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
Purpose of this Notice: Elizabeth Fire Protection 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 Elizabeth Fire Protection District
is permitted to use and disclose your PHI.
Elizabeth Fire Protection District is also required to abide by the
terms of the version of this Notice currently in effect.
We may use this information after we obtain your consent, and in certain
emergency and other specific situations
without your immediate consent.
Uses and Disclosures of PHI: Elizabeth Fire Protection
District may use PHI for the purposes of treatment, payment, and other health
care operations. 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 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.
Use and Disclosure of PHI
Without Your Consent. Elizabeth Fire Protection
District is authorized to use PHI without your consent, authorization,
or written permission in certain situations, including:
·
Emergency situations (in these
situations, in accordance with the law we will attempt to get your written
consent after the emergency service is provided and we would appreciate your
cooperation when we do so);
·
To a relative, friend or
individual involved in your care;
·
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, in compliance with workers' compensation laws.
Any other use or disclosure of PHI, other than those listed above will
only be made with your written consent or an authorization (an authorization
specifically identifies 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 consent or
authorization at any time, in writing, except to the extent that we have
already used or disclosed medical information in reliance on that consent or
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 certain types of denials may be appealed. We have
available forms to request PHI and 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, such as when we believe the information you have asked us to
amend is correct. You can appeal our denial of your request to amend the
information. If you wish to 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 disclosures 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 of uses or disclosures made prior to
April 14, 2003. If you wish to request an accounting of the medical information
about you that we have used or disclosed, 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 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
healthcare provider to provide you with emergency treatment. Elizabeth Fire
Protection District is not required to agree to any restrictions you request,
but any restrictions agreed to by Elizabeth Fire Protection District are
binding on Elizabeth Fire Protection District.
Legal Rights and Complaints:
Notice of any changes in Elizabeth Fire Protection District privacy
policy may be shown directly on the consent form and this Notice will be
updated when any significant changes in our
privacy
practices occur. Elizabeth Fire Protection District reserves the right to
change the terms of this Notice at any time, and the changes will be effective
immediately. We also reserve the right to make any changes effective for PHI
that we have created or received prior to the effective date of the Notice
provision that was changed.
You also have the right to file a complaint with us,
or the Secretary of the federal 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.
If you have any questions or if you wish to file a
complaint or exercise any rights listed in this Notice, please contact:
Elizabeth Fire Protection
District
Attn: Privacy Officer
PO Box 441, 155 W. Kiowa Ave.
(303) 646-3800
Effective Date of the Notice: April 1, 2003
Elizabeth Fire Protection District may revise this Notice at any time.
You can get a copy of the latest version of this notice by contacting the
Privacy Officer or any staff member.