IMPORTANT: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY

Harris County Emergency Services District 11, d/b/a Harris County ESD 11, Mobile Healthcare is required by the Health Insurance Portability and Accountability Act (“HIPAA”) to maintain the privacy of your protected health information (“PHI”). HCESD 11 is also required by law to provide you with the attached detailed Notice of Privacy Practices (“Notice”) explaining HCESD 11’s legal duties and privacy practices with respect to your PHI.

Uses and Disclosure for Treatment, Payment, or Healthcare Operations

HCESD 11 may use or disclose your PHI without your authorization, for the following purposes

We can use your PHI for treatment provided to you by HCESD 11 and other medical personnel (including doctor and nurses who give orders to allow HCESD 11 to provide treatment to you). HCESD 11 may also share your PHI with other individuals involved in your care. For example, HCESD 11 may share PHI via radio or telephone to the hospitals or dispatch center as well as provide the hospital with a copy of the record HCESD 11 create in the course of providing you with treatment and transport. HCESD 11 may also share your PHI with other healthcare providers for their treatment activities.

Payment:

HCESD 11 may use and disclose your PHI for any activities HCESD 11 must undertake in order to get reimbursed for the services that HCESD 11 provides to you. This includes such things as: organizing your PHI, submitting bills to insurance companies (either directly, or through a third-party billing company), managing billed claims for services rendered, performing medical necessity determinations and reviews, performing utilization reviews, and collecting outstanding accounts. HCESD 11 may also disclose PHI to another healthcare provided or entity for the payment activities of the provider or entity that receives the PHI (such as your hospital).

Healthcare Operations:

HCESD 11 may use or disclose your PHI for things such as quality assurance activities, licensing, and training programs to ensure that our personnel meet HCESD 11’s standards of care and follow established policies and procedures, obtaining legal and financial services, conducting business planning, process grievances and complaints, creating reports that do not individually identify you for data collection purposes, fundraising, and certain marketing activities. HCESD 11 may also disclose your PHI to another healthcare provider (such as the hospital to which you are transported) for the healthcare operations activities of the entity that
receives the information if the entity receiving the information has or has had a relationship with you and the PHI pertains to that relationship.

Fundraising:

HCESD 11 may contact you when HCESD 11 is in the process of raising funds for HCESD 11, or to provide you with information about HCESD 11’s annual subscription program. We may also share this information with another organization that may contact you to raise money on our behalf. If HCESD 11 does use your PHI to conduct fundraising activities, you have the right to opt out of receiving such fundraising communications from HCESD 11 by contacting us.

Reminder for Scheduled Transports and Information on Other Services:

HCESD 11 may also contact you to provide you with a reminder of any scheduled appointments for non emergency ambulance and medical transportation, or for other information about alternative services HCESD 11 provides or other health-related benefit and services that may be of interest to you.

Other Uses and Disclosures of Your PHI HCESD 11 Can Make Without Authorization:

HCESD 11 is also permitted to use or disclose your PHI without your written authorization in the following situations:

• For healthcare fraud and abuse detection or for activities, related to compliance with the law;

• To a family member, other relative, or close personal friend or another individual involved in your care;

• To a public healthcare authority in certain situations (such as reporting a birth, death or disease, as required by law), as part of a public health investigation, to report child or adult abuse, neglect or domestic violence, to report adverse events such as product defects, or to notify a person about exposure to possible communicable disease, as required by law;

• For health oversight activities including audits or other actions undertaken by the government (or their contractors) by law to oversee the healthcare 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 to stop a crime;

• 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, HCESD 11 may release health information to organizations that handle organ procurement or organ and as necessary to facilitate organ donation and transplantation

Uses and Disclosures of Your PHI That Require Your Written Authorization:

Any other use or discloser of PHI, other than those listed above, will only be made with your written authorization. You may revoke this authorization at any time by contacting HCESD 11. Specifically, HCESD 11 must obtain your written authorization before using or disclosing your: (a) psychotherapy notes, other than for the purpose of carrying out HCESD 11’s own treatment, payment or health care operations purposes, (b) PHI for marketing when HCESD 11 receives payment to make a marketing communication; or (c) PHI when engaging in a sale of your PHI.

Your Rights Regarding Your PHI

As a patient, you have several rights with respect to your PHI, including:

Right to access, copy, or inspect your PHI

You have the right to inspect and obtain a paper or electronic copy of most of the PHI that HCESD 11 collects and maintains about you. You also have the right to request that HCESD 11 transmits your PHI to a third party. Requests for access to your PHI or to transmit your PHI to a third party should be made in writing to our HIPAA Privacy Officer, and by filling out an access request form.

Right to request an amendment of your PHI

You have the right to ask HCESD 11 to amend PHI that HCESD 11 maintains about you. Requests for amendments to your PHI should be made in writing and you should contact our HIPAA Privacy Officer if you wish to make a request for an amendment.

Right to request an accounting of certain disclosures of your PHI

You may request an accounting of certain disclosures of your PHI. HCESD 11 will provide an accounting of those disclosures that HCESD 11 is required to account for under HIPAA. If you wish to request an accounting of disclosures of your PHI that are subject to the accounting requirement, you should contact HCESD 11 HIPAA Privacy Officer and make the request in writing.

Right to request restrictions on uses and disclosures of your PHI

You have the right to request that HCESD 11 restrict how HCESD 11 uses and discloses your PHI for treatment, payment, or healthcare operations purposes, or to restrict the information that is provided to family, friends and other individuals involved in your healthcare. However, HCESD 11 is only required to abide by a requested restriction under limited circumstances, and it is generally HCESD 11’s policy that HCESD 11 will not agree to any restrictions unless required by law to do so. If you wish to request a restriction on the use or discloser of your PHI, you should contact our HIPAA Privacy Officer and make the request in writing.

Right to notice of breech of unsecured PHI

If HCESD 11 discovers that there has been a breach of your unsecured PHI, HCESD 11 will notify you about the breach by first-class mail dispatched to the most recent address that HCESD 11 has on file. If you prefer to be notified about breached by electronic mail, please contact our HIPAA Privacy Officer, to make HCESD 11 aware of this preference and to provide a valid email address to send the electronic notice.

Right to request confidential communications

You have the right to request that HCESD 11 send your PHI to an alternate location (e.g., somewhere other than your home address) or in a specific manner (e.g., by email rather than regular mail). If you wish to request that HCESD 11 communicate PHI to a specific location, or in a specific format, you should contact HCESD 11’s HIPAA Privacy Offer and make the request in writing.

Internet, Email, and the Right to Obtain a Copy of Paper Notice

If HCESD 11 maintains a website, HCESD 11 will prominently post a copy of this Notice on the website and make the Notice available electronically through the website. If you allow, HCESD 11 will provide its Notice of Privacy Practices to you electronically instead of on paper. You may always request a paper copy of our Notice.

Revisions of the Notice

HCESD 11 is required to abide by the terms of the version of this Notice currently in effect. However, HCESD 11 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 PHI that HCESD 11 maintains. Any material changes to the Notice will be promptly posted in at HCESD 11 facilities and on HCESD 11’s website, if a website is maintained. You can obtain a copy of the latest version of this Notice by contacting HCESD 11’s HIPAA Privacy Officer.

Your Legal Rights and Complaints

You also have the right to complain to HCESD 11, or to the Secretary of the United States Department of Health and Human Services, if you believe that your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with HCESD 11 or the federal government. If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact:

HCESD 11 Privacy Officer
18334 Stuebner Airline Road
Spring, TX 77379
[email protected]

Effective Date of the Notice
09-01-21