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.
Protected health information for patients of
Goshen Volunteer Ambulance Corps.


Goshen Volunteer Ambulance 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 notice
of our legal duties and privacy practices with respect to your PHI. Goshen Volunteer Ambulance Corps 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 PHI:  

For treatment.  This includes such things as obtaining verbal and written information about your medical condition and treatment from you as well as from others such as doctors & nurses who give
orders to allow us to provide you with treatment to you. We may give 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 as submitting bills to insurance companies, making
medical necessity determinations and collecting outstanding accounts.

For health care operations.  This includes 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 other management functions.
Use and Disclosure of PHI Without Your Authorization.
Goshen Volunteer Ambulance is permitted to use PHI without your written authorization, or opportunity to object in certain situation,s and unless prohibited by a more stringent state law, including:
- For the 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 verbal 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 reporting 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 over see 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 military, national defense and security and other special government functions;
- To avert a serious threat 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:
-For research projects, but this will be subject to strict oversight and approvals;
-We may also 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:
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You have 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. In limited circumstances, we may deny you access to your medical information, and you may
appeal certain types of denials. We will provide you with a written response if we deny you access and let you know your appeal rights. You may also have the right receive confidential communications of your PHI. If you wish to inspect and copy
your medical information, you should contact our Privacy Officer.   
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You have the right to amend your PHI and your written medical information that we 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.
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You have the right to request an accounting from us of certain disclosures of your medical 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 we have used
or disclosed for purposes of treatment, payment or health care operations, or when we share your health information with our business associates, like our billing company or a medical facility from/to which we have transported you.
We are also not required to give you an accounting of our uses of protected health information for which you have already given us written authorization.  If you wish to request an accounting contact our Privacy Officer.

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You have the right to request that we restrict how we use and disclose your medical information that we have about you. Goshen Volunteer Ambulance is not required to agree to any restrictions you request, but any restrictions agreed to by Goshen
Volunteer Ambulance in writing are binding on Goshen Volunteer Ambulance.
If we maintain a web site, we will prominently post a copy of this Notice on our web site and make the Notice available electronically through the web site.  
Revisions to the Notice: from Goshen Volunteer Ambulance 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.  
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You have the right to make a complaint 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. 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 listed at the end of this Notice.
If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact:
Privacy Officer
Captain David Grippe
Goshen Volunteer Ambulance
PO Box 873
Goshen, NY 10924
845 294 9695
Effective Date of the Notice:  June 1, 2005
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