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.
Who must follow this notice:
Westside Ambulance Association, Inc. (“Westside Ambulance”) is required by the Health Insurance Portability and Accountability Act (“HIPAA”) to maintain the privacy of your protected health information (“PHI”). We are also required by law to provide you with the attached detailed Notice of Privacy Practices (“Notice”) explaining our legal duties and privacy practices with respect to your PHI.
Uses and Disclosures for Treatment, Payment or Healthcare Operations
Westside Ambulance may use or disclose your PHI without your authorization, for the following purposes:
Other Uses and Disclosure of Your PHI We Can Make Without Authorization
Westside Ambulance is also permitted to use or disclose your PHI without your written authorization the following situations:
Uses and Disclosures of Your PHI That Require Your Written Authorization
Any other use or disclosure of PHI, other than those listed above, will only be made with your written authorization. You make revoke this authorization at any time by contacting us. Specifically, we must obtain your written authorization before using or disclosing your: (a) psychotherapy notes, other than for the purpose of carrying out our own treatment, payment or health care operations purposes, (b) PHI for marketing when we receive payment to make a marketing communication; or (c) PHI when engaging in a sale of your PHI.
Your Rights Regarding Your PHI
As a patient, you have a number of rights with respect to your PHI, including:
Right to access, copy or inspect your PHI
You have the right to inspect and obtain a paper or electronic copy of most of the PHI that we collect and maintain about you. You also have the right to request that we transmit your PHI to a third party. Requests for access to your PHI or to transmit your PHI to a third party should be made in writing to our Privacy Officer, and by filling out an access request form.
Right to request an amendment of your PHI
You have the right to ask us to amend PHI that we maintain about you. Requests for amendments to your PHI should be made in writing and you should contact our Privacy Officer if you wish to make a request for amendment.
Right to request an accounting of certain disclosures of your PHI
You may request an accounting of certain disclosures of your PHI. Westside Ambulance will provide an accounting of those disclosures that we are required to account for under HIPAA. If you wish to request an accounting of disclosures of your PHI that are subject to the accounting requirement, you should contact, our Privacy Officer and make a request in writing.
Right to request restrictions on uses and disclosures of your PHI
You have the right to request that we restrict how we use and disclose your PHI for treatment, payment or healthcare operations purposes, or to restrict the information that is provided to family, friends and other individuals involved in your healthcare. However, we are only required to abide by a requested restriction under limited circumstances, and it is generally our policy that we will not agree to any restrictions unless required by law to do so. If you wish to request a restriction on the use or disclosure of your PHI, you should contact our Privacy Officer and make a request in writing.
Right to notice of a breach of unsecured PHI
If we discover that there has been a breach of your unsecured PHI, we will notify you about that breach by first-class mail dispatched to the most recent address that we have on file. If you prefer to be notified about breaches by electronic mail, please contact our Privacy Officer, to make Westside Ambulance aware of this preference and to provide a valid email address to send the electronic notice.
Right to request confidential communications
You have the right to request that we send your PHI to an alternate location (e.g., somewhere other than your home address) or in a specific manner (e.g., by email rather than regular mail). If you wish to request that we communicate PHI to a specific location or in a specific format, you should contact our Privacy Officer and make a request in writing.
Internet, Email and the Right to Obtain Copy of Paper Notice
We maintain a web site and will prominently post a copy of this Notice on our web site and make the Notice available electronically through the web site. If you allow us, we will provide our Notice of Privacy Practices to you electronically instead of on paper. You may always request a paper copy of our Notice.
Revisions to the Notice
Westside Ambulance is required to abide by the terms of the version of this Notice currently in effect. However, Westside Ambulance reserves the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all PHI that we maintain. Any material changes to the Notice will be promptly posted in our facilities and on our web site, if we maintain one. You can get a copy of the latest version of this Notice by contacting our Privacy Officer.
Your Legal Rights and Complaints
You also have the right to complain to us, or to the Secretary of the United States Department of Health and Human Services, if you believe that your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with us or to the government. If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact:
Privacy Officer
Westside Ambulance Association
604 4th Street
Orland, CA 95963
Office number: (530) 865-3998
E-mail: westsideALS@gmail.com
Effective Date of the Notice: February 28, 2024
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