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• Terms of Use
• Privacy Practices

 

 

 

Privacy Policy

NOTICE OF PRIVACY PRACTICES

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, sign the attached acknowledgment form, and give the acknowledgement to Gilpin Ambulance Authority personnel. Retain the first two pages for your records.

Gilpin Ambulance Authority is required by law to protect the privacy of your confidential health information.  This notice describes your rights, our legal duties, and how Gilpin Ambulance Authority might use and disclose information about you.  In most situations we can use your health information without your permission but in some situations we cannot give the information to another without your written authorization.

Gilpin Ambulance Authority’s Uses and Disclosures of your “Protected Health Information”

Gilpin Ambulance Authority may use your information for the purposes of treatment, payment, and for health care operations, in most cases without your written permission.  Medical treatment includes a variety of activities, including transportation in our ambulance (if any), sharing information with the facility to which we transport you, and giving information to your doctors and nurses.  Payment activities include anything Gilpin Ambulance Authority must do to get paid for the services we provide you, such as communicating with insurance, billing, and collection agencies, and legal counsel.  ‘Health care operations’ includes any administrative activity that is a necessary part of health care including quality monitoring, licensing, training, financial services, planning, handling complaints, and obtaining legal counsel. 

Gilpin Ambulance Authority may disclose your information to family members or other individuals who are involved in your care if you verbally give us your agreement, if you do not object when asked, or even if, based on the circumstances, we believe that you would not object.  For example, we may assume that you would not object to giving your information to a family member or close personal friend who has called the ambulance for you.  We may also disclose certain information to a relative or friend who we reasonably believe is involved in your medical care, if we believe it is in your best interest.  We may also use or disclose your information when required or permitted by Colorado or Federal laws. For example:

• To detect health care fraud;
• To report a birth or a death;
• As part of a public health investigation;
• To report child or adult abuse or neglect;
• To report domestic violence;
• To assist investigation into dangerous products;
• To inform others about exposure to communicable disease;
• To provide information to a court of law;
• In response to a subpoena or warrant;
• To help locate a suspect, stop a crime, or prevent an accident;
• For national defense;
• For workers’ compensation;
• To assist in identification and cause of death;
• To facilitate organ donation, if you are a donor;
• At any time if the information does not personally identify you or reveal who you are;
• For research purposes if the project meets strict legal requirements designed to protect your privacy.

In circumstances other than those listed above Gilpin Ambulance Authority may not use or disclose your protected health information without your specific written authorization.          

Patient Privacy Rights on Reverse Side

Your Privacy Rights

Your rights regarding your protected health information include the following:

Right to revoke written permission. If you have given Gilpin Ambulance Authority a written authorization to use or disclose your protected health information, you can revoke it in writing except to the extent that we have already used or disclosed the information.

Right to access, copy or inspect your protected health information.  You have the right to request a copy of most of the medical information about you that we have in our files.  We will normally reply to your request within 30 days.  If your request is granted we may charge you a reasonable fee.  If we do not grant your request we will give you a written explanation and information about whether you have the right to appeal the denial.

Right to receive your information confidentially.  You have the right to request that we communicate your protected health information to you confidentially, by alternative means or at alternative locations.

Right to amend your protected health information.  You have the right to amend medical information about you in our files.  This means that if you believe the information in our files is incorrect, you have the right to ask us to change it.  We have the right to deny your request if we believe the information in the file is correct. If we grant your request we will usually make the change within 60 days and will send you a notification that the information has been corrected.

Right to request an accounting of use and disclosure of your protected health information.  You have the right to request a list of the instances when Gilpin Ambulance Authority used or disclosed your health information, up to six years prior to the date of your request.  We are not required to include those instances when we used or disclosed your information for treatment, payment or ‘health care operations’ (described above), or for which you have given us written authorization.

Right to request that we restrict uses and disclosures of your protected health information.  You have the right to request that we restrict our use and disclose of your information.  For example, you can request that we restrict giving information to your family members even if they are otherwise involved in your medical care.  Gilpin Ambulance Authority has the right to deny your request.  If we grant your request we are required to abide by it unless the information is necessary for your emergency medical treatment.

Right to Obtain a Copy of this Notice on Request.  You may always request a copy of this notice, and with your permission we can send it to you via e-mail.

Right to File Complaints:  You have the right to file a complaint with us if you believe your rights have been violated. You also have the right to file a complaint with the Secretary of the Federal Department of Health and Human Services.  You will not be retaliated against for filing a complaint.

If you have any questions about your privacy rights, if you wish to exercise any of the rights described above, or if you wish to file a complaint, please contact: Gilpin Ambulance Authority, Privacy Officer Zane Laubhan, P.O. Box 638, Black Hawk, Colorado, 80422.  (303) 582-5499.

Gilpin Ambulance Authority reserves the right to change the terms of this notice at any time, and is required to abide by the terms of the notice currently in effect.  Changes will be effective immediately and will apply to all protected health information we maintain.  You can get a copy of the latest version of this notice by contacting the Privacy Officer identified above.

Copyright Gilpin Ambulance Authority, 2011