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 NOTICE OF PRIVACY ACT FOR
PLAINFIELD TWP. VOL. FIRE CO. 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 Sullivan Trail , Wind Gap , PA 18091 .  This notice of privacy describes how our company may use and disclose your Protected Health Information (PHI) to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.  It also describes your rights to access and control your PHI.  PHI is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.  Our Company is dedicated to maintaining the privacy of your PHI.  We are required to abide by the terms of this Notice of Privacy.  We may revise or amend the terms of our notice, at any time.  The new notice will be effective for all PHI that we have at that time and for future information.  We will post our current notice in our office in a visible location at all times and upon your request, we will provide you with any revised notice.
 
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 Sullivan Trail , Wind Gap , PA 18091 (610)863-3302.  You have the right to request that our company communicate with you about your health and related issues in a particular manner or at a certain location.  For instance, you may ask that we contact you at home, rather than work.  In order to request a type of confidential communication, you must make a written request to Plainfield Twp. Vol. Fire Co. & Ambulance Corp., Attn: Privacy Officer or call (610) 863-3302 specifying the requested method of contact, or the location where you wish to be contacted.  Our company will accommodate reasonable requests. You do not need to give a reason for your request.
·        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.