Notice of Privacy Practices

Effective: April 14, 2003

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.

Privacy Promise

Eagle Air Med (EAM) understands that your medical and health information is personal. Protecting your health information is important. We follow strict federal and state laws that require us to maintain the confidentiality of your health information.

How We Use Your Health Information

When you receive care from EAM, we may use your health information for treating you, billing for services, and conducting our normal business (known as “health care operations”). Examples of how we use your information include:

Treatment:
We keep records of the care and services provided to you. Health care providers use these records to deliver quality of care to meet your needs. Some health records, including some confidential communications with a mental health professional, some substance abuse treatment records, and some health information of minors, may have additional restrictions for use and disclosure under state and federal laws.

Payment:
We keep billing records that include payment information and documentation of the services provided to you. Your information may be used to obtain payment from you, your insurance company, or other third party. We may also contact your insurance company to verify coverage for your care or to notify them of upcoming services that may need prior notice or approval.

Health Care Operations:
We use health information to improve the quality of care, train staff, provide customer service, conduct required business duties, marketing, research, or other activities Eagle Air Med deems appropriate. We may also share information with third parties who assist us with treatment, payment, and health care operations. Our business associates must protect your information by following our privacy practices. At times, when appropriate we may share information with family or friends involved in your care or payment for your care.

Sharing Your
Health Information

There are limited situations when we are permitted or required to disclose health information without your signed authorization.
These situations are:
• For public health purposes such as reporting communicable diseases, work-related illnesses, or other diseases and injuries permitted by law; reporting births and deaths; and reporting reactions to drugs and problems with medical devices.
• To protect victims of abuse, neglect, or domestic violence.
• For health oversight activities such as investigations, audits, and inspections.
• For lawsuits and similar proceedings.
• When requested by law enforcement as required by law or court order.
• To medical examiners, coroners, or funeral directors.
• For research approved by our review process under strict federal guidelines.
• To reduce or prevent a serious threat to public health and safety.
• For workers’ compensation or other similar programs if you are injured at work.
• For specialized government functions such as intelligence and national security.
• We may also use or disclose health information about you in a way that does not personally identify you or reveal who you are.

All other uses and disclosures, not described in this notice, require your signed 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.

Our Privacy Responsibilities

EAM is required by law to:
• Maintain the privacy of your health information.
• Provide this notice that describes the ways we may use and share your health information.
• Follow the terms of the notice currently in effect.
We reserve the right to make changes to this notice at any time and make the new privacy practices effective for all information we maintain. Any material changes will be posted in our corporate offices. You can obtain a copy of the latest version of this notice by contacting EAM.

Your Individual Rights

You have the right to:
• Request restrictions on certain uses and disclosures of protected health information. EAM is not required to agree to any restrictions you request.
• Request that we use a specific telephone number or address to communicate with you.
• Inspect and copy your health information, including medical and billing records, upon written request. Fees may apply.
• Request corrections or additions to your health information in writing.
• Request an accounting of certain disclosures of your health information that we have made in the six years prior to the date of your request. We are not required to give you an accounting of information made for treatment, payment, and normal health care operations, or when we share your health information with our business associates like our billing company or a medical facility. We are also not required to give you an accounting of our uses of PHI for which you have already given us written authorization. (limited to disclosures made on or after April 14, 2003) Requests must be made in writing.
• Request a paper copy of this notice even if you agree to receive it electronically.

Our Organization

This notice describes the privacy practices of EAM. We reasonably safeguard protected health information to limit incidental uses or disclosures.

COMPLAINTS: Individuals may send a complaint to EAM, without fear of retaliation by the organization, if they feel their privacy rights have been violated. Please send your complaint in writing to: Eagle Air Med, P.O. Box 305, Blanding, UT 84511, or call us at (435) 678-3222. You may also file a written complaint with the Office of Civil Rights of the U.S. Department of Health and Human Services.

We may elect to limit the uses or disclosures of protected health information by releasing only that part necessary to fill each legitimate request or obligation.