Ø Right to Inspect and Copy Your Health Information. You may request access to your
medical record file and billing records maintained by us in order to inspect and
request copies of the records. Under limited circumstances, we may deny you access
to a portion of your records. We will comply with the law if the physician says that
review of any record would be harmful to your best interest. For example, we may
withhold certain portions of a psychiatric record if the physician or psychologist
believes that such review of the complete record would be harmful to your best interest.
If you desire access to your medical records, please obtain a record request form
from our office and submit the completed form to us. We may charge you a reasonable
copying fee in accordance with Virginia State law.
You should take note that if you are a parent or legal guardian of a minor, certain
portions of the minor’s medical record will not be accessible to you (for example,
records relating to pregnancy, sexually transmitted diseases, substance use or abuse,
and/or fertility awareness services).
Ø Right to Amend Your Records. You have the right to request that we amend PHI maintained
in your medical record or billing records. If you desire to amend your records, please
obtain an amendment request form from our offices and submit the completed form to
us. We will comply with your request unless we believe that the information that
would be amended is accurate and complete or other special circumstances apply, or
unless you are requesting us to amend PHI that we maintain, but that we have not
authored (i.e., another provider’s records “incorporated” into your record here).
We will respond to your request to amend your records within thirty (30) days of
receiving the request. We are not required to amend incorporated records, such as
records received from another health care facility or provider.
Ø Right to Receive an Accounting of Disclosures. Upon request, you may obtain an
accounting of certain disclosures of your PHI made by us during any period of time
prior to the date of your request provided such period does not exceed six years
and does not apply to disclosures that occurred prior to January 1, 2007. If you
request an accounting more than once during a twelve (12) month period, we will charge
you a reasonable amount for the accounting statement. We will respond to your request
for an accounting within thirty (30) days of receiving the request.
Ø Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper
copy of this Notice, even if you have agreed to receive such notice electronically.
In an emergency situation, we will send you the notice as soon as possible after
the emergency (usually, by mail).
EFFECTIVE DATE and DURATION of THIS NOTICE
Ø Effective Date. This Notice is effective on January 1, 2010.
Ø Right to Change Terms of this Notice. We may change the terms of this Notice at
any time. If we change this Notice, we may make the new notice terms effective for
all Protected Health Information that we maintain, including any information created
or received prior to issuing this new notice. If we change this Notice, we will post
the new notice in a clear and prominent location where it is reasonable to expect
individuals seeking service from us to be able to read the notice, and on our Internet
site at www.paladintransport.org. We will not post this notice in our ambulances,
as it would be unreasonable to do so, due to space limitations. You also may obtain
any new notice by contacting the Privacy Office.
Ø For Further Information: Complaints. If you desire further information about your
privacy rights, are concerned that we have violated your privacy rights or disagree
with a decision that we made about access to your PHI, you may contact our Privacy
Office. You may also file written complaints with the Director, Office of Civil Rights
of the U.S. Department of Health and Human Services. Upon request, the Privacy Office
will provide you with the correct address for the Director.
WE WILL NOT RETALIATE AGAINST YOU IF YOU FILE A COMPLAINT WITH US OR THE DIRECTOR.
You may contact the Privacy Officer or the Assistant Privacy Officer at: