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: Simla Volunteer 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 Simla Volunteer Fire Department
is permitted to use and disclose your PHI. Simla Volunteer Fire Department 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:
Simla Volunteer Fire Department
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.
Simla Volunteer Fire Department 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. Simla Volunteer Fire Department is not required to agree
to any restrictions you request, but any restrictions agreed to by Simla Volunteer
Fire Department are binding on Simla Volunteer Fire Department
.
Legal Rights and
Complaints:
Notice
of any changes in Simla Volunteer Fire Department 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. Simla Volunteer Fire Department 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:
Simla Volunteer Fire Department
District
Attn: Privacy
Officer
PO Box 161, 219 Souix
Ave.
(719)
541-2883
Effective
Date of the Notice:
April 1, 2003
Simla Volunteer Fire Department 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.