This
notice makes reference to The Worth Fire Department. The
Village has contracted all fire department related services
to The North Palos Fire Protection District. For purposes
of this notice the North Palos Fire Protection District
adheres to the same HIPAA requirements this notice details
and as we're required to present to you.
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. IF YOU HAVE ANY
QUESTIONS ABOUT IT, PLEASE CONTACT THE FIRE CHIEF, OUR
PRIVACY OFFICER, AT (708) 974-4474.
Worth
Fire Department 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 Protected Health Information (PHI):
Worth Fire Department may use PHI for the purposes of
treatment, payment, and health care operations, in most
cases without your permission. Examples of our use of
your PHI:
For
treatment. This includes such things as vebal 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 accouts.
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 Authorization.
Worth Fire Department is permitted to use PHI without your
written authorization, or opportunity to object in certain
situations, including:
- For Worth
Fire Department's use of 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
th 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 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 judgement, 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 subpeona 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 type of denials.
We
have available forms to request access to your PHI and we
will provide a written response if we deny you 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 an 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 to 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. Worth Fire Department is not
required to agree to any restrictions you request, by any
restrictions agreed to by Worth Fire Department are binding
on Worth Fire Department.
Internet,
Electronic Mail, and the Right to Obtain Copy of Paper
Notice on Request. 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.
Revisions
to the Notice: Worth Fire Department 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. 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.
Effective
Date of the Notice: 14 April 2003 |
