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Rockingham
County Department of Emergency Services 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: Rockingham
County EMS is required by law to maintain the privacy of certain
confidential health care information, known as protected health
information (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 Rockingham County EMS is permitted to use
and disclose PHI about you. Rockingham
County EMS 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 PHI:
Rockingham County EMS may use PHI for the purposes of treatment, payment,
and other health care operations, in most cases without your written
permission. An example of our
use of your PHI: 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. Uses
and Disclosures of PHI without your Authorization: Rockingham
County EMS is permitted to use PHI without your written authorization, or
opportunity to object in certain situations, including: Ø For Rockingham County EMS’s use in treating you or in obtaining payment for services provided to you or in other health care operations; Ø
For the treatment
activities of another health care provider; Ø
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). Ø
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 the entity receiving the information has or has had
a relationship with you and the PHI pertains to that relationship; Ø
For health care fraud and
abuse detection or for activities related to compliance with the law; Ø
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; Ø
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; Ø
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; Ø
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; Ø
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; Ø
For military, national
defense and security and other special government functions; Ø
To avert a serious threat
to the health and safety of a person or the public at large; Ø
For workers’
compensation purposes, and in compliance with workers compensation laws; Ø
To coroners, medial
examiners, and funeral directors for identifying a deceased person,
determining cause of death, or carrying on their duties as authorized by
law; Ø
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; Ø
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; Ø
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 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 request an alternative method of contact.
You have the right to request to be contacted at a different
location or by a different method. For
example, you may prefer to have all written information mailed to your
work address rather than to your home address.
We will agree to any reasonable request for alternative methods of
contact. If you would like to
request an alternative method of contact, you must provide us with a
request in writing. The
right to access, copy or inspect your PHI. This means that you may
come to our offices and inspect and receive copies of the medical
information about you that we maintain.
We will normally provide your with access to this information
within thirty days of your request. We
may also charge you a reasonable fee 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 access to your 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 receive copies of your medical
information, you should contact the privacy officer listed at the end of
this Notice. The
right to amend you 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 sixty 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.
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, beginning April 1, 2003.
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 a medical facility from /to which you have been
transported. 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 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 you 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. Rockingham
County EMS must request that any such health care provider not use or
disclose the information further. Rockingham
County EMS is not required to agree to any restrictions you request, but
any restrictions agreed to by Rockingham County EMS shall be binding on us
except as otherwise provided by law. Internet,
Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request.
If we maintain a web site, we will prominently post a cop of this
Notice on our web site and make the Notice available electronically
through the web site. If you
allow us, we will forward you this Notice by electronic mail instead of on
paper and you may always request a paper copy of the Notice. Revisions
to the Notice.
Rockingham County EMS 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, if we maintain one.
You can get a copy of the latest version of this Notice by contact
the Privacy Officer identified below. Legal
Rights and Complaints. If you
believe your privacy rights have been violated you have the right to
complain to us, or to the Secretary,
Department of Health and Human Services You
will not be retaliated against in any way for filing a complaint with us
or with the government. Should
you have any questions, comments or complaints you may direct all inquires
to the privacy officer listed at the end of this Notice. If you have
questions or if you wish to file a complaint or exercise any rights listed
in this Notice, please contact: Kent
Greene, Director Effective
Date:
April 1, 2003 We will revise this 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. |