Purpose of this Notice:
Glenwood Springs Fire Department 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 your 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 Glenwood Springs Fire Department is permitted to use and disclose PHI about you. Glenwood Springs Fire Department is required to abide by the terms of the version of this Notice currently in effect. Current Colorado State and/or Federal statutes are referenced as a resource to you.
Glenwood Springs Fire Department’s responsibilities as a provider of emergency medical services:
We may use your PHI for the purposes of treatment, payment and other health care operations, as stated below (45 CFR 164.501):
· 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 you r 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, management of billed claims for services rendered, medical necessity determinations and reviews, utilization review, and collection of outstanding accounts.
· For healthcare operations. This includes quality assurance activities, licensing, and training programs to ensure that our personnel meet the highest standards of care and follow established policies and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints, and creating reports that do not individually identify you (for data collection purposes). Please note that in using your PHI for these purposes, all identifying factors of your PHI will be removed.
In addition, Glenwood Springs Fire Department may be required to release protected health information about you under the following circumstances:
· To a public health authority in certain situations (such as reporting a birth, death or disease as required by law [45 CFR 164.512 (b) (I) (i)], 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 or subpoena 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 to 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 a signed and notarized request from you. You may revoke your request at any time, in writing, except to the extent that we have already used or disclosed medical information in reliance on that consent.
Your rights as a patient:
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 that you may come to our office and inspect and request a copy of the medical information about you that we maintain. We have available forms to request PHI, and we will normally provide you with access to this information within 14 days of our receipt of your request. As the patient, you will not be assessed a fee to obtain a copy of any medical information that you have the right to access.
If you wish to request a copy of your medical information, you should contact the Privacy Officer listed at the end of this Notice.
In limited circumstances, we may deny you access to your medical information, and certain types of denials may be appealed. We will provide written response if we deny you access and notify you of your appeal rights.
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 in certain circum-
stances, for example, when we believe the information you have asked us to amend is incorrect. 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, send your written request to the Privacy Officer listed at the end of this Notice.
The right to request an accounting of our use and disclosure 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 healthcare operations, or of uses or disclosures made prior to April 14, 2003.
If you wish to request an accounting of your PHI that we have used or disclosed, you may send a written request to 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 the medical information that we have about you for treatment, payment or healthcare operations, or to restrict the information that is provided to family, friends and other individuals involved in your healthcare. 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. Glenwood Springs Fire Department is not required to agree to any restrictions you request, but any restrictions agreed to by Glenwood Springs Fire Department are binding on Glenwood Springs Fire Department (45 CFR 164.522 (a)).
Legal rights and complaints. Notice of any changes in Glenwood Springs Fire Department’s Privacy Policy will be posted on our website, www.glenwoodfire.com, and the changes will be effective immediately. You may also request a copy of the latest version of the latest version of this Notice by contacting the Privacy Officer listed at the end of this Notice.
We 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 have the right to complain to Glenwood Springs Fire Department, or to the Secretary of the Federal Department of Health and Human Services if you believe that 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 in writing to the Privacy Officer listed at the end of this Notice.
Privacy Officer: Michelle Simono
Fire Chief: Michael E. Piper
Glenwood Springs Fire Department
101 West 8th street
Glenwood Springs, CO 81601
970-384-6480
Fax: 970-945-8506
Updated August 2006