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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.
Oberlin Fire Department (“OFD”) 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. OFD is also required to abide by the terms of the version of this
Notice currently in effect.
Uses and Disclosures of PHI:
OFD 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 obtaining verbal and written information about your medical
condition and treatment from you as well as from others, such as doctors and
nurses who give orders to allow us to provide treatment to you. We may give
your PHI to other health care providers involved in your treatment, and may
transfer your PHI via radio or telephone to the hospital or dispatch center.
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 submitting bills to insurance
companies, making medical necessity determinations, and collecting
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, as well as certain other management
functions.
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 to provide information about other services we render.
Fundraising. We may contact
you when we are in the process of raising funds for Chesterfield Fire and
EMS, or to provide you with information about our annual subscription
program called EMS Passport.
Use and Disclosure of PHI Without
Your Authorization. OFD is permitted to use PHI without your
written authorization, or opportunity to object, in certain situations, and
unless prohibited by a more stringent state law, including:
- For the treatment, payment, or health care
operations activities of another health care provider who treats you;
- As required by law, including reporting
for public health purposes;
- 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, and in
certain other circumstances where we are unable to obtain your agreement
and believe the disclosure is in your best interests;
- To report abuse, neglect or domestic
violence;
- 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, discovery request, or other legal
process;
- For law enforcement activities in limited
situations, such as when responding to a warrant;
- 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;
- We may also 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.
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 your PHI, including:
The right to access, copy, or inspect
your PHI. This means you may 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 if you disagree with our decision, you may
obtain a review of certain types of denials. We have available forms to
request access to your PHI. We will provide a written response if we deny
you access and let you know your review rights. You also have the right to
receive confidential communications of your PHI. To assure your records are
discussed and disclosed only to the proper person (you or your legally
authorized representative), we normally require you to appear in person at
our office to access or discuss your medical information. However, we will
honor reasonable requests by you to receive communications about your
medical information by alternative means or at alternative locations. If you
wish to inspect and copy your medical information, you should contact our
Privacy Officer, whose address and phone number are listed below.
The right to amend your PHI.
You have the right to ask us to amend written medical information that we
may have about you if you think it is inaccurate or incomplete. 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 and complete. If you wish to request that we amend the
medical information that we have about you, you should contact our Privacy
Officer.
The right to request an accounting.
We are required to keep a record of certain disclosures of your medical
information, and you may request an accounting of what that record contains.
Disclosures that we are NOT required to keep a record of include:
- Information we have used or disclosed for
purposes of treatment, payment or health care operations,
- When we share your health information with
our business associates, like our billing company or a medical facility
from or to which we have transported you, or
- Information for which you have already
given us written authorization to disclose.
We are required to keep this record of
disclosures for the past six years, or back to the compliance date of April
14, 2003 for federal privacy regulations, whichever is later. If you wish to
request an accounting of these disclosures, contact our Privacy Officer.
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 the medical information that we
have about you. OFD is not required to agree to any restrictions you
request, but any restrictions agreed to by OFD in writing are binding on OFD.
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. 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: OFD
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
our Privacy Officer.
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
our Privacy Officer.
Privacy Officer Contact Information
Oberlin Fire Department
Attn: Privacy Officer
430 South Main Street
Oberlin, OH 44074
(440) 774-3211
Effective Date of the Notice: April 14, 2003
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