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Purpose of this Notice:
Centerville-Osterville-Marstons Mills Fire District 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 Centerville-Osterville-Marstons Mills Fire District is permitted to use
and disclose PHI about you.
Centerville-Osterville-Marstons Mills Fire District 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:
Centerville-Osterville-Marstons Mills Fire District 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, and certain
marketing activities.
Use and Disclosure of PHI
Without Your Authorization.
Centerville-Osterville-Marstons Mills Fire District is permitted to use PHI
without your written authorization, or opportunity to object in certain
situations, including:
·
For
Centerville-Osterville-Marstons Mills Fire District’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 written 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.
Centerville-Osterville-Marstons Mills Fire District is not required to agree to
any restrictions you request, but any restrictions agreed to by
Centerville-Osterville-Marstons Mills Fire District are binding on
Centerville-Osterville-Marstons Mills Fire District.
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:
Centerville-Osterville-Marstons Mills Fire District 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:
Deputy Craig E. Whiteley,
Privacy Officer
Centerville-Osterville-Marstons
Mills Fire District
1875 Route 28
Centerville, MA 02632
Effective Date of this
Notice: APRIL
14, 2003
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