Effective Date of This Notice: 08/11/2010
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.
As an essential part of our commitment to you, the City of St. Marys Fire Department maintains the privacy of certain confidential health care information about you, known as Protected Health Information or PHI. We are required by law to protect your health care information and to provide you with the following Notice of Privacy Practices.
The notice outlines our legal duties and privacy practices with respect to your PHI. It not only describes our privacy practices and your legal rights, but lets you know, among other things, how the City of St. Marys Fire Department is permitted to use and disclose PHI about you, how you can access and copy that information, how you may request amendment of that information, and how you may request restrictions on our use and disclosure of your PHI.
We respect your privacy, and treat all health care information about our patients with care under strict policies of confidentiality that all of our staff is committed to following at all times.
The City of St. Marys Fire Department 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 the City of St. Marys Fire Department is permitted to use and disclose PHI about you.
The City of St. Marys 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 you 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.
The City of St. Marys Fire Department 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, 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 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.
The City of St. Marys Fire Department is permitted, but not required, to use and disclose PHI without your written authorization or opportunity to object for the following purposes or situations:
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.
As a patient, you have a number of rights with respect to the protection of your PHI, including:
You have the right to inspect and obtain copies of your PHI for as long as your information is maintained in the designated record set. We may charge you a reasonable fee for copies of such information as well as postage if applicable. Your right of access to PHI does not extend to certain information. This includes information compiled in reasonable anticipation of, or for use in a civil, criminal or administrative proceeding.
Any request to exercise your right to access your PHI must be in writing. You may obtain a form to request access by contacting the Privacy Officer listed at the end of this notice. We will respond to your request for access within 30 days of receiving the request. If all or any part of your request is denied, the response will detail any appeal rights you may have.
You have the right to request that we amend your PHI if you believe it is inaccurate or incomplete. A request to amend your PHI must be done in writing. You may obtain a form to request an amendment by contacting the Privacy Officer listed at the end of this notice. We will respond to your request within 60 days of receiving your request. If we accept your request to amend the information, we will notify you. We will also make reasonable efforts to inform other persons, including those identified by you has having received your PHI and needing the amendment. We are permitted by law to deny your request to amend your medical information only in certain circumstances, for example if we believe the information you have asked us to amend is accurate. If your request is denied, you will receive notice which will explain any appeal rights you may have.
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 the medical facility 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. You may obtain a form from the Privacy Officer listed below 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 will receive a response within 60 days of your request.
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. However, 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. The City of St. Marys Fire Department is not required to agree to any restrictions you request, but any restrictions agreed to by the City of St. Marys Fire Department are binding on the City of St. Marys Fire Department. To request a restriction, you must direct your request to the Privacy Officer listed at the end of this notice.
You have the right to receive communications of PHI from us by alternate means or to an alternate location. Such requests must be directed to the Privacy Officer listed at the end of this notice and the proper form must be completed.
This Notice is prominently posted on our web site and is available electronically through our web site at www.cityofstmarys.net
The City of St. Marys 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 we maintain. Any material changes to the notice will be promptly posted in our facility and on our web site. You can get a copy of the latest version of this notice by contacting the Privacy Officer identified below.
You may file a written complaint with us or 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, nor for exercising any of your rights provided by the Privacy Rule.
If you have any questions or if you wish file a complaint or exercise any rights listed in this notice, please contact:
Fire Chief, Privacy Officer
City of St. Marys Fire Department
222 Indiana Avenue
St Marys, OH 45885