When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
Ask us to correct your medical record.
Request confidential communications
Ask us to limit what we use or share
Get a list of those with whom we’ve shared information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you feel your rights are violated
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases,you have both the right and choice to tell us to:
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
In the case of fundraising:
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
Example: We use health information about you to manage your treatment and services.
Bill for your services
Example: We give information about you to your health insurance plan so it will pay for your services.
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
Respond to organ and tissue donation requests.
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
Address workers’compensation, lawenforcement, and othergovernment requests
We can use or share health information about you:
Respond to lawsuits and legal actions
Note: Campion Ambulance Service does not create or maintain a hospital directory and does not create or maintain psychotherapy notes.
We are required by law to maintain the privacy and security of your protected health information.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
This notice is effective as of 10/17/2016.
To contact us with regard to this notice or your privacy, please contact our privacy officer below.
Campion Ambulance Service, Inc.
15 West Dover Street
Waterbury, CT 06706
(203) 753-5055 ext. 222
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