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                                                                           GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.



 As an essential part of our commitment to you, Rotterdam Emergency Medical Services, Inc (“Rotterdam EMS” or “REMS”) maintains the privacy of certain confidential health care  information about you, known as Protected Health Information or PHI.  We are required by law to protect your health care information and to provide you with the attached Notice of  Privacy Practices.

 The Notice outlines our legal duties and privacy practices respect to your PHI.  It not only describes our privacy practice and your legal rights, but lets you know, among other things,  how Rotterdam EMS is permitted to use and disclose PHI about you, how you can access and copy that information, how you may request amendment of that information, and how you  may request restrictions on our use and disclosure of your PHI. 


 Rotterdam EMS is also required to abide by the terms of the version of this Notice currently in effect.  In most situations we may use this information as described in this Notice without  your permission, but there are some situations where we may use it only after we obtain your written authorization, if we are required by law to do so.


 We respect your privacy, and treat all health care information about our patients with care under strict policies of confidentiality that all of our staff is committed to follow at all times.



 Purpose of this Notice: Rotterdam EMS 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.  REMS is also required to abide by the terms of the version of this Notice currently in effect.


 Uses and Disclosures of PHI: Rotterdam EMS may use PHI for the purposes of treatment, payment, and health care operations, in most cases without your written permission.  Examples  of our use of your PHI:


    •    For treatment: This includes such things as verbal and written information about your medical condition and treatment from you as well as from others such as doctors and nurses            who give orders to allow us to provide treatment to you.  We may give your PHI to other health care providers involved in your treatment and may transfer your PHI via radio or                  telephone to the hospital or dispatch center.


    •    For payment: This includes any activities we must undertake in order to get reimbursed for the services we provide to you, including such things as submitting bills to insurance                companies, making medical necessity determinations and collection of outstanding accounts.


    •    For health care 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, as well as certain other management functions.


    •    Reminders for scheduled transports and information on other services: We may also contact you to provide you with a reminder of any scheduled appointments for non-emergency            ambulance and medical transportation, or to provide information about other services we provide.


 Use and Disclosure of PHI Without Your Authorization: REMS is permitted to use PHI without your written authorization, or opportunity to object in certain situations, and unless  prohibited by a more stringent state law, including:


    •    For treatment, payment or health care operations activities of another health care provider who treats you


    •    For health care and legal compliance activities


    •    To a family member, other relative, or close personal friend or other individual involved in your care if we obtain your written 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 interests


    •    To a public health authority in certain situations as required by law (such as to report abuse, neglect or domestic violence)


    •    For health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and other administrative or judicial actions undertaken by the                government (or their contractors) by law 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 health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank,          as necessary to facilitate organ donations and transplantation


    •    For research projects, but this will be subject to strict oversight and approvals and health information will be released only when there is a minimal risk to your privacy and                        adequate safeguards are in place in accordance with the law


    •    We may use or disclose health information about you in a way that does not personally identify you or reveal who you are

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

 Patient Rights: As a patient, you have a number of rights with respect to the protection of your PHI, including:

    •    The right to access, copy or inspect your PHI: This means you may inspect and copy most of the medical information about you that we maintain.  We will normally provide you with  access to this information within 30 days of your request.  We may also charge you a reasonable fee for you to copy any medical information that you have the right to access.  In limited  circumstances, we may deny you access to your medical information, and you may appeal certain denials.  We have available forms to request access to you PHI and we will provide a  written response if we deny you access and let you know your appeal rights.  You also have the right to receive confidential communications of your PHI.  If you wish to inspect and copy  your medical information, you should contact the privacy officer.


    •    The right to amend your PHI: You have the right to ask us to amend written medical information that we may have about you.  We will generally amend your information within 60  days of your request and will notify you when we have amended the information.  We are permitted by law to deny your request to amend your medical information only in certain  circumstances, like when we believe the information you have asked us to amend is correct.  If you wish to request that we amend the medical information that we have about you, you  should contact the privacy officer.


   •    The right to request an accounting: You may request an accounting from us of certain disclosures of your medical information that we have made in the last six years prior to the  date of your request.  We are not required to give you an accounting of information we have used or disclosed for purposes of treatment, payment or health care operations, or when we  share your health information with a medical facility from/to which we have transported you.  We are also not required to give you an accounting of our uses or protected health  information for which you have already given us written authorization.  If you wish to request an accounting, contact the privacy officer.


   •    The right to request that we restrict the uses and disclosures of your PHI: You have the right to request that we restrict how we use and disclose your medical information that we  have about you.  Rotterdam EMS is not required to agree to any restrictions you request, but any restrictions agreed to by Rotterdam EMS are binding on Rotterdam EMS.


   •    Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request: If we maintain a web site, we will prominently post a copy of this Notice on our web site.  If you  allow us, we will forward you this Notice by electronic mail instead of on paper and you may always request a paper copy of the Notice.

 Revision to the Notice: Rotterdam EMS reserves the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all protected  health information that we maintain.  Any material changes to the Notice will be promptly posted in our facilities and posted to our web site, if we maintain one.  You can get a copy of  the  latest version of this Notice by contacting the Privacy Officer identified below.

 Your Legal Right and Complaints: You also have the right to complain to us, or the Secretary of the United States Department of Health and Human Services if you believe your privacy  rights have been violated.  You will not be retaliated against in any way for filing a complaint with us or to the government.  Should you have any questions, comments or complaints you  may direct all inquiries to the privacy officer.


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


 Dean Romano, Chief of Operations

 Privacy Officer

 2007 Cardiff Rd

 Schenectady, NY 12303


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