at a certain location. For example, you may ask that contact occur only at home or only at your place of business. In this situation, you may submit a written request to the Privacy Officer at Arlington Ambulance Service specifying the communication method or alternate location being requested.

Arlington Ambulance Service will accommodate reasonable requests. However, if the request could result in Arlington Ambulance Service not being able to collect for services, Arlington Ambulance Service reserves the right to require you to provide additional information about how payment for services will be handled.

Complaints

Arlington Ambulance Service honors your right to file a concern or complaint. Arlington Ambulance Service would not—nor could it legally or ethically—take action against you for filing a concern or complaint. Arlington Ambulance Service reserves the right, however, to take necessary and appropriate action to maintain an environment that serves the best interests of its patients and providers.

For more information about any of Arlington Ambulance Service’s privacy practices, contact the privacy officer at Arlington Ambulance Service.

Authorization is your signed, written permission, specific to a narrow, defined purpose—such as for a medical research authorization. You may be asked to sign the same authorization form each year, if required by state law. You may revoke your authorization in writing at any time.