THIS NOTICE DESCRIBES HOW SCITUATE AMBULANCE AND RESCUE CORPS MAY USE AND DISCLOSE YOUR HEALTHCARE INFORMATION AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We are required by law to protect the privacy of your health information and to provide you with a copy of this notice, which describes the health information privacy practices of our ambulance service. We reserve the right to change the terms of this Notice and to make any new provisions effective for all protected health information that we maintain. An individual may obtain a copy of the current Notice from our office at any time.

USES AND DISCLOSURES

Scituate Ambulance and Rescue Corps may use and disclose your protected health information, without your written consent or authorization, to provide you with treatment, bill and/or collect payments for service, report communicable disease, criminal activity and to support our business functions. There are certain restrictions on uses and disclosures of treatment records, which include services for mental illness, developmental disabilities, alcoholism, HIV or drug dependence.

The following categories describe and give examples of different ways we are permitted or required to us and disclose your protected health information:

Payments: We may use and disclose information for services delivered to you that are to be considered for coverage by your health plan, to determine your eligibility for benefits, or to issue explanations of benefits to the health plan you participate.

Health Care Operations: We use and disclose your protected health information to support the operations of our organization. For example, to evaluate the performance or our staff. We may disclose information to hospital personnel or other covered entity.

For Treatment: We use your protected health information to provide, coordinate and manage your healthcare and may include transfer of PHI by radio, telephone, cellular or written record. This will include disclosing protected health information about you to doctors, nurses, technicians or other healthcare professionals who care for you.

Your Family and Friends: We may disclose your protected health information to family member, other relative, or close personal friend or other individual involved in your care if we obtain your 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 the disclosure is in your best interest. Health information may be released without written permission to a parent, guardian, or legal custodian of a child, the guardian of an incompetent adult, the healthcare agent designated in an incapacitated patient/s healthcare power of attorney or the personal representative or spouse of a deceased patient.

Business Associates: We may disclose your protected health information to business associates who provide services or activities on our behalf such as billing and collection services and accountants.

As Required by Law: We disclose protected health information about you when required to do so by federal, state or local law and to local law enforcement officials in certain cases. To prevent a serious and imminent threat to your health and safety and that of the public.

Process and Proceedings: We may disclose your personal health information in response to a court order or administrative order, subpoena, or other lawful process.

Workers Compensation: We may disclose your personal health information to comply with workers compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.

Secretary of DHHS: We are required to disclose your personal health information to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA Privacy Regulations.

Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we will release your protected health information as permitted under Rhode Island law.

Questions of Capacity to Consent: In situations where you lack capacity to consent, we may use and disclose your protected health information as permitted by applicable state law.

As permitted by law we may also disclose protected health information about you for:

Victims of Abuse, Neglect or Domestic Violence, National Security, Legal Proceedings, Coroners, Medical Examiners and Funeral Directors.

YOUR RIGHTS REGARDING YOUR PROTETCTED HEALTH INFORMATION

You are permitted to request that restrictions be placed on certain uses or disclosures of your protected health information by Scituate Ambulance and Rescue Corps. to carry out treatment, payment or healthcare operations. You must request such a restriction in writing. We are not required to agree, except when your protected health information is needed in an emergency treatment situation. In this event, information may be disclosed only to healthcare providers treating you. Also, a restriction would not apply when we are required by law to disclose certain healthcare information.

You have the right to review and/or obtain a copy of you healthcare records, with the exception of information compiled for use in a civil, criminal, or administrative action or proceeding. Scituate Ambulance and Rescue Corps may deny an access under other circumstances, in which case you have the right to have such a denial reviewed.

You may request that Scituate Ambulance and Rescue Corps send protected health information, including billing information, to you by alternative means or to alternative locations. You may also request that Scituate Ambulance and Rescue Corps not send information to a particular address or location or contact you at a specific location, perhaps your place of employment. This request must be submitted in writing.

You have the right to request that Scituate Ambulance and Rescue Corps amend portions of your healthcare records, as long as such information is maintained by us. You must submit this request in writing, and under certain circumstances the request may be denied.

You may request to receive an accounting of the disclosures of your protected health information made by Scituate Ambulance and Rescue Corps for the six years prior to the date of request, beginning with disclosures made after April 14, 2003. We are not required, to record disclosures we make pursuant to a signed consent or authorization.

You may request and receive a paper copy of this Notice, if you had previously received or agreed to receive the Notice electronically.

Any person or patient may file a complaint with Scituate Ambulance and Rescue Corps and/or the Secretary of Health and Human Services if they believe their privacy rights have been violated. To file a complaint with Scituate Ambulance and Rescue Corps , please contact the Privacy Officer at the following address:

Privacy Officer

Scituate Ambulance And Rescue Corps

P.O. Box 333

N. Scituate, RI 02857