THIS NOTICE DESCRIBES HOW YOUR PERSONAL MEDICAL INFORMATION MAY BE USED AND DISCLOSED AMD HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY
The East Brookfield Fire Department Ambulance is required by law to maintain the privacy of certain confidential health care information, know 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. EAST BROOKFIELD FIRE DEPARTMENT AMBULANCE is also required to abide by the terms of this notice.
Uses and disclosure of PHI: EAST BROOKFIELD FIRE DEPARTMENT AMBULANCE may use PHI for the purposes of treatment, payment and healthcare 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/or written information about your medical condition and treatment from you as well as others (i.e. doctors, nurses) who give orders to allow us to provide treatment to you. We may give your PHI to other healthcare 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 submitting bills to insurance companies, making medical necessity determinations and collecting outstanding accounts.
· For healthcare operations: This may include quality assurance activities, licensing and training programs to ensure that our personnel follow established policies and procedures, meet established standards of care and in the performance of certain management functions.
Use and disclosure of your PHIU without your authorization: EAST BROOKFIELD FIRE DEPARTMENT AMBULANCE is permitted to use PHI without your written authorization OR opportunity to object, in certain situations unless prohibited by a more stringent state or federal law including:
· For the treatment, payment or healthcare operations of another healthcare provider who treats you.
· For healthcare and legal compliance activities.
· To a family member, other relative, close personal friend or other individual involved in your care if EAST BROOKFIELD FIRE DEPARTMENT AMBULANCE obtains 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 EAST BROOKFIELD FIRE DEPARTMENT AMBULANCE is not able to obtain your agreement and believes the disclosure is in your best interest.
· To a public health authority in certain situations as required by law (i.e. 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 healthcare 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 serving a warrant.
· For military, national defense and security or other special government functions.
· To avert a serious threat to the health and/or safety of a person or public at large.
· For workers’ compensation purposes and in compliance with workers’ compensation laws.
· To coroners, medical examiners and funeral directors for identification of a deceased person, determining a 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 and tissue donation or transplantation.
· For research projects, but this will be subject to strict oversight and approvals.
· EAST BROOKFIELD FIRE DEPARTMENT AMBULANCE 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 EAST BROOKFIELD FIRE DEPARTMENT AMBULANCE has already used or disclosed medical information in reliance on that authorization.
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 that you may inspect and receive a copy of the medical information about you that EAST BROOKFIELD FIRE DEPARTMENT AMBULANCE maintains. EAST BROOKFIELD FIRE DEPARTMENT AMBULANCE will normally provide you access to this information within 30 Days of your request. All requests for access to PHI must be received in writing. EAST BROOKFIELD FIRE DEPARTMENT AMBULANCE also charges a reasonable fee for copies of any medical information that you have the right to access. In limited circumstances, EAST BROOKFIELD FIRE DEPARTMENT AMBULANCE may deny your request for access and you may appeal certain types of denials. In the event of a denial, you will receive a written explanation of the denial as well as your right to appeal. You also have the right to receive confidential communications of your PHI. If you wish to obtain a copy of your medical information, you should contact the privacy officer.
· 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 written request and we will provide you with written confirmation when we have amended your PHI. EAST BROOKFIELD FIRE DEPARTMENT AMBULANCE reserves the right to deny your request for amendment as permitted by law, these circumstances may include: the information requested to be amended is believed to be correct; there are other legal proceedings that prohibit alteration of medical information. Please contact the privacy officer via certified mail with requests for amendments.
· The right to request an accounting. You may request an accounting from us of certain disclosures of your PHI that we have made in the 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 of healthcare operations, or when we share health information with our business associates, such as 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 PHI for which you have already given us written authorization. If you wish to request an accounting, contact the privacy officer
· The right to request that we restrict the uses and disclosure of your PHI. You have the right to restrict how we use and disclose medical information we have about you. The requests must be made in writing to East Brookfield Fire Department Ambulance. East Brookfield Fire Department Ambulance is not required to agree to any restrictions you request, but any restrictions agreed to by East Brookfield Fire Department Ambulance in writing are considered binding.
· Internet, electronic mail (email) and the right to obtain a paper notice upon request. If East Brookfield Fire Department maintains a website, we will prominently post a copy of this notice on the website. If you allow us, we will forward you this notice by electronic mail instead of on paper. You may always request a paper copy of this notice.
· Revisions to the notice. East Brookfield Fire Department Ambulance reserves the right to change the terms of this notice at any time and the changes made will be effective immediately and apply to any and all PHI we maintain. Any material changes to the notice will be promptly posted in our facility and on our website, if we maintain one. You can request a copy of the most recent notice by contacting our privacy officer.
· Your legal rights and complaints: You also have the right to file a complaint with us or to 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.
· Privacy officer contact information:
East Brookfield Fire Department Ambulance
Attention: Privacy Officer
P.O. Box 356
East Brookfield, MA 01515
Effective date of notice: August 8, 2013