Ajo Ambulance

AJO, AZ 85321

PHONE: 520-387-5154
FAX: 520-387-6050

To return to Ajo Ambulance's home page, click here.



As an essential part of our commitment to you, Ajo Ambulance maintains the privacy of certain confidential health care information about you, known as Protected Health Information or PHI. We are required by law to protect your health care information and to provide you with the attached Notice of Privacy Practices.

The notice outlines our legal duties and privacy practices respect to your PHI. It not only describes our privacy practices and your legal rights, but lets you know, among other things, how Ajo Ambulance is permitted to use and disclose PHI about you, how you can access and copy that information, how you may request amendment of that information and how you may request restrictions of our use and disclosure of your PHI.

Ajo Ambulance is also required to abide by the terms of the version of this Notice currently in effect. In most situations we may use this information as described in this Notice without your permission, but there are some situations where we may use it only after we obtain your written authorization, if we are required by law to do so. We respect your privacy and treat all health care information about our patients with care under strict policies of confidentiality that all of our staff is committed to following at all times.

USES AND DISCLOSURES OF PHI: Ajo Ambulance 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 your PHI:

FOR TREATMENT: This includes such things as verbal and written information that we obtain about you and use pertaining to your medical condition and treatment provided to you by us and other medical personnel, including doctors and nurses who give orders to allow us to provide treatment to you). It also includes information we give to other health care personnel, to whom we transfer your care and treatment, and includes transfer of PHI via radio or telephone to the hospital or dispatch center as well as providing the hospital with a copy of the written record we create in the course of providing you with treatment and transport.

FOR PAYMENT: This includes any activities we must undertake in order to get reimbursed for the services we provide to you, including such as organizing your PHI and submitting bills to insurance companies (either directly or through a third party billing company), management of billed claims for services rendered, medical necessity determination and review, utilization review and collection of outstanding accounts.

FOR HEALTH CARE OPERATIONS: This includes quality assurance activities, licensing and training programs to ensure that our personnel meet our standards of care and follow established polices and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints, creating reports that do not individually identify you for data collection purposes, fundraising and certain marketing activities.

FUNDRAISING: We may contact you when we are in the process of raising funds for Ajo Ambulance or to provide you with information about our annual subscription program.

REMINDERS FOR SCHEDULED TRANSPORTS & INFORMATION ABOUT OTHER SERVICES: We may also contact you to provide you with a reminder of any scheduled appointments for non-emergency ambulance and medical transports, or with other information about alternative services were provide or other health-related benefits and services that may be of interest to you.

USE & DISCLOSURE OF PHI WITHOUT YOUR AUTHORIZATION: Ambulance is permitted to use PHI without your written authorization or opportunity to object in certain situations, including:

Any other use or disclosure of PHI, other than those listed above all only be made with your written authorization, (the authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to use or disclose it). 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:

The right to access, copy or inspect your PHI: This means you may come to our offices and inspect and copy most of the medical information about you that we maintain. We will normally provide you with access to this information within 30 days of your request. We may also charge you a reasonable fee for you to copy any medical information that you have the right to access. In limited circumstances, we may deny you access to your medical information, and you may appeal certain types of denials. We have available forms to request access to your PHI and will provide a written response if we deny you access and let you know your appeal rights. If you wish to inspect and copy your medical information, you should contact the privacy officer listed at the end of this Notice.

The right to amend your PHI: You have the right to ask us to amend 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 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 listed at the end of this Notice.

The right to request an accounting of our use and disclosure of your PHI: You may request an accounting form of certain disclosures of your medical information that we have made in the last 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 purpose 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 or 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 of the medical information about you that we have used or disclosed that is not exempted from the account requirement, you should contact the privacy officer listed at the end of this Notice.

The right to request that we restrict the uses and disclosures of your PHI: You have the right to request that we restrict how we use and disclose your medical information that we have about you for treatment, payment or health care operations, or to restrict the information that is provided to family, friends and other individuals involved in your health care. But if you request a restriction and the information you asked us to restrict is needed to provide you with emergency treatment, then we may use the PHI or disclosed the PHI to a health care provider to provide you with emergency treatment. Ajo Ambulance is not required to agree to any restrictions you request, but any restrictions agreed to by Ajo Ambulance are binding on Ajo Ambulance.

Internet, Electronic Mail and the Rights to Obtain Copy of Paper Notice on Request: 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. If you allow us, we will forward you this Notice by electronic mail instead of on paper and you may always request a paper copy of the Notice.

Revisions to the Notice: Ajo Ambulance reserves the rights 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. Any material changes to the Notice will be promptly posted in our facilities and posted to our web site if we maintain one. You can get a copy of the latest version of the Notice by contacting the privacy officer listed below.

Your Legal Rights and Complaints: You also have the right to complain to us or to the Secretary of the United State 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 filling a complaint with us or to the government. Should you have any questions, comments or complaints you may direct all inquires to the privacy officer listed at the end of this Notice. Individuals will not be retaliated against for filling a complaint.

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
Ajo Ambulance Inc.
410 Malacate St.
Ajo, AZ 85321
Phone: 520-387-5154   Fax: 520-387-6050

Effective Date of this Notice: April 14, 2003 To return to Ajo Ambulance's home page, click here.

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