CHAMBERSBURG FIRE DEPT. AMBULANCE.
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.
Chambersburg Fire Dept. ( Chambersburg FD
) 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. Chambersburg
FD is also required to abide by the terms of the version of
this Notice currently in effect.
Uses and Disclosures of PHI : Chambersburg FD 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 center. 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.
Reminders for Scheduled Transports and Information on Other
Services. We may also contact you to provide you with a reminder
of any scheduled appointments for non-emergency ambulance and
medical transportation, or to provider information about other
services we provide.
Use and Disclosure of PHI Without Your Authorization. Chambersburg
FD 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 approval;
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. Chambersburg FD is not required to agree to any restrictions
you request, but any restrictions agreed to by Chambersburg
FD in writing are binding on Chambersburg FD.
Internet, Electronic Mail, and the Right to Obtain Copy of Paper
Notice on Request. If we maintain a web site, 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: Chambersburg FD 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, if we maintain one. 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:
David Finch, Privacy Officer
Borough of Chambersburg
100 Second St.
Chambersburg, Pa 17201
(717) 261- 3200 - Telephone
(717) 264- 0224 - Fax
Effective Date of the Notice: April 14, 2003 Copyright 2003,
Page, Wolfberg & Wirth, LLC. Use by individual ambulance
services permitted. Any other use or reproduction in any
form requires our express written permission.
Contact us at www.pwwemslaw.com
All contents � Copyright 2010 by Borough of Chambersburg. No part may be reproduced in any form without explicit written permission.
