Use and Disclosure of PHI without your authorization:

• For the treatment, payment or health care provider who treats you;
• For health care and legal compliance activities;
• To a family member, other relative or close personal friend or other individual involved in you care if we obtain a verbal agreement to do so or if we give you an opportunity 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 this disclosure is not to your best interest.
• To public authorities in certain situations as required by law (such as to report abuse, neglect, or domestic violence).
• For health oversight activities including audits, government investigations, inspections, disciplinary proceedings, and other administrative judicial actions undertaken by government (or their contractors) by law to oversee the health care system;
• For judicial and administrate proceedings as required by a court or administrative orders, or in some cases in response to subpoena or other legal process;
• For law enforcement activities in limited situations, such as when responding to a warrant;
• For military, national defense and other special governmental functions;
• To avert a serious threat to the health and safety of a person or the public at large

• For workers compensation purposes;
• To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of death, or carrying their duties as authorized by law;
• If you are an organ donor, we may release health care information to organizations that handle organ procurement, or organ and tissue transplantation;
• For research projects, but this will be subject to strict oversight and approvals,
• We may also disclose health information about you in a way that does not personally identify you;
• Any other use of disclosure of PHI, other then those listed above will only be made with your 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 the authorization.

Patient Rights:

• The Right to Access, Copy or Inspect your PHI. 

This means you may inspect and copy most of the medical information about you that we maintain. We will normally provide you with access to this information within 30 days of your request. We may also charge you a reasonable fee for us to copy any medical information that you have the right to access. In limited circumstances, we may deny you access to your medical information, and you may appeal certain types of denials. We have available forms to request access to your PHI and we will provide a written response if we deny you access and advise you of your rights to appeal. You also have the right to receive confidential communications of your PHI. If you wish to inspect and copy your medical information, you should contact our privacy officer.

You have the right to ask us to amend written medical information that we may have about you. We will generally amend your information within 60 days of your request and will notify you when we have amended the information. We are permitted by law to deny your request for medical information only in certain circumstances, when we believe the information you have asked us to amend is correct. If you wish to amend medial information that we have, you should contact our privacy officer.

• The Right to Request an Accounting.

You may request an accounting from us of certain disclosures of your medical information that we have made in the six years prior to the date of your request. We are not required to five you an accounting of information we have used or disclosed for purpose of treatment, payment of your health care operations, or when we share your health information with our business associates. i.e. billing companies or medical facility we have transported you to. We are also not required to give you an accounting of our uses of protected health information for which you have already given us written authorization. If you wish to request an accounting , contact our privacy officer.

• The Right to Request That We Restrict the Use and Disclosures of your PHI.

You have the right to request that we restrict how we use and disclose your information that we maintain. Converse EMS is not required to agree to any restrictions you request, but any restrictions agreed to by Converse EMS in writing are binding on Converse EMS.

• Right to Obtain Copy of Paper Notice on Request..

If you allow us, we will also forward you this Notice by mail, or fax, and you may also request an additional copy in our office.

• For Treatment:

This includes such things as obtaining verbal and 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 provide treatment to you. We may give your PHI to other health care providers involved in your treatment, and my transfer your PHI via radio or telephone to the hospital or dispatch center.

• For Payment:

This includes any activities we must undertake in order to get reimbursed for the service we provide you, including such things as submitting bills to the insurance companies, making medical necessity determinations and collecting outstanding accounts.

• For Health Care Operations:

This includes quality assurance activities, licensing, and training programs to ensure that our standards of care follow established policies and procedures, as well as certain other management functions.

Privacy Officer Contact Information:

Converse Fire/ EMS
107 Station Street
Converse, Texas 78109

Phone: 210-658-8900
Fax: 210-658-2222

Effective Date of this Notice: April 14, 2003