506 Couch Street

Vallejo, CA  94590

8689 Folsom Blvd.

Sacramento, CA  95670

Tel: 707-644-1761
Fax: 707-644-1784

Dispatch: 707-644-8989

© 2018 by Medic Ambulance Service

PATIENT'S RIGHTS

 

Medic Ambulance respects your rights as an individual, and more importantly as our patient. We recognize and respect that you have placed your trust in us as our patient. That is why we would like you to be informed of your rights as our patient.

 

The following is our official notice of your rights as our patient. It details your rights regarding your documented information with our company, restriction of that information, and how we communicate with you.

 

This notice is not an exhaustive list. Medic Ambulance is proud of being a family owned, patient oriented business. We want your experience with us to be a positive one, and will facilitate reasonable request as often as possible. For any requests or concerns not covered by this notice please contact Helen Pierson.

 

RIGHT TO INSPECT AND COPY.  You have the right to inspect and copy health information that may be used to make decisions about your care or payment for your care. To inspect and copy this health information, you must make your request, in writing, to our Privacy Officer.

RIGHT TO AMEND.  If you feel the health information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, you must make your request, in writing, to: (Need Name/Address).

 

RIGHT TO AN ACCOUNTING OF DISCLOSURES.  You have the right to request an accounting of certain disclosures of health information we made. To request an accounting of disclosures, you must make your request, in writing, to (Need Name/Address).

 

RIGHT TO REQUEST RESTRICTIONS.  You have the right to request a restriction or limitation on the health information we use or disclose for treatment, payment, or health care operations. In addition, you have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about your surgery with your spouse. To request a restriction, you must make your request, in writing, to (Need Name/Address). We are not required to agree to your request. If we agree, we will comply with your request unless we need to use the information in certain emergency treatment situations.

 

RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you only by mail or at work. To request confidential communications, you must make your request, in writing, to our Privacy Officer. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.

 

CHANGES TO THE NOTICE:

 

WE RESERVE THE RIGHT TO CHANGE THIS NOTICE.  We reserve the right to make the revised or changed notice effective for health information we already have as well as any information we receive in the future. We will post a copy of the current notice at the hospital. The notice will contain the effective date on the first page, in the top right-hand corner.

 

COMPLAINTS:

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact our Privacy Officer, Brian Meader, HIPAA Compliance Officer at bmeader@medicambulance.net. All complaints must be made in writing. You will not be penalized for filing a complaint.