Polson/ Ronan Ambulance is committed to providing all aspects of our service and conducting our business operations in compliance with all applicable laws and regulations.  This policy sets forth our commitment to compliance with those standards established by the Federal Trade Commission under the  Identity Theft Red Flags and Address Discrepancies under the Fair and Accurate Credit Transaction Act of 2003 (“the Red Flag Rules”) at 16 C.F.R. §681.2, regarding the establishment of a written Identity Theft Prevention Program (“Program”) that is designed to detect, prevent, and mitigate identity theft in connection with the opening of a covered account or any existing covered account. Please read Identity_Theft_Prevention_Program.pdf for details on our Identity Theft Prevention Program.


        As an essential part of our commitment to you, Polson/ Ronan 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 with respect to your PHI. It not only describes our privacy practices and your legal rights, but lets you know, among other things, how Polson/ Ronan 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 on our use and disclosure of your PHI.

         Polson/ Ronan 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.




Under the HIPAA Privacy Rule, individuals have the right to access and to request amendment or restriction on the use of their protected health information, or PHI, and restrictions on its use that is maintained in “designated record sets,” or DRS. 

 To provide consistent guidelines for Polson/ Ronan Ambulance staff to assist patients in amending the protected health information (PHI) of their patient care records in accordance with their rights under the federal Privacy Regulations.


Please complete the following form to request access to your protected health information. 



Please complete the following forms to request an amendment to your protected health information. 

#1:  Patient_Request_for_Access_to_PHI.pdf 

#2 Patient_Request_for_Amendment_of_PHI.pdf


Please complete the following forms to request restrictions to your protected health information.




You have the right to make a complaint directly to the Privacy Officer of Polson/ Ronan Ambulance concerning our policies and procedures with respect to the use and disclosure of protected health information (PHI) about you. You may also make a complaint about concerns you have regarding our compliance with any of our established policies and procedures concerning the confidentiality and use or disclosure of your PHI, or about the requirements of the federal Privacy Rule.    Procedure_for_Filing_Complaints_about_PHI.pdf


         All complaints should be directed to our Privacy Officer at the following address and phone number:  Tim Brester, 106 Division St. Polson, Mt 59860, (406) 883-5778



If you believe Polson/ Ronan Ambulance is not complying with the applicable requirements of the Federal Privacy Rule, you may file a complaint with the Secretary of the U.S. Department of Health and Human Services. The Privacy Rule states the following:


Requirements for filing complaints. Complaints under this section must meet the following requirements:


(1) A complaint must be filed in writing, either on paper or electronically.


(2) A complaint must name the entity that is the subject of the complaint and describe the acts or omissions believed to be in violation of the applicable requirements of the Federal Privacy Rule or the applicable standards, requirements, and implementation specifications of subpart E of part 164 of the Federal Privacy Rule.


(3) A complaint must be filed within 180 days of when the complainant knew or should have known that the act or omission complained of occurred, unless the Secretary for good cause shown waives this time limitation.


(4) The Secretary may prescribe additional procedures for the filing of

 complaints, as well as the place and manner of filing, by notice in the Federal Register.


(5) Investigation. The Secretary may investigate complaints. Such investigation may include a review of the pertinent policies, procedures, or practices of the covered entity and of the circumstances regarding any alleged acts or omissions concerning compliance.


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