Mayville Area Ambulance Service
Patient Privacy Disclosure
Effective: April 15, 2003; Revised June 28, 2021
THIS NOTICE DESCRIBES HOW PRIVATE INFORMATION IS OR MAY BE USED AND DISCLOSED AND YOUR RIGHTS AS THEY PERTAIN TO THAT INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Mayville Area Ambulance Service (herein known as MAAS) takes the matter of patient confidentiality very seriously. During all patient encounters, MAAS collects private information for each patient. This information is used for several different purposes – those are described below. Please be aware that MAAS keeps all patient information confidential and private, and that we are required by law to give you this notice of our privacy practices.
How MAAS Uses and/or Discloses Your Private Information
Below describes the use, disclosures, and handling of private information by the MAAS.
Continuum of Care: As an ambulance provider, MAAS transports patients to and from hospitals, nursing homes, and other healthcare facilities and/or providers. In order for care to be continued when a patient leaves the care of MAAS at a healthcare facility – private information is provided to the facility receiving the patient.
Quality Control/Assurance and Research: To ensure that proper procedures for patient care are being followed, MAAS may disclose private information to internal staff and external local and state agencies responsible for overseeing ambulance operations. In addition, in certain situations, private information may be disclosed for research purposes related to treatments, demographics, illness and injury, and/or ambulance operations.
Payment of Claims: In order for insurance carriers (including but not limited to Medicare, Medicaid, Workers Compensation, private health and/or auto insurance) to properly process claims from MAAS, MAAS discloses private information so that the carrier may identify you and/or your coverage, and process the claims as applicable.
Ambulance Operations: During the course of your treatment by MAAS, private information will be disclosed between the staff providing care to you. In addition, other staff not directly caring for you (office and/or supervisory) may be privileged to private information as needed for operational purposes.
Disclosures as Required by Law: MAAS will disclose any private information when it is required by law – such as a subpoena. In addition, MAAS is required to report to law enforcement, any cases of abuse, neglect, and/or domestic violence.
To Avoid Health, Safety, and Security Threats: MAAS may use and disclose private information to prevent threats of health, safety and security to yourself, our staff, other healthcare providers and the general public.
Your Rights Regarding Your Private Information
You have the following rights regarding the private information the MAAS collects and retains about you.
Right to Inspect and Copy: You have the right to review and copy any private information that MAAS has collected about you. To exercise this right, you must make a written request to MAAS as described within this disclosure. If you request copies, MAAS may charge fees for copying, mailing and supplies needed to fulfill your request.
Right to Amend: If you feel that any of your private information is incorrect or incomplete, you have the right to request an amendment. Amendment requests must be made in writing, including the reason for the amendment. MAAS may deny amendment requests. Accepted and denied amendments will become part of your record, and you will be notified as to such.
Right to an Accounting of Disclosure: You have right to request a list of disclosures of your private information. This request must be made in writing to the MAAS. This request must include a time period, not more that 6 years, and may not include dates prior to April 14, 2003. MAAS may charge fees for copying, mailing and supplies needed to fulfill your request.
Right to Request Restrictions: You have the right to request a restriction or limitation on the use and/or disclosure of your private information. MAAS will comply with all reasonable requests, expect  in emergency situations,  it is essential for continuation of emergency care, and  when required by law to disclose. This request must be made in writing to the MAAS. The request must include what information you want restricted, to who it should be restricted, and dates of the start and end of the restriction.
Limitations of Document Retention: Documentation maintained by MAAS is subject to MAAS’ document retention policy. Documents that have exceeded the retention time period will be discarded in a manner that ensure that they are not able to be viewed or retrieved. MAAS will not be able to provide documents that have been destroyed or deleted.
Changes to this Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective to private information we already have about you as well as any information we receive in the future. We will post a copy of the current notice at the MAAS main facility in a prominent location. The notice will contain, on the first page, centered below the title, the effective date. In addition, each time you are treated by MAAS, copies of the current notice will be available.
If you believe your privacy rights have been violated, you may file a complaint with the MAAS or with the Secretary of the Department of Health and Human Services. To file a complaint with the MAAS, please put your complaint in writing and submit it to the MAAS as described below.
Contacting MAAS about your private information
All contacts about your private information, including requests for copies, amendments, additional copies of this disclosure, questions and/or complaints should be directed to:
Mayville Area Ambulance
Attention: Privacy Officer
PO Box 181
Mayville, MI 48744-0181