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LONGBOAT KEY FIRE
RESCUE
Patient Privacy Notice
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 of this Notice:
Longboat Key Fire Rescue is required by law to maintain the privacy of
certain confidential health care information, known as protected health
information or 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 Longboat Key Fire Rescue is permitted to use and disclose PHI
about you. Longboat Key Fire Rescue is also required to abide by the
terms of the version of this Notice currently in effect. We may use this
information after we obtain your consent, and in emergency and other
situations without your immediate consent.
Uses and Disclosures of PHI:
Longboat Key Fire Rescue may use PHI for the purposes of
treatment, payment, and other health care operations. Examples of our
use of your PHI:
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 your 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 (either
directly or through a third party billing company), management of billed
claims for services rendered, medical necessity determinations and
reviews, utilization review, and collection of outstanding accounts.
For health care 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, obtaining legal and
financial services, conducting business planning, processing grievances
and complaints, creating reports that do not individually identify you
for data collection purposes, fundraising, and certain marketing
activities.
Use and Disclosure of PHI
Without Your Consent
Longboat Key Fire Rescue is authorized to use PHI without your
consent, authorization, or written permission in certain situations,
including:
- Emergency situations (in these
situations, in accordance with the law we will attempt
to get your written consent
after the emergency service is provided and we would
appreciate your cooperation
when we do so);
- To a relative, friend or individual
involved in your care;
- 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;
- 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
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 your written consent or
an authorization (an authorization specifically identifies 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 access copy or inspect your PHI
This means you may come to our offices and 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 certain types of
denials may be appealed. We have available forms to request 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 copy your medical information,
you should contact the privacy officer listed at the end of this Notice.
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 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. 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 of uses or disclosures made prior to April
14, 2003. If you wish to request an accounting of the medical
information about you that we have used or disclosed, 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 in 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. Longboat Key Fire Rescue is not required to agree
to any restrictions you request, but any restrictions agreed to by
Longboat Key Fire Rescue are binding on Longboat Key Fire Rescue.
Legal Rights and Complaints
Notice of any changes in Longboat Key Fire Rescue's privacy policy may
be shown directly on the consent form and this Notice will be updated
when any significant changes in our privacy practices occur. Longboat
Key Fire Rescue reserves the right to change the terms of this Notice at
any time, and the changes will be effective immediately. We also 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 also have the right to complain to
us, or to the Secretary of the federal 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 government. Should you have any questions, comments or complaints
you may direct all inquiries to the privacy officer listed at the end of
this Notice.
If you have any questions or if you wish
to file a complaint or exercise any rights listed in this Notice, please
contact:
Thomas Sousa, Deputy Chief
Longboat Key Fire Rescue
5490 Gulf of Mexico Drive
Longboat Key, FL 34228
Effective Date of the Notice: 4/16/03
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.
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