NOTICE OF PRIVACY
FOR THE
PLAINFIELD TOWNSHIP VOLUNTEER FIRE CO. AND AMBULANCE CORP.
Notice of Privacy as required by the Privacy Regulations created as a result of
the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE
REVIEW THIS NOTICE CAREFULLY.
If you have any questions about this notice, please contact our privacy officer
at 6480
DISCLOSURES
1.
Uses and
Disclosures to carry out treatment, payment or health care operations:
a.
Under HIPAA
regulations, we do not need to obtain permission to use health information for
treatment, payment and health care operations.
b.
We may use and
disclose your PHI for the following reasons:
i.
Treatment: We
will use and disclose your PHI to provide, coordinate, or manage your health
care and any related services. This includes the coordination or management
of your health care with a third party.
ii.
We may disclose
your PHI to others who may assist in your care, such as your spouse, children or
parents. Finally, we may also disclose your PHI to other health care providers
for purposes related to your treatment.
c.
Payment: Your
PHI will be used, as needed, to obtain payment for your health care services.
This may include certain activities that your health insurance plan may
undertake before it approves or pays for the health care services we provided
for you.
d.
Healthcare
Operations: We may use or disclose, as-needed, your PHI in order to support the
business activities of Plainfield Township Volunteer Fire and Ambulance Company.
These activities include, but are not limited to, quality assessment activities,
employee review activities, training of students, and certification activities.
We will share your PHI with third party "business associates"
that perform activities (e.g., billing) for the company. However, whenever an
arrangement between our office and a business associate involves the use or
disclosure of your PHI, we will have a written contract that contains terms that
will protect the privacy of your PHI.
e.
Appointment
Reminders (if applicable): We may use or disclose your PHI, as necessary, to
contact you to remind you of appointments or prescheduled transports.
f.
Treatment
Options and Services (if applicable): We may use or disclose your PHI, as
necessary, to provide you with information about transport alternatives or other
health-related benefits and services that may be of interest to you. However, we
will get a written authorization from you for further marketing purposes.
i.
Uses and
disclosures that you can agree or object to:
1.
We may use and
disclose your PHI in the following instances, which you have the opportunity to
object to.
a.
Others Involved
in Your Healthcare: Unless you object, we may disclose to a member of your
family, a relative, a close friend or any other person you identify, your PHI
that directly relates to that person's involvement in your health care.
If you are unable to agree or object to such a disclosure, we may
disclose such information as necessary if we determine that it is in your best
interest based on our professional judgment.
We may use or disclose PHI to notify or assist in notifying a family
member, personal representative or any other person that is responsible for your
care of your location, general condition or death.
Finally, we may use or disclose your PHI to an authorized public or
private entity to assist in disaster relief efforts and to coordinate uses and
disclosures to family or other individuals involved in your health care.
b.
Emergencies: We
may use or disclose your PHI in an emergency treatment situation.
If this happens, your physician shall allow you to object to future
disclosures as soon as reasonably practicable after the delivery of treatment.
2.
Uses and
disclosures that we will obtain your written authorization for:
a.
Marketing: For
most marketing purposes we will obtain your written consent.
3.
Uses and
disclosures for which an authorization or opportunity to agree or object to is
not required.
a.
We may use or
disclose your PHI in the following situations:
i.
Required By Law:
We may use or disclose your PHI to the extent that the use or disclosure is
required by law. The use or
disclosure will be made in compliance with the law and will be limited to the
relevant requirements of the law. You will be notified, as required by law, of
any such uses or disclosures.
ii.
Public Health:
We may disclose your PHI for public health activities and purposes to a public
health authority that is required or permitted by law to receive the
information. The disclosure will be made for the purpose of controlling or
reporting disease, injury or disability. We
may also disclose your PHI, if directed by the public health authority, to a
foreign government agency that is collaborating with the public health
authority.
iii.
Communicable
Diseases: We may disclose your PHI, if authorized by law, to a person who may
have been exposed to a communicable disease or may otherwise be at risk of
contracting or spreading the disease or condition.
iv.
Abuse or
Neglect: We may disclose your PHI to a public health authority that is
authorized by law to receive reports of child abuse or neglect. In addition, we
may disclose your PHI if we believe that you have been a victim of abuse,
neglect or domestic violence to the governmental entity or agency authorized to
receive such information. In this
case, the disclosure will be made consistent with the requirements of applicable
federal and state laws.
v.
Maintenance of
Vital Records: We may report data such as births and deaths.
vi.
Health
Oversight: We may disclose PHI to a health oversight agency for activities
authorized by law, such as audits, investigations, and inspections. Oversight
agencies seeking this information include government agencies that oversee the
health care system, government benefit programs, other government regulatory
programs and civil rights laws.
vii.
Legal
Proceedings: We may disclose PHI in the course of any judicial or administrative
proceeding, in response to an order of a court or administrative tribunal (to
the extent such disclosure is expressly authorized), in certain conditions in
response to a subpoena, discovery request or other lawful process.
viii.
Law Enforcement:
We may also disclose PHI, so long as applicable legal requirements are met, for
law enforcement purposes. These law
enforcement purposes include (1) legal processes and otherwise required by law,
(2) limited information requests for identification and location purposes, (3)
pertaining to victims of a crime, (4) suspicion that death has occurred as a
result of criminal conduct, (5) in the event that a crime occurs on the premises
of the company and (6) medical emergency (not on the company's premises) and it
is likely that a crime has occurred.
ix.
Coroners,
Funeral Directors, and Organ Donation: We may disclose PHI to a coroner or
medical examiner for identification purposes, determining cause of death or for
the coroner or medical examiner to perform other duties authorized by law.
We may also disclose PHI to a funeral director, as authorized by law, in
order to permit the funeral director to carry out their duties. We may disclose
such information in reasonable anticipation of death.
PHI may be used and disclosed for cadaveric organ, eye or tissue donation
purposes.
x.
Research: We may
disclose your PHI to researchers when their research has been approved by an
institutional review board that has reviewed the research proposal and
established protocols to ensure the privacy of your PHI.
Otherwise, we will ask for a written authorization from you.
xi.
Criminal
Activity: Consistent with applicable federal and state laws, we may disclose
your PHI, if we believe that the use or disclosure is necessary to prevent or
lessen a serious and imminent threat to the health or safety of a person or the
public. We may also disclose PHI if
it is necessary for law enforcement authorities to identify or apprehend an
individual.
xii.
Workers'
Compensation: Your PHI may be disclosed by us as authorized to comply with
workers' compensation laws and other similar legally-established programs.
xiii.
Required Uses
and Disclosures: Under the law, we must make disclosures to you and when
required by the Secretary of the Department of Health and Human Services to
investigate or determine our compliance with the requirements of Section 164.500
et. seq.
YOUR RIGHTS
Following is a statement of your rights with respect to your PHI and a brief
description of how you may exercise these rights.
·
You have the
right to inspect and copy your PHI:
o
This means you
may inspect and obtain a copy of PHI about you that is contained in a designated
record set for as long as we maintain the PHI.
A "designated record set" contains medical and billing records
and any other records that your physician and the Company uses for making
decisions about you. This may not
include psychotherapy notes. You
must submit your request in writing to the Privacy Officer in order to inspect
and/or obtain a copy of your PHI. Our
company may charge a fee for the costs of copying, mailing, labor and supplies
associated with your request. Our
company may deny your request to inspect and/or copy in certain limited
circumstances; however, you may request a review of our denial.
Another licensed health care professional chosen by us will conduct
reviews. Please contact our Privacy
Officer, at (610) 863-3302 if you have questions about access to your medical
record.
·
You have the
right to request a restriction of your PHI:
o
This means you
may ask us not to use or disclose any part of your PHI for the purposes of
treatment, payment or healthcare operations.
You may also request that any part of your PHI not be disclosed to family
members or friends who may be involved in your care or for notification purposes
as described in this Notice of Privacy. Your
request must state the specific restriction requested and to whom you want the
restriction to apply. Your physician
is not required to agree to a restriction that you may request.
You may request a restriction by contacting: Privacy Officer, 6480
·
You may have the
right to have the company amend your PHI:
o
This means you
may request an amendment of PHI about you in a designated record set for as long
as we maintain this information. In
certain cases, for example if we think the information is correct, or was not
created by our company, we may deny your request for an amendment.
If we deny your request for amendment, you have the right to file a
statement of disagreement with us and we may prepare a rebuttal to your
statement and will provide you with a copy of any such rebuttal.
Please contact our Privacy Officer to determine if you have questions
about amending your medical record. To
file an amendment, your request must be in writing and must be submitted to the
Privacy Officer, (610) 863-3302.
·
You have the
right to receive an accounting of certain disclosures we have made, if any, of
your PHI:
o
This right
applies to disclosures for purposes other than treatment, payment or healthcare
operations as described in this Notice of Privacy Statement. Accounting
is not required for disclosures we may have made to you, incidental disclosures,
disclosures you have authorized, disclosures for a facility directory,
disclosures to family members or friends involved in your care, or disclosures
made to carry out treatment, payment or health care operations.
You have the right to receive specific information regarding disclosures
that occurred after April 14, 2003 up to a six year timeframe.
You may request a shorter timeframe.
The right to receive this information is subject to certain exceptions,
restrictions and limitations.
o
In order to
obtain an accounting of disclosures, you must submit your request in writing to
the Privacy Officer, (610)863-3302. The
company may charge you for additional lists within the same 12-month period. Our
company will notify you of the costs involved with additional requests, and you
may withdraw your request before you incur any costs.
o
You have a right
to a paper copy of this notice. You
are entitled to receive a paper copy of our notice of privacy even if you have
agreed to receive an electronic copy of the notice. You
may ask us to give you a copy of this notice at any time. To obtain a paper copy
of this notice, contact the Privacy Officer at (610)863-3302.
o
You have a right
to file a complaint if you believe your privacy rights have been violated.
You may file a complaint with our company or with the Secretary of the
Department of Health and Human Services. To
file a complaint with our company, contact the Privacy Officer at (610)
863-3302. All complaints must be
submitted in writing. You will not be penalized for filing a complaint.
This
notice was published and becomes effective on April 13, 2003.
We
will revise the notice if we make material changes to it. You
can get a copy of the latest version of this notice by contacting the Privacy
Officer or any staff member.