Privacy Practices

ADVANCED MONITORING SERVICES (AMS)

NOTICE OF PRIVACY PRACTICES

Updated: April 11, 2008

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.

Advanced Monitoring Services (AMS) provides many types of health services. AMS staff must collect information about you to provide these services. AMS knows that information we collect about you and your health is private. AMS is required to protect this information by Federal and State law. We call this information “protected health information” (PHI).

The Notice of Privacy Practices will tell you how AMS may use or disclose information about you. Not all situations will be described. AMS is required to give you a notice of our privacy practices for the information we collect and keep about you. AMS is required to follow the terms of the notice currently in effect.

AMS May Use and Disclose PHI Without Your Authorization

• For Treatment. AMS may use or disclose PHI with health care providers who are involved in your health care. For example, PHI may be shared to create and carry out a plan for your treatment. We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party for treatment purposes. We may also disclose protected health information to physicians who may be treating you or consulting with the facility with respect to your care. In some cases, we may also disclose your protected health information to an outside treatment provider for purposes of the treatment activities of the other provider.

• For Payment. AMS may use or disclose PHI to get payment or to pay for the health care services you receive. For example, AMS may provide PHI to bill your health plan for health care provided to you. This may include certain communications to your health insurance company to get approval for the procedure that we have scheduled. For example, we may need to disclose information to your health insurance company to get prior approval for the surgery. We may also disclose protected health information to your health insurance company to determine whether you are eligible for benefits or whether a particular service is covered under your health plan. In order to get payment for the services we provide to you, we may also need to disclose your protected health information to your health insurance company to demonstrate the medical necessity of the services or, as required by your insurance company, for utilization review. We may also disclose patient information to another provider involved in your care for the other provider’s payment activities. This may include disclosure of demographic information to anesthesia care providers for payment of their services.

• For Health Care Operations. AMS may use or disclose PHI in order to manage its programs and activities. For example, AMS may use PHI to review the quality of services you receive. Health care operations include such activities as: quality assessment and improvement activities, employee review activities, training programs including those in which students, trainees, or practitioners in health care learn under supervision, accreditation, certification, licensing or credentialing activities, review and auditing, including compliance reviews, medical reviews, legal services and maintaining compliance programs, and business management and general administrative activities. In certain situations, we may also disclose PHI to another provider or health plan for their health care operations.

• For Health Oversight Activities. AMS may use or disclose PHI to inspect or investigate health care providers.

• As Required by Law and For Law Enforcement. AMS will use and disclose PHI when required or permitted by federal or state law or by a court order.

• For Abuse Reports and Investigations. AMS is required by law to receive and investigate reports of abuse.

• For Government Programs. AMS may use and disclose PHI for public benefits under other government programs.

• To Avoid Harm. AMS may disclose PHI to law enforcement in order to avoid a serious threat to the health and safety of a person or the public.

• For Research. AMS uses PHI for studies and to develop reports. These reports do not identify specific people.

If you do not object and the situation is not an emergency and disclosure is not otherwise prohibited by stricter laws, AMS is permitted to release your PHI under the following circumstances:

• Individuals Involved in Your Care: AMS may disclose PHI to a family member, relative, or other person(s) whom you have identified to be involved in your health care or the payment of your health care.

• Family: AMS may use your PHI to notify a family member, a personal representative or a person responsible for your care, of your location, general condition or death.

• Disaster Relief Agencies: AMS may release your PHI to an agency authorized by law to assist in disaster relief efforts.

• As Required by Law: If you are involved in a lawsuit or a dispute, AMS may release PHI about you in response to a court or administrative order. We may also release PHI about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

• Coroners, Medical Examiners and Funeral Directors: AMS may release PHI to a coroner, medical examiner or funeral director, as necessary to carry out duties as authorized by law.

• National Security and Protection of the President: AMS may release your heath PHI to an authorized federal official or other authorized persons for purposes of national security, for providing protection to the President, or to conduct special investigations, as authorized by law.

• Correctional Institution: If you are an inmate of a correctional institution or under the custody of a law enforcement officer, AMS may release your PHI to the correctional institution or law enforcement officer. The PHI released must be necessary for the institution to provide you with health care, protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

• Military: If you are a veteran or a current member of the armed forces, AMS may release your PHI as required by military command or veteran administration authorities.

Uses and Disclosures Permitted without Authorization but with Opportunity to Object

We may disclose your protected health information to your family member or a close personal friend if it is directly relevant to the person’s involvement in your surgery or payment related to your surgery. We can also disclose your information in connection with trying to locate or notify family members or others involved in your care concerning your location, condition or death.
You may object to these disclosures. If you do not object to these disclosures or we can infer from the circumstances that you do not object or we determine, in the exercise of our professional judgment, that it is in your best interests for us to make disclosure of information that is directly relevant to the person’s involvement with your care, we may disclose your protected health information as described.

Other Uses and Disclosures Require Your Written Authorization

For other situations, AMS will ask for your written authorization before using or disclosing PHI. You may cancel this authorization at any time in writing. AMS cannot take back any uses or disclosures already made with your authorization.

Your PHI Privacy Rights

• Right to See and Get Copies of Your Records. In most cases, you have the right to look at or get copies of your records. You must make the request in writing. You may be charged a fee for the cost of copying your records.

• Right to Request a Correction or Update of Your Records. You may ask AMS to change or add missing information to your records if you think there is a mistake. You must make the request in writing, and provide a reason for your request.

• Right to Get a List of Disclosures. You have the right to ask AMS for a list of disclosures made after April 14, 2003. You must make the request in writing. This list will not include the times that information was disclosed for treatment, payment, or health care operations. The list will not include information provided directly to you, your family, or guardian, PHI that was sent with your authorization.

• Right to Request Limits on Uses or Disclosures of PHI. You have the right to ask that AMS limit how your PHI is used or disclosed. You must make the request in writing and tell AMS what PHI you want to limit and to whom you want the limits to apply. AMS is not required to agree to the restriction. You can request that the restrictions be terminated in writing or verbally.

• Right to Revoke Permission. If you are asked to sign an authorization to use or disclose PHI, you can cancel that authorization at any time. You must make the request in writing. This will not affect PHI that has already been shared.

• Right to Choose How We Communicate with you. You have the right to ask that AMS share PHI with you in a certain way or in a certain place. For example, you may ask AMS to send PHI to your work address instead of your home address. You must make this request in writing. You do not have to explain the basis for your request.

• Right to File a Complaint. You have the right to file a complaint if you do not agree with how AMS has used or disclosed PHI about you.

• Right to Get a Paper Copy of this Notice. You have the right to ask for a paper copy of this notice at any time.

How to contact DHS to Review, Correct, or Limit Your Protected Health Information (PHI)
You may contact the AMS office or the AMS Privacy Officer at the address listed at the end of this notice to:
• Ask to look at or copy your records
• Ask to correct or change your records
• Ask to limit how information about you may be used or disclosed
• Ask for a list of the times AMS disclosed is used or disclosed information about you
• Ask to cancel your authorization

AMS may deny your request to look at, copy or change your records. If AMS denies your request, we will send you a letter that tells you why your request is being denied and how you can ask for a review of the denial. You will also receive information about how to file a complaint with AMS.

How to File a Complaint or Report a Problem
You may contact any of the people listed below if you want to file a complaint or to report a problem with how AMS has used or disclosed PHI about you. Any benefits you may receive will not be affected by any complaints you make. AMS cannot retaliate against you for filing a complaint, cooperating in an investigation, or refusing to agree to something that you believe to be unlawful.

Advanced Monitoring Services
Privacy Officer
P.O. Box 8686
Fayetteville, Arkansas 72703

For More Information
If you have any questions about this notice or need more information, please contact the AMS Privacy Officer.
In the future, AMS may change its Notice of Privacy Practices. Any changes will apply to information AMS already has, as well as any information AMS receives in the future.