|
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.
WHO MUST FOLLOW THIS NOTICE:
This notice describes the privacy practices of First
Responder EMS, Inc.
We are required by law to:
-
Maintain the
privacy of protected health information;
-
Give you this
notice of our legal duties and privacy practices regarding health information
about you; and
-
Follow the terms
of our notice that is currently in effect.
-
For Treatment. We may use
Health Information to treat you or provide you with health care services.
We may disclose Health Information to doctors, nurses, technicians, or other
personnel, including people outside our facility who may be involved in your
medical care. For example, we may tell your primary physician about the
care we provided you or give Health Information to a specialist to provide you
with additional services.
-
For Payment. We may use and disclose Health Information so that we or others may
bill or receive payment from you, an insurance company or a third party for the
treatment and services you received. For example, we may give your health plan
information about your treatment so that they will pay for such treatment. We
also may tell your health plan about a treatment you are going to receive to
obtain prior approval or to determine whether your plan will cover the
treatment.
-
For Health Care Operations.
We may use and disclose Health Information for health care operations purposes.
These uses and disclosures are necessary to make sure that all of our patients
receive quality care and for our operation and management purposes. For
example, we may use Health Information to review the treatment and services we
provide to ensure that the care you receive is of the highest quality.
SPECIAL CIRCUMSTANCES
-
As Required by Law.
We will disclose Health Information when required to do so by international,
federal, state or local law.
-
To Avert a Serious Threat to Health or Safety.
We may use and disclose Health Information
when necessary to prevent or lessen a serious threat to your health and safety
or the health and safety of the public or another person. Any disclosure,
however, will be to someone who may be able to help prevent the threat.
-
Business Associates. We
may disclose Health Information to our business associates that perform
functions on our behalf or provide us with services if the information is
necessary for such functions or services. For example, we may use another
company to perform billing services on our behalf. All of our business
associates are obligated, under contract with us, to protect the privacy of your
information and are not allowed to use or disclose any information other than as
specified in our contract.
-
Organ and Tissue Donation. 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 or tissue donation and transplantation.
-
Military and Veterans.
If you are a member of the armed forces, we may release Health Information as
required by military command authorities. We also may release Health
Information to the appropriate foreign military authority if you are a member of
a foreign military.
-
Workers’ Compensation.
We may release Health Information for workers’ compensation or similar programs.
These programs provide benefits for work-related injuries or illness.
-
Public Health Risks. We
may disclose Health Information for public health activities. These
activities generally include disclosures to prevent or control disease, injury
or disability; report births and deaths; report child abuse or neglect; report
reactions to medications or problems with products; notify people of recalls of
products they may be using; track certain products and monitor their use and
effectiveness; notify a person who may have been exposed to a disease or may be
at risk for contracting or spreading a disease or condition; and conduct medical
surveillance of the office in certain limited circumstances concerning workplace
illness or injury. We also may release Health Information to an
appropriate government authority if we believe a patient has been the victim of
abuse, neglect or domestic violence; however, we will only release this
information if you agree or when we are required or authorized by law.
-
Health Oversight Activities. We may disclose Health Information to a health oversight
agency for activities authorized by law. These oversight activities include,
for example, audits, investigations, inspections, and licensure. These
activities are necessary for the government to monitor the health care system,
government programs, and compliance with civil rights laws.
-
Lawsuits and Disputes. If
you are involved in a lawsuit or a dispute, we may disclose Health Information
in response to a court or administrative order. We also may disclose
Health Information in response to a subpoena, discovery request, or other lawful
process by someone else involved in the dispute, but only if efforts have been
made to tell you about the request or to obtain an order protecting the
information requested.
-
Law Enforcement. We may
release Health Information if asked by a law enforcement official for the
following reasons: (1) in response to a court order, subpoena, warrant, summons
or similar process; (2) limited information to identify or locate a suspect,
fugitive, material witness, or missing person; (3) about the victim of a crime
if, under certain limited circumstances, we are unable to obtain the person’s
agreement; (4) about a death we believe may be the result of criminal conduct;
(5) about criminal conduct on our premises; and (6) in emergency circumstances
to report a crime, the location of the crime or victims, or the identity,
description, or location of the person who committed the crime.
-
Coroners, Medical Examiners and Funeral Directors.
We
may release Health Information to a coroner or medical examiner. This may
be necessary, for example, to identify a deceased person or determine the cause
of death. We also may release Health Information to funeral directors as
necessary for their duties.
-
National Security and Intelligence Activities. We
may release Health Information to authorized federal officials for intelligence,
counter-intelligence, and other national security activities authorized by law.
-
Protective Services for the President and Others.
We may disclose Health Information to
authorized federal officials so they may provide protection to the President,
other authorized persons or foreign heads of state or conduct special
investigations.
-
Inmates or Individuals in Custody. If you are an inmate of a correctional institution
or under the custody of a law enforcement official, we may release Health
Information to the appropriate correctional institution or law enforcement
official. This release would be made only if necessary (1) for the institution
to provide you with health care; (2) to protect your health and safety or the
health and safety of others; or (3) for the safety and security of the
correctional institution.
YOUR RIGHTS:
You
have the following rights regarding Health Information we maintain about you:
-
Right to Inspect and Copy. You
have the right to inspect and copy Health Information that may be used to make
decisions about your care or payment for your care.
-
Right to Amend. If you feel
that Health Information we have is incorrect or incomplete, you may ask us to
amend the information. You have the right to request an amendment for as
long as the information is kept by or for us.
-
Right to an Accounting of Disclosures.
You have the right to request an accounting of
certain disclosures of Health Information we made.
-
Right to Request Restrictions. You
have the right to request a restriction or limitation on the Health Information
we use or disclose for treatment, payment, or health care operations. In
addition, you have the right to request a limit on the Health Information we
disclose about you to someone who is involved in your care or the payment for
your care, like a family member or friend. For example, you could ask that
we not share information about your surgery with your spouse.
We are not required to agree to
your request. If we agree, we will comply with your request unless we
need to use the information in certain emergency treatment situations.
-
Right to Request Confidential Communications. You
have the right to request that we communicate with you about medical matters in
a certain way or at a certain location. For example, you can ask that we
contact you only by mail or at work. Your request must specify how or
where you wish to be contacted. We will accommodate reasonable requests.
-
Right to a Paper Copy of This Notice.
You
have the right to a paper copy of this notice. You may ask us to give you
a copy of this notice at any time. Even if you have agreed to receive this
notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this
notice at our web site:
www.firstresponder.com
To obtain a paper copy of this notice, or to request restrictions to any
of the above rights, please the submit the request in writing to:
First Responder EMS, Inc.
PO Box 24, Chico, CA. 95927
CHANGES TO THIS NOTICE:
We reserve the right to change
this notice. We reserve the right to make the revised or changed notice
effective for Health Information we already have as well as any information we
receive in the future. We will post a copy of the current notice at our
office. The notice will contain the effective date on the first page, in the
top right-hand corner.
COMPLAINTS:
If you
believe your privacy rights have been violated after April 14, 2003, you may
file a complaint with us or the Secretary of the Department of Health and Human
Services. To file a complaint with us, please submit the complaint in writing
to:
First Responder EMS, Inc.
PO Box 24
Chico, CA. 95927
Attn: Privacy Officer
or
By
contacting the Secretary of the United States Department if Health & Human
Services at the address below:
Secretary of the U.S. Department
of Health and Human Services
Office for Civil Rights
Attention: Regional Manager
50 United Nations Plaza, Room 322
San Francisco, CA. 94102
|