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Notice of Privacy Practices
IMPORTANT: 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.
As an essential part
of our commitment to you, Deerfield Township Fire Rescue 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 respect to your PHI. It not only
describes our privacy practices and your legal rights, but lets you know, among
other things, how Deerfield Township Fire Rescue 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.
Deerfield Township
Fire Rescue 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 are committed to
following at all times.
PLEASE READ THE
ATTACHED DETAILED NOTICE. IF YOU HAVE ANY QUESTIONS ABOUT IT, PLEASE CONTACT
DOUG KOCH, OUR PRIVACY OFFICER, AT 513 459-0875.
Purpose of this Notice:
Deerfield Township
Fire Rescue 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 Deerfield Township Fire Rescue is permitted to
use and disclose PHI about you.
Deerfield Township
Fire Rescue 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.
Uses and
Disclosures of PHI: Deerfield Township Fire Rescue may use PHI for the
purposes of treatment, payment, and health care operations, in most cases
without your written permission. Examples of our use of your PHI:
For treatment.
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 dispatch
center as well as providing the hospital with a copy of the written record we
create in the course of providing you with treatment and transport.
For payment.
This includes any activities we must undertake in order to get reimbursed for
the services we provide to you, including such things as organizing your PHI and
submitting bills to insurance companies (either directly or through a third
party billing company), management of billed claims for services rendered,
medical necessity determinations and reviews, utilization review, and collection
of outstanding accounts.
For 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, fundraising, and certain marketing activities.
Reminders for
Scheduled Transports and Information on Other Services. We may also
contact you to provide you with a reminder of any scheduled appointments for
non-emergency ambulance and medical transportation, or for other information
about alternative services we provide or other health-related benefits and
services that may be of interest to you.
Use and
Disclosure of PHI Without Your Authorization. Deerfield Township Fire
Rescue is permitted to use PHI without your written authorization, or
opportunity to object in certain situations, including:
·
For Deerfield Township Fire Rescue’s 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;
·
To another health care provider or entity for the payment activities of
the provider or entity that receives the information (such as your hospital or
insurance company);
·
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 the information as long as the entity receiving the information has or
has had a relationship with you and the PHI pertains to that relationship;
·
For health care fraud and abuse detection or for activities related to
compliance with the law;
·
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 will
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;
·
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;
·
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 crime;
·
For military, national defense and security and other special government
functions;
·
To avert a serious threat to the health and safety of a person or the
public at large;
·
For workers’ compensation purposes, and in compliance with workers’
compensation laws;
·
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;
·
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;
·
For research projects, but this will be subject to strict oversight and
approvals and health information will be released only when there is a minimal
risk to your privacy and adequate safeguards are in place in accordance with the
law;
·
We may use or disclose health information about you in a way that does
not personally identify you or reveal who you are.
Any other use or
disclosure of PHI, other than those listed above will only be made with your
written authorization, (the authorization must specifically identify the
information we seek to use or disclose, as well as when and how we seek to use
or disclose it). You may revoke your authorization at any time, in writing,
except to the extent that we have already used or disclosed medical information
in reliance on that authorization.
Patient Rights:
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 to 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 access to 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 correct. 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 six 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, like our billing
company or a medical facility from/to which we have transported you.
We are 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. Deerfield
Township Fire Rescue is not required to agree to any restrictions you request,
but any restrictions agreed to by Deerfield Township Fire Rescue are binding on
Deerfield Township Fire Rescue.
Internet,
Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request.
If we maintain a web site, we will prominently post a copy of this Notice on our
web site and make the Notice available electronically through the web site. If
you allow us, we will forward you this Notice by electronic mail instead of on
paper and you may always request a paper copy of the Notice.
Revisions to the
Notice: Deerfield Township Fire Rescue 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 and
posted to our web site, if we maintain one. You can get a copy of the latest
version of this Notice by contacting the Privacy Officer identified below.
Your Legal Rights
and 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.
If you have any
questions or if you wish to file a complaint or exercise any rights listed in
this Notice, please contact:
Doug Koch
Deerfield Township Fire Rescue
8355 Snider Road
Mason, Ohio 45040
513 459-0875
Effective Date of the Notice4/13/2003
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