Factoryville
Fire Company
HIPAA
Notice
The Factoryville
Fire Company Volunteer Fire Department (FFC VFD) Notice of Privacy Practices
(NPP)
This notice describes
how medical information about you may be used and disclosed and how you
can access to this information. PLEASE READ IT CAREFULLY.
FFC VFD Ambulance
Service, is required by law to maintain the privacy of certain confidential
health 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 FFC VFD Ambulance is also requried to abide by the
terms of the version of this notice currently in effect.
Uses and Disclosures
of PHI:
FFC VFD Ambulance
may use PHI for the purposes of treatment, payment, and health care operations,
in most cases without your written persmission. Examples of our use
of you PHI:
For Treatment:
This includes such things as obtaining verbal and written information about
your medical condition and treatment from you as well as from others, such
as doctors and nurses who give orders to allow us to provide treatment
to you. We may give you PHI to other health care providers involved
in your treatment, and may transfer you PHI via radio or telephoe to the
hospital or dispatch center.
For Payment:
This includes any activities we must under take in order to get reimbursed
for the services we provide to you, including such things as submitting
bills to insurance companies, making medical necessity determinations,
and collecting outstanding accounts.
For healthcare
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, as well as certain
other management functions.
Use and Disclosure
of PHI without your Authorization.
FFC VFD Ambulance
is permitted to use PHI without your written authorization, or opportunity
to object, in certain situations, and unsless prohibited by a more strigent
state law, including:
- For the treatment,
payment or health care operations activities of another health care provider
who treats you.
- For health care and
legal compliance activities.
- To a family member,
other realtive, 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 disclosure is in your best interests.
- To a public health
authority in certain situations as required by law (such as to report abuse,
neglect or domestic violence;
- 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 or 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 responding to a warrant.
- For military,
national defense and security and other special government functions.
- To avert a serious
threat to health and safety of a person or the public at large.
- For workers' compensation
purposes, and in compliance with workers compensation laws.
- To coroners, medical
examiners, and funeral directors for identifying a deceased person, determining
cause of death, or carrying on their duties as authorized by law.
- 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.
- For research projects,
but this will be subject to strict oversightand approvals.
- We may also disclose
health information about you in a way that does not personally identify
or reveal who you are.
Any other use or discloser
of PHI, other than those listed above will only be made with your written
authorization. You may revoke your authorization at any time in writing,
except to the extent that we have already used or disclosed medical information
in reliance on that authorization.
Patient's Rights:
As a patient,
you have a number of rights with respect to your PHI, including:
The right to access
copies or inspect your PHI. This means you may 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 you may appeal certain types
of denials. 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. You also have the right to recieve confidential communications
of your PHI. If you wish to inspect and copy your medical information,
you should contact our privacy officer.
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 the medical information we have about
you, you should contact our privacy officer.
The right to request
an accounting.
You may request an
accounting from us of certain disclosures of your medical information that
we made in 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 when we share
your health information with our business associates, like our billing
company or a medical facility from/to which we have transported you. 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 ask our privacy officer.
The right to request
that we restrict the uses and disclosures of your PHI.
You have the right
to request that we restrict how we use and disclose your medical information
that we have about you. FFC VFD Ambulance is not required to agree to any
restrictions you request, but any restrictions agreed to by Ambulance in
writting are binding on FFC VFD Ambulance.
Internet, Electronic
Mail, and the Right to Obtain Copy of Paper Notice on Request.
If we maintain a
website, we will promptly post a copy of this notice on our website. If
you allow us, FFC VFD Ambulance will forwqard 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.
FFC VFD Ambulance
reserves the right to change the terms of this Notice at ant time, and
the changes will be effective immediately and will apply to all protected
health information that we maintain. Anr material changes to the Notice
will be promptly posted in our facilities and posted to our website, if
we maintain one. You can get a copy of the latest versionof this Notice
by contacting our privacy officer.
Your Legal Rights
and Complaints.
You also have the
right to complain to us, or to the Secretary of the United States 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 governmant. Should you have any questions, comments,
or complaints you may direct them to our privacy officer.
Privacy Officer
Contact Information:
Mary M. Greenley
Factoryville Fire
Company VFD
PO Box 321 Factoryville,
Pa. 18419
Phone # 570-945-5769
FAX # 570-945-7252
E-Mail FactoryvilleEMS@aol.com
Effective date of
the Notice:
April 14, 2003
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