Records / Privacy / HIPAA
All requests for Patient Care Reports require the actual patient to report to EMS Headquarters to complete an Records Release Form and present a valid government issued picture identification of the patient listed in the report when picking up a report. If you are not the patient listed in the report, see below for authorized persons other than the patient permitted to receive patient records.
Patient Care Reports may also be sent to the requestor by contacting our Custodian of Records and requesting Records Release Form which must be returned fully completed and accompany a copy of your government issued picture identification.
Captain Trudy Rayburn - email, phone 281-470-0060 or visit:
La Porte EMS Headquarters
La Porte, TX 77571
Release of Records to Others
Consent for the release of confidential and protected health information must be in writing and signed by the patient, a parent or legal guardian if the patient is a minor, a legal guardian if the patient has been adjudicated incompetent to manage the patient’s personal affairs, and attorney ad litem appointed for the patient, or a personal representative if the patient is deceased. The written consent must specify:
1. The information or records to be covered by the release
2. The reason or purpose for the release; and
3. The person to whom the information is to be released.
The patient or other person authorized to consent to the release of any information by submitting a written notice of withdraw to the person or program to which consent was provided. Withdraw of consent does not affect any information disclosed before the date on which the written notice was received.
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.
If you have any questions, contact Capt. Trudy Rayburn, HIPAA Compliance Officer, by email, by phone at 281-470-0060 or visit:
La Porte EMS Headquarters
La Porte, TX 77571
Purpose of this Notice
The City of La Porte EMS is required by law to maintain the privacy of certain confidential health care information, known as Protected Health Information (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 the City of La Porte EMS is permitted to use and disclose PHI about you.
The City of La Porte EMS 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 permission, if we are required by law to do so.
We may also contact you to provide you with other information about services we provide or other health-related benefits and services that may be of interest to you.
The City of La Porte EMS is permitted to use PHI without your written authorization, or opportunity to object in certain situations, including:
- For health care fraud and abuse detection or for activities related to compliance with the law
- For health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and other administrative or judicial actions undertaken by the government (or their contractors) by law to oversee the health care system
- For judicial and administrative proceedings as required by a court or administrative order or in some cases in response to a subpoena or other legal process
- For law enforcement activities in limited situations, such as when there is a warrant for the request, or when the information is needed to locate a suspect or stop a imminent crime
- For military, national defense and security and other special government functions
- For research projects, but this will be subject to strict oversight and approvals and health information will be released only when there is minimal risk to your privacy and adequate safeguards are in place in accordance with the law
- For the City of La Porte EMS use in treating you or in obtaining payment for services provided to you or in other health care operations
- For the treatment activities of another health care provider
- For workers’ compensation purposes, and in compliance with workers’ compensation laws
- If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ donation and transplantation
- To a public health authority in certain situations (such as reporting a birth, death or disease as required by law, as part of a public health investigation, to report child or adult abuse or neglect or domestic violence, to report adverse events such as product defects, or to notify a person about exposure to a possible communicable disease as required by law
- To another health care provider (such as the hospital to which you are transported) for the health care operations activities of the entity that receives relationship with you and the PHI pertains to that relationship
- To another health care provider or entity for the payment of the provider or entity that receives the information (such as your hospital or insurance company)
- To avert a serious threat to the health and safety of a person or the public at large
- To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of death, or carrying on their duties as authorized by law
- We may use or disclose health information about you in a way that does not personally identify you or reveal who you are
We are also allowed to give information to a family member, other relative, or close personal friend or other individual involved in your care if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection. We may also disclose health information to your family, relatives, or friends if we infer from the circumstances that you would not object. For example, we may assume you agree to our disclosure of your personal health information to your spouse when your spouse has called the ambulance for you. In situations where you are not capable of objecting (because you are not present or due to your incapacity or medical emergency), we may, in our professional judgment, determine that a disclosure to your family member, relative, or friend is in your best interest. In that situation, we with disclose only health information relevant to that person’s involvement in your care. For example, we may inform the person who accompanied you in the ambulance that you have certain symptoms and we may give that person an update on your vital signs and treatment that is being administered by our ambulance crew.
The City of La Porte EMS may use PHI for the purpose of treatment, payment and health care operations, in most cases without your written permission. Examples of our use of your PHI:
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 communications center as well as providing the hospital with a copy of the written record we create in the course of providing you with the treatment and transport.
This includes any activities we must undertake in order to get reimbursed for the services we provide you, including such things as organizing your PHI and submitting bills to insurance companies (either directly or through a 3rd party billing company), management of the billed claims for services rendered, medical necessity determinations, and reviews, utilization review, and collection of outstanding accounts.
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 policies 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 and certain statistical activities.
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 into 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 your PHI and we 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 may 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 amend your medical information only in certain circumstances, like when we believe the information you have asked us to amend is incorrect. 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 from us of certain disclosures of your medical information that we have made in the last 6 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 purposes of treatment, payment or health care operations, or when we share your health information with our business associates or a medical facility to which we have transported you.
The City of La Porte EMS is 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 accounting 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 disclose the PHI to a health care provider to provide you with emergency treatment. The City of La Porte EMS is not required to agree to any restrictions you request, but any restrictions agreed to by the City of La Porte EMS are binding on the City of La Porte EMS.
Internet, Electronic Mail, & the Right to Obtain Copy of Paper Notice on Request
This document (PDF) can be reviewed at your convenience in its entirety. You may print this document from your web browser or you may send an electronic mail request to the privacy officer listed below to have a copy mailed to your chosen address.
Revisions to this Notice
The City of La Porte EMS reserves the right 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, ambulances and posted to our web site. You may get a copy of the latest version of this Notice by contacting the Privacy Officer listed below.
Your Legal Rights & Complaints
You also have the right to complain to us, or to the Secretary of the United States 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 filing a complaint with us or to the government. Should you have any questions, comments or complaints you may direct all inquiries to the privacy officer listed at the end of this Notice. Individuals will not be retaliated against for filing a complaint.