TCLS Privacy Practices

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.

Trinity County Life Support (TCLS) is required by law to maintain the privacy of certain confidential health care information, known as Protected Health Information or PHI, and to provide you with a notice of our legal duties and privacy practices with respect to your PHI. This notice describes your legal rights, advises you of our privacy practices, and lets you know how TCLS is permitted to use and disclose your protected health information.

Treatment. TCLS may disclose PHI for the purpose of treatment. This includes verbal and written information that we obtain and use during the course of your medical treatment. This information may be shared with doctors, nurses and other health care personnel to whom we transfer your care and treatment, and includes transfer of such information via radio or telephone to the hospital or dispatch center. The receiving hospital is also provided a written patient care report.

Payment. TCLS may disclose PHI for the purpose of payment. This includes any activities we must undertake in order to get reimbursed for the services we provide to you, including submitting bills to insurance companies, management of billed claims for services rendered, medical necessity determinations and reviews, utilization review, and collection of outstanding accounts.

Health Care Operations. TCLS may disclose PHI for the purpose of operations. This includes quality assurance activities, licensing, and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures.

TCLS is permitted by law to use your PHI without your written authorization in specific situations:

For treatment, payment and operations functions as described above;
For the detection of health care fraud and abuse detection or for activities related to compliance with the law;
To a public health authority in certain situations, such as reporting a birth, death or reportable disease, as part of a public health investigation, to report child or adult abuse or neglect or domestic violence, to report adverse events such as product defects, or to notify a person about exposure to a possible communicable disease as required by law;
For health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and other administrative or judicial actions undertaken by government to oversee the health care system;
For judicial and administrative proceedings as required by a court or administrative order, or in some cases in response to a subpoena or other legal process;
For law enforcement activities in limited situations, such as when there is a warrant for the request, or when the information is needed to locate a suspect or stop a crime;
For military, national defense and security and other special government functions;
To avert a serious threat to the health and safety of a person or the public at large;
For workers’ compensation purposes, and in compliance with workers’ compensation laws;
To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of death, or carrying on their duties as authorized by law;
If you are an organ donor we may release information as necessary to facilitate organ donation and transplantation;
To a family member, close friend, or other individual involved in your care if we infer from the circumstances that you would not object. For example, we may assume you agree to our disclosure of health information to your spouse when your spouse has called the ambulance for you. In situations where you are not capable of objecting we may determine that a brief update on your symptoms and treatment to your family, friend or caregiver is appropriate.

Any other use or disclosure of PHI will only be made with your written authorization. You may revoke such authorization at any time, in writing, except to the extent that we have already used or disclosed PHI in reliance on that authorization.

PATIENT RIGHTS

As a patient, you have a number of rights with respect to the protection of your protected health information.

Access. You have the right to access, copy, or inspect your PHI, by making a written request. We will normally provide you with access to this information within 30 days of your request. We may also charge you a reasonable copying fee. In limited circumstances, a request for access may be denied, and you may appeal certain types of denials. Request for Access forms are available at our office, and we will provide a written response if access is denied, notifying you of your appeal rights. If you wish to inspect and copy your medical information, please contact the privacy officer listed at the end of this notice.

Amend. You have the right to request amendment to medical information in your patient care record, by making a written request. We are permitted by law to deny the request in certain circumstances. We will act upon the request within 60 days of your request and will notify you when we have amended the information or provide explanation of circumstances for denial. If you wish to amend your medical information, please contact the privacy officer listed at the end of this notice.

Accounting. You have the right to an accounting of uses and disclosures made of your PHI in the last six years. We are not required to account for disclosures made for the purpose of treatment, payment or health care operations, or for which you have already given written authorization. This accounting would apply for non-routine disclosures such as subpoenas. We will respond to your request within 60 days of the written request. If you wish an accounting of this type, please contact the privacy officer listed at the end of this notice.

Restrict Uses and Disclosures. You have the right to request that we restrict how we use and disclose your medical information related to treatment, payment and operations, or to restrict the information that is provided to family and other individuals that are involved in your health care. If the information you wish to restrict is needed to provide you with emergency treatment, we may use or disclose the PHI to provide emergency treatment. TCLS is not required to agree to a requested restriction.

Recourse. You have the right to complain to us, or to the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated. Individuals will not be retaliated against in any way for filing a complaint. Should you have any questions, comments, or complaints you may direct your inquires to the privacy officer listed at the end of this Notice.

TCLS reserves the right to revise the terms of this Notice at any time. Changes will be effective immediately and will apply to all protected health information. Any material changes to the Notice will be promptly posted in our facilities and on our web site at http://www.tcls.org. You may request a paper copy of the Notice at any time.

If you have any questions, wish to exercise any of the rights listed in this Notice, or have a complaint, please contact:

Kathy Ratliff, Privacy Officer, or

Vickie Van Denover, Billing / Privacy Officer

Trinity County Life Support

314 North Main Street

P.O. Box 2907

Weaverville, CA 96093

(530) 623-2500

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