Notice of Privacy Policy

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.

The following is a privacy policy (“Privacy Policy”) for Survival Flight, Inc. (“SFI”) as described in the Health Insurance and Portability and Accountability Act of 1996 and regulations promulgated thereunder (“HIPAA”). SFI 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 a notice of our legal duties and privacy practices with respect to your PHI. This notice describes your legal rights, advises you of our privacy practices, and lets you know how SFI is permitted to use and disclose PHI about you.

The law requires that we follow the terms of the notice that is currently in effect. SFI reserves the right to change the terms of this Notice at any time. A revised notice of privacy practices will be effective for all protected health information that we maintain. If SFI revises this Notice, a current revised copy of the Notice may be obtained upon request or by accessing SFI’s website at: www.survivalflightinc.com.

PERMITTED USES AND DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION
1. TREATMENT, PAYMENT, HEALTHCARE OPERATIONS. You should be aware that during the course of our relationship SFI is permitted to use PHI without your written authorization, or opportunity to object in certain situations, including:
  1. For Treatment. Your confidential healthcare information may be used and/or disclosed for the provision, coordination, or management of your health care and related services by health care practitioners, consultation between health care practitioners relating to a patient, or the referral of a patient for health care from one health care practitioner to another.
  2. For Payment. Your confidential payment information may be used and/or disclosed for billing and collection activities and related data processing, medical necessity and appropriateness of care reviews, utilization review activities, and disclosure to consumer reporting agencies of information relating to collection of premiums or reimbursement.
  3. For Healthcare Operations. Your confidential healthcare information may be used and/or disclosed in connection with our healthcare operations. Healthcare operations include: development of clinical guidelines, use and/or disclosure of clinical records to evaluate qualifications and training of health care professionals, medical review, legal services, and auditing functions, and general administrative activities such as customer service and data analysis.
2. AS REQUIRED BY LAW. SFI may use or disclose your personal health information to the extent that such use or disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of such law. Examples of instances in which we are required to disclose your personal health information include: (a) disclosures regarding victims of abuse, neglect, or domestic violence including, reporting to social service or protective services agencies; (b) judicial and administrative proceedings in response to an order of a court or administrative tribunal, a warrant, subpoena, discovery request, or other lawful process; (c) to avert a serious threat to health or safety.
3. AUTHORIZATIONS. You may specifically authorize us to use your health information for any purpose or to disclose your health information to anyone. Further, we are required to use or disclose your personal health information consistent with the terms of your authorization. You may revoke your authorization to use or disclose any personal health information at any time, except to the extent that we have taken action in reliance on such authorization, or, if you provided the authorization as a condition of obtaining insurance coverage, other law provides the insurer with the right to contest a claim under the policy.
4. MARKETING. We will not use your health information for marketing communications without your written authorization. We will not sell your health information to anyone.
5. PATIENT AND THIRD PARTY PROTECTION. We may disclosure your health information to avoid a serious threat to your health or safety, or to the health or safety of others to the extent permitted by law.
6. SCHEDULED TRANSPORT REMINDERS. We may use or disclose your protected health information to provide you with a reminder (such as voicemails, postcards, or letters) of any scheduled transports.
7. WORKERS’ COMPENSATION. We may disclose health information to the extent authorized by law relating to workers’ compensation or to other similar programs established by law.
8. BUSINESS ASSOCIATES. There are some services provided through contracts with our business associates. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we have asked them to do and bill you or your insurance company for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
PATIENT RIGHTS
1. REQUEST OF RESTRICTIONS ON USE OR DISCLOSURE. You have the right to request restrictions on certain uses and disclosure of your personal health information. You may request restrictions on uses or disclosures regarding treatment, payment, or health care operations; and/or disclosures to family members, relatives, or close personal friends of personal health information directly relevant to your care or payment related to your health care. We are not required to agree to any requested restriction. Under certain circumstances, including emergency treatment, we may disclose your location and general condition to a family member, other relative, or close personal friend. All requests for restrictions should be sent to:
  
  Compliance Coordinator
  Survival Flight
  705 Heber Springs Road
  Batesville, AR 72501
2. ACCESS TO RECORDS. You have the right to inspect and copy your protected health information contained in a “designated record set,” other than (a) psychotherapy notes; (b) information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding; and (c) health information maintained by us to the extent to which the provision of access to you would be prohibited by law. Generally, a designated record set contains enrollment, payment, claims adjudication and case or medical management records we may have about you, as well as other records that we use to make recommendations and decisions about your health care needs. We require a written request. We must provide you with access to your personal health information in the form or format requested by you, if it is readily producible in such form or format, or, if not, in a readable hard copy form or such other form or format. We may provide you with a summary of the personal health information requested in lieu of providing access to the personal health information or may provide an explanation of the personal health information to which access has been provided, if you agree in advance to such a summary or explanation and agree to the fees imposed for such summary or explanation. We will provide you with access as requested in a timely manner, including arranging with you a convenient time and place to inspect or obtain copies of your personal health information or mailing a copy to you at your request. If you request a copy of your health information, we may charge a reasonable fee for copying, assembling costs and postage, if applicable, associated with your request. We reserve the right to deny you access to and copies of certain personal health information as permitted or required by law. Upon denial of a request, we will provide you with a written denial specifying the legal basis for denial, a statement of your rights, and a description of how you may file a complaint with us. If we do not maintain the information that is the subject of your request for access but we know where the requested information is maintained, we will inform you of where to direct your request for access. All requests for inspection and copy should be sent to:
  
  Compliance Coordinator
  Survival Flight
  705 Heber Springs Road
  Batesville, AR 72501
3. AMENDMENT TO PERSONAL HEALTH INFORMATION. You have the right to request that we amend your personal health information or a record about you contained in your designated record set, for as long as the designated record set is maintained by us. We have the right to deny you a request for an amendment, if (a) we determine that the information or record that is the subject of the request was not created by us, unless you provide a reasonable basis to believe that the originator of the information is no longer available to act on the requested amendment; (b) the information is not part of your designated record set; (c) the information is prohibited from inspection by law; or (d) the information is accurate and complete. We may require that you submit a written request and provide a reason to support the request. If we deny your request, we will provide you with a written denial stating the basis of the denial, your right to submit a written statement disagreeing with the denial, and a description of how you may file a complaint with us or the Secretary of the U.S. Department of Health and Human Services (“HHS”). If we accept your request for amendment, we will make reasonable efforts to inform you and provide the amendment within a reasonable time to persons identified by you as having received personal health information of yours prior to amendment and persons that we know have the personal health information that is the subject of the amendment and that may have relied, or could foreseeable rely on such information to your detriment. All requests for an amendment should be sent to:
  
  Compliance Coordinator
  Survival Flight
  705 Heber Springs Road
  Batesville, AR 72501
4. ACCOUNTING OF DISCLOSURES. Upon written request, you have the right to receive a written accounting of disclosures of your personal health information that we have made within the six (6) year period immediately preceding the date on which the accounting is requested. You may request an accounting of disclosures for a period of time less than six (6) years from the date of the request. Such disclosures will include the date of each disclosure, the name and, if known, the address of the entity or person who received the information, a brief description of the information disclosed, and a brief statement of the purpose and basis of the disclosure or, in lieu of such statement, a copy of your written authorization or written request for disclosure pertaining to such information. We will provide the first accounting to you in any twelve (12) month period without charge, but will impose a reasonable cost-based fee for responding to each subsequent request for accounting within that same twelve (12) month period. All requests for accounting should be sent to:
  
  Compliance Coordinator
  Survival Flight
  705 Heber Springs Road
  Batesville, AR 72501
COMPLAINTS

You may file a complaint with us and/or the Secretary of HHS if you believe that your privacy rights have been violated. You may submit your complaint with us in writing, by mail, or electronically to our privacy officer, compliance@survivalflightinc.com. A complaint must name the entity that is the subject of the complaint and describe the acts or omission believed to be in violation of the applicable requirements of HIPAA or this Privacy Policy. A complaint must be received by us or filed with the Secretary of HHS within 180 days of when you knew or should have known that the act or omission complained of occurred. You will not be retaliated against for filing any complaint.

Revised: 02/2019
4840-3997-1463, v. 1