This notice describes the practices of Southern Berkshire Ambulance Squad (SBAS) including: any healthcare professional authorized to enter information into your Prehospital Care Report (PCR); all employees involved in your care; any member of a volunteer group we allow to help you while you are in our care; and any employee of an organization we have contracted with to provide care to you.
Our pledge regarding health information
We understand that information about you and your health is personal. We are committed to protecting your health information. We create a record of the care and services you receive while transported by SBAS. We need this record to provide you with quality care and to comply with local protocols and legal requirements.
We are required by law to:
- Keep health information that identifies you private;
- Give you this notice of our legal duties and privacy practices with respect to your health information;
- Follow the terms of the notice currently in effect.
How we may use and disclose health information about you
For treatment
We may use health information about you to provide medical treatment or services, and may disclose it to doctors, nurses, or other hospital personnel involved in your care. We may also disclose information to people involved in your medical care after you enter the hospital, such as family members or clergy.
For payment
We may use and disclose health information so that treatment and services you receive in transit may be billed to and payment collected from you, an insurance company, or another party. We may also tell your health plan about transport requirements to obtain prior approval or determine coverage.
For prehospital healthcare operations
We may use and disclose health information for ambulance operations. These uses and disclosures are necessary to run the ambulance service and ensure that all patients receive quality care.
As required by law
We will disclose health information about you when required to do so by federal, state, or local law.
To avert a serious threat to health or safety
We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Your rights regarding health information about you
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. To inspect or copy your health information, submit a written request to our Privacy Officer at 31 Lewis Avenue, Great Barrington, MA 01230. We may charge a fee for copying, mailing, or other supplies.
Right to request amendment
If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. Submit your request in writing to our Privacy Officer. We may deny your request under certain circumstances.
Right to an accounting of disclosures
You have the right to request a list of disclosures we have made of health information about you. Submit your request in writing to our Privacy Officer.
Right to request restrictions
You have the right to request a restriction on health information we use or disclose about you for treatment, payment, or operations. We are not required to agree to your request.
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.
Right to a paper copy of this notice
You have the right to a paper copy of this notice at any time. Contact our office at (413) 528-3632 to request one.
Changes to this notice
We reserve the right to change this notice at any time. The current notice will be posted on our website and available at our office. The effective date appears at the bottom of this notice.
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 at 31 Lewis Avenue, Great Barrington, MA 01230 or call (413) 528-3632. You will not be penalized for filing a complaint.
Contact information
Privacy Officer
Southern Berkshire Ambulance Squad
31 Lewis Avenue
Great Barrington, MA 01230
(413) 528-3632
Contact Us
For the full updated Patient Privacy Notice, please download the April 2024 PDF →