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PRIVACY PRACTICES
NORTH CENTRAL EMS
NCEMS Privacy Practices
NORWALK AREA HEALTH SYSTEMS NOTICE OF PRIVACY PRACTICES

  1. THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS YOUR MEDICAL INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices applies to Norwalk Area Health Systems operating as a clinically integrated health care arrangement composed of: Fisher-Titus Medical Center including Fisher-Titus Memorial Hospital and Norwalk Memorial Home; Norwalk Area Health Services, d.b.a. North Central EMS; The Carriage House of Fisher-Titus Medical Center; Fisher-Titus Medical Center Home Health Center; Fisher-Titus Foundation; and the independent Members of the Fisher-Titus Medical Center Medical Staff and other licensed professionals seeing and treating patients at Fisher-Titus Medical Center. The members of this clinically integrated health care arrangement work and practice at the above-named entities. All of the entities and persons listed will share personal health information of our patients as necessary to carry out treatment, payment, and health care operations as permitted by law.
  1. WE HAVE A LEGAL DUTY TO PROTECT YOUR PERSONAL HEALTH INFORMATION
We are required by law to maintain the privacy of our patient’s personal health information and to provide patients with notice of our legal duties and privacy practices with respect to your personal health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary to make the new Notice effective for all personal health information maintained by us. You may receive a copy of any revised notices at the North Central EMS Milan, Ohio station or a copy may be obtained by mailing a request to Privacy Officer, North Central EMS, 12513 US. Rt. 250 North, Milan, Ohio 44846. You can also view a copy of this Notice on our web site at www.northcentralems.com.

  1. HOW WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION

  1. USE AND DISCLOSURE THAT DOES NOT REQUIRE YOUR AUTHORIZATION
  2. Uses and Disclosures for Treatment. We will make uses and disclosures of your personal health information as necessary for your treatment. For instance, paramedics, EMTs and others involved in your care, will use information in your medical record and that you provide to plan and care for you. We also may release your personal health information to another health care facility or professional who is not affiliated with our organization, but who is or will be providing treatment to you. For instance, emergency room personnel.

  1. Uses and Disclosures for Payment. We will make uses and disclosures of your personal health information as necessary for the payment of pre-hospital care and emergency/non-emergency ambulance transportation or wheelchair van services. For example, we may give information to our billing department and to your health plan or to you or the person responsible for your payment to get paid for the services we provided to you. We may give your information to our business associates, such as billing companies, claims processing companies, law firms, collection agencies, and others that process our health care claims. We may also give your information to another health care provider who has treated you for their payment purposes.

  1. Uses and Disclosures for Health Care Operations. We will use and disclose your personal health information as necessary and as permitted by law, for our health care operations. These include quality improvement/assurance, critical incident debriefing, accrediting, licensing, business management, etc. We may provide information about you to our accountants, attorneys, consultants and others in order to make sure we are complying with laws that affect us. We may also disclose your information to another health care facility, health care professional or health plan for their health care operations if they have or had a patient relationship with you.

  1. Uses and Disclosures Permitted or Required by Law
  2. For Public Health Activities. For example, we may release your personal health information about deaths and various diseases to government officials in charge of collecting that information, and we give coroners, medical examiners and funeral directors necessary information relating to a death.

  1. When Required by Federal, State or Local Law, Judicial or Administrative Proceedings or Law Enforcement. We may release your personal health information for any purpose required by law. For example, we may release your information when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect or domestic violence; when dealing with gunshot and other wounds; or when ordered by the court.

  1. For Health Oversight Activities. For example, we will provide information to assist the government when it conducts an audit, investigation inspection or civil or criminal proceeding regarding a health care provider or organization. We may release your personal health information to the Food and Drug Administration if necessary to report adverse events, product defects or to participate in product recalls.

  1. To Avoid Harm. In order to avoid a serious threat to the health or safety of a person or the public, we may give your information to law enforcement personnel or person able to prevent or lessen such harm.

  1. For Employee Health and Workers’ Compensation Purposes. We may release your personal health information to your employer when we have provided health care at your employer’s request to determine workplace-related illness or injury. In most cases you will receive notice that the information is disclosed to your employer. We may release information in order to comply with workers’ compensation laws.

  1. Legal Actions. We may release your personal health information if required to do so by subpoena or discovery request. In some cases, you will have notice of such release.

  1. Business Associates. Certain aspects of our services are performed through contracts with outside people or organizations such as auditing, accreditation, legal services, satisfaction surveys, etc. At times it may be necessary for us to provide your information to one or more of these outside people or organizations who assist us with our health care operations.

  1. Fundraising. We may contact you to raise funds for our organization. The money raised through these activities is used to expand and support the health care services and educational programs we provide to the community. If you do not wish to be contacted as part of our fundraising efforts please contact the person listed in Section VII. below.

  1. Appointments and Services. We may contact you to provide appointment reminders.

  1. Health Products and Services. We may from time to time use your personal health information to communicate with you about services we provide.

  1. YOU HAVE THE OPPORTUNITY TO OBJECT TO THESE DISCLOSURES
  2. Disclosures to family, friends or others. We may provide your information to a family member, friend, or other person that you indicate is involved in you care or the payment for your health care, unless you object and fill out the appropriate form.

  1. YOUR HEALTH INFORMATION RIGHTS
  2. The Right to Request Limits on How We Use and Disclose Your Health Information. You have the right to ask that we limit certain uses and disclosures of your information for treatment, payment or health care operations. A restriction request form can be obtained from the Privacy Officer. We will carefully consider your request. We are not required to agree to your restriction request, but will attempt to accommodate reasonable requests when appropriate. We retain the right to terminate an agreed to restriction if we believe such termination is appropriate. If we terminate, we will notify you. You have the right to terminate in writing or orally, any agreed to restriction by contacting the Privacy Officer at North Central EMS, 12513 US Rt. 250 North, Milan, Ohio 44846.

  1. The Right to Correct or Update Your Health Information. You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments, but will carefully consider each. All amendment requests must be in writing, signed by you or your representative, and must state the reasons for the amendment. If an amendment you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. You may obtain an amendment request form from the Privacy Officer at North Central EMS, 12513 US Rt. 250 North, Milan, Ohio 44846.

  1. The Right to Access Your Personal Health Information. You have the right to copy and/or inspect much of the personal health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your representative. We will charge $10.00 for the first ten pages, $.50 per page 11-50, and $.20 per page 51 and over. You may obtain an access request form from the Office Manager at North Central EMS, 12513 US Rt. 250 North, Milan, Ohio 44846.

  1. The Right to Accounting for Disclosures of Your Health Information. You have the right to receive an accounting of certain disclosures made by us of your personal health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from the Office Manager at North Central EMS, 12513 US Rt. 250 North, Milan, Ohio 44846. The first accounting in any 12-month period is free; you will be charged a fee of $10.00 for each subsequent accounting you request within the same twelve-month period.

  1. The Right to Choose How We Send Your Information to You. You have the right to ask that we send information to an alternate address. For example, you may ask us to send information to your work address rather than your home address. You can also ask that it be sent by alternate means. For example, you can ask that we send information by fax instead of regular mail. We will agree to your request if we can easily provide it in the format you request.

  1. The Right to Get This Notice. You will be asked to acknowledge that you have received this Notice of Privacy Practices. You have the right to request a paper copy of this notice. You also have a right to get a copy of this notice by e-mail.

  1. CHANGES TO THE POLICY
If our privacy policy should change at any time in the future, we will change and post the new notice.

  1. COMPLAINTS
If you believe that your privacy rights have been violated, you can file a compliant with the person listed in Section VII below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights. There will be no action taken against you if you file a complaint about our privacy practices.

  1. FOR FURTHER INFORMATION
If you have any questions or need further assistance regarding this Notice, you may contact the Privacy Officer, North Central EMS, 12513 US Rt. 250 North, Milan, Ohio 44846, at 419/663-1367.

  1. EFFECTIVE DATE OF THIS NOTICE
This notice went into effect April 14, 2003.