Notice Of Privacy Practices- Effective April 14,2003
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Understanding Your Health Record/Information
Each time an MVFD#5 Ambulance visits you, a record of the visit is made. Typically this record contains, for example, your symptoms, medical history and any treatments given. This information, often referred to as your health or medical record, serves as a:
record of the care you received;
basis for your care and treatment;
means of communication among the many health professionals who contribute to your care;
tool in educating health professionals;
potential data for medical research;
source of information for public health officials charged with improving the health of the nation: and
tool with which we can assess and continually work to improve the car we render and the outcomes we achieve.
Understanding what is in your record and how your health information is used helps you to:
better understand who, what, when, where and why others may access you health information; and
make more informed decisions when authorizing disclosure to others.
Your Rights
Although your health record is the physical property of MVFD#5, the information belongs to you. You have the right to:
Request a restriction on certain uses and disclosures of your information. You may ask us not
to use or disclose, or to limit the manner in which we use or disclose, your protected health information. You request must be in writing and must the specific restriction requested and to whom you want the restriction to apply.
If MVFD#5 believes that it is in your best interest to permit use and discloser of this information then we will not agree to your request, and this information will not be restricted. If MVFD#5 does agree to the requested restriction, then we may not use or disclose this information in violation of that restriction, unless it is needed to provide emergency treatment. Please direct any written inquiries regarding restrictions of your health information to MVFD#5.
Obtain a paper copy of this Notice of Privacy Practices upon request. If you received this
Notice on our website, you are also entitled to receive this notice in written form. MVFD#5 can provide you with a copy on request.
Inspect and copy your health record. You may obtain and inspect a copy of you protected health information for as long as we maintain said information. Typical records on file contain billing, treatment, past medical history, medication, allergies and address. Please note that you may be charged a reasonable copy fee. Please direct any written request to MVFD#5.
Amend your health record. Yu may request an amendment of your protected health information as long as we maintain said information. In certain cases, we may deny your request for an amendment. If we deny your request for an amendment, you have the right to file a statement of disagreement with us; we may prepare a rebuttal to your statement and will provide you with any such rebuttal. Please direct any written request to MVFD#5.
Obtain an accounting of disclosures of your health information. This right applies to disclosures for purposes other than treatment, payment or other health care operations and the other uses and disclosures discussed in the last two sections of this Notice. It also may exclude disclosures that are made to you or pursuant to your authorization; to family members or friends involved in your care; incidental to a use or disclosure; or disclosure that are made pursuant to state or federal law. You have a right to receive specific information regarding these disclosures that occurred after April 14th. 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations. Please direct written requests to MVFD#5.
Our Responsibilities
We are required by the HIPPA Privacy Rule to give you this notice about our privacy practices. Under the HIPPA Privacy Rule, MVFD#5 is required to:
maintain the privacy of your health information;
Provide you with a notice as to our legal duties and privacy practices with respect to information we and maintain about you;
Abide by the terms of this notice.
We will not use or disclose your health information without your written authorization, except as described by this Notice, You have the right to revoke your authorization to use or disclose your health information except to the extent that action has already been taken.
We may change the provisions of our Notice at any time. The new provisions will be effective for all protected health information that we maintain as long as the revised notice is in effect. You may obtain an updated copy of our Notice by access our website. ( www.mvfd5.com ) or by calling the Fire House and requesting one be mailed to you.
For more information or to Report a Complaint
If you want more information about our privacy practices or have questions or concerns, please contact us at
If you are concerned that we may have violated your privacy rights, you may complain to us using the contact information above. You may also submit a written complaint to the U.S. Department Of Health and Human Services.
Examples of Disclosures for Treatment, Payment and Health care Operations
We will use your health information for treatment. For example: We will use and disclose your protected health information to provide and manage your health care. For example we may disclose you're your protected health information to another E.M.S. service or any other health care provider related to your care.
We will use your health information for payment. For example: A bill may be sent to you or a third party payer. The information on or accompanying the bill may contain your treatments, supplies used in your treatment and information that identifies you.
Note that we may require your written consent to disclose some types of Protected Health Information covered by state or federal law more stringent than the HIPPA Privacy Policy. This includes, for example information relative to HIV, AIDS, mental health and/or substance and alcohol abuse.
Other Permitted Uses or Disclosures
Business Associates: MVFD#5 uses a contracted billing company to transmit bills for services rendered. We may disclose your protected information to these associates so that they can perform the job we have asked them to do. So that your health information is protected, however we require the associate to appropriately safeguard your information.
Others involved with your healthcare: MVFD#5 using its best judgment may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that persons involvement in you care or to payment related to your care. When you are not present to give consent. If we believe the disclosure is in your best interest. We may also disclose information to disaster relief agencies for the purpose of coordinating disaster relief or notifying friends or family members in times of disaster.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food.
Public Health: As required by law, we may disclose your health information to public or legal authorities charged with preventing or controlling disease, injury or disability.
Correctional Institution: If you are an inmate of a correctional institution, we may disclose to the institution, or agents thereof, health information necessary for health, and the safety of other individuals.
Law Enforcement: We may disclose health information for law enforcement purposes as required by law, in response to a valid subpoena, or to assist in identifying victims of crime.
Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child, senior or handicap abuse, neglect or domestic violence to the government entity or agency authorized to receive such information.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lesson a serious and imminent threat to a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to apprehend an individual.
Military Activity and National Security: We may disclose health information relative to specialized government functions, such as military and veteran activities, national security and intelligence activities, and to protect the President and others.
Legal Proceedings: We may disclose your protected health information in the course of legal proceedings, or in response to an order of the court or other lawful process, once we have met all administrative requirements of the HIPPA policy.
Health Oversight Activities: We may disclose your protected heath information to health oversight agency for activities authorized by law, such as audits; investigation; licensure or disciplinary actions, or civil, administrative or criminal proceedings or actions. Oversight agencies seeking this information include government agencies that over see: the health care system; government benefits programs; other government regulatory programs; and the compliance with civil rights laws.
Disclosure to the Secretary of the U.S. Department of Health and Human Services: We are required to disclose your protected health information to the Secretary of Health and Human Services when the Secretary is investigating or determining our compliance the HIPPA Privacy Rule.
