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
Topsfield Fire Department (“TFD”) 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. TFD is also required to abide by the terms of the version of this Notice currently in effect.
Uses and Disclosures of PHI: TFD may use PHI for the purposes of treatment, payment, and health care operations, in most cases without
your written permission. Examples of our use of your 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 your PHI to other health care providers involved in your treatment, and may transfer your PHI
via radio or telephone to the hospital or dispatch.
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 submitting bills to insurance companies, making medical necessity determinations and collecting 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, as well as certain other management functions.
Use and Disclosure of PHI Without Your Authorization: TFD is permitted to use PHI without your written authorization, or opportunity to
object, in certain situations, and unless prohibited by a more stringent 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 relative, 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 a disclosure and
you do not raise an objection, and in certain other circumstances where we are unable to obtain your agreement and believe
the 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 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 responding to a warrant;
·
For military, national defense and security and other special government functions;
·
To avert a serious threat to the 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 oversight and approvals;
·
We may also use or disclose health information about you in a way that does not personally
identify you or reveal who you are.
Any other use or disclosure 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 Rights: As
a patient, you have a number of rights with respect to your PHI, including:
The right to access, copy 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 we will provide a written
response if we deny you access and let you know your appeal rights. You also
have the right to receive 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 your medical information only in certain circumstances, like when we believe
the information you have asked us to amend is correct. If you wish to request
that we amend the medical information that 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 have made in the 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, contact 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. TFD is not required
to agree to any restrictions you request, but any restrictions agreed to by TFD in writing are binding on TFD.
Internet, Electronic Mail, and the Right to Obtain Copy of
Paper Notice on Request.
We will prominently post a copy of this Notice on our web site. If you allow us, we will forward 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:
TFD reserves the right to change the terms of this Notice at any
time, and the changes will be effective immediately and will apply to all protected health information that we maintain. Any material changes to the Notice will be promptly posted in our facilities and posted
to our web site. You can get a copy of the latest version of 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 government. Should you have any questions, comments or complaints, you may direct all inquiries
to our privacy officer.
Privacy Officer Contact Information:
Jenifer Collins-Brown
Topsfield Fire Department
27 High Street
Topsfield, MA 01983
1-978-887-5148
jcbrown@topsfieldfire.com
