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Notice of Privacy Practices
IMPORTANT: 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.
As an essential part of our commitment to
you, Hampton Fire/Rescue maintains the privacy of certain
confidential health care information about you, known as
Protected Health Information or PHI. We are required by law
to protect your health care information and to provide you
with the attached Notice of Privacy Practices.
The Notice outlines our legal duties and
privacy practices with respect to your PHI. It not only
describes our privacy practices and your legal rights, but
lets you know, among other things, how Hampton Fire/Rescue
is permitted to use and disclose PHI about you, how you can
access and copy that information, how you may request
amendment of that information, and how you may request
restrictions on our use and disclosure of your PHI.
Hampton Fire/Rescue is also required to
abide by the terms of the version of this Notice currently
in effect. In most situations we may use this information as
described in this Notice without your permission, but there
are some situations where we may use it only after we obtain
your written authorization, if we are required by law to do
so.
We respect your privacy, and treat all
health care information about our patients with care under
strict policies of confidentiality that all of our staff are
committed to following at all times.
PLEASE READ THE ATTACHED DETAILED NOTICE.
IF YOU HAVE ANY QUESTIONS ABOUT IT, PLEASE CONTACT OUR
PRIVACY OFFICER, AT 603-926-3316.
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:
Hampton Fire/Rescue is required by law to
maintain the privacy of certain confidential health care
information, known as Protected Health Information “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 Hampton Fire/Rescue is
permitted to use and disclose PHI about you.
Hampton Fire/Rescue is also required to
abide by the terms of the version of this Notice currently
in effect. In most situations we may use this information as
described in this Notice without your permission, but there
are some situations where we may use it only after we obtain
your written authorization, if we are required by law to do
so.
Uses and Disclosures of PHI:
Hampton Fire/Rescue 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
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 or dispatch center, 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.
Fundraising.
We may contact you when we are in the
process of raising funds for Hampton Fire/Rescue, or to
provide you with information about our annual subscription
program.
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 for
other information about alternative services we provide or
other health-related benefits and services that may be of
interest to you.
Use and Disclosure of PHI Without Your Authorization.
Hampton Fire/Rescue is permitted to use PHI without
your written authorization, or opportunity to object in
certain situations, including:
· For Hampton Fire/Rescue’s use in treating you or in
obtaining payment for services provided to you or in other
health care operations;
· For the treatment activities of another health care
provider;
· To another health care provider or entity for the payment
activities of the provider or entity that receives the
information (such as your hospital or insurance company);
· To another health care provider (such as the hospital to
which you are transported) for the health care operations
activities of the entity that receives the information as
long as the entity receiving the information has or has had
a relationship with you, and the PHI pertains to that
relationship;
· For health care fraud and abuse detection, or for activities
related to compliance with the law;
· 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. We may also disclose health information to your
family, relatives, or friends if we infer from the
circumstances that you would not object. For example, we may
assume you agree to our disclosure of your personal health
information to your spouse when your spouse has called the
ambulance for you. In situations where you are not capable
of objecting (because you are not present or due to your
incapacity or medical emergency), we may, in our
professional judgment, determine that a disclosure to your
family member, relative, or friend is in your best interest.
In that situation, we will disclose only health information
relevant to that person's involvement in your care. For
example, we may inform the person who accompanied you in the
ambulance that you have certain symptoms and we may give
that person an update on your vital signs and treatment that
is being administered by our ambulance crew;
· 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, neglect or domestic violence, 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 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, 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 and health information will be
released only when there is a minimal risk to your privacy
and adequate safeguards are in place in accordance with the
law;
· We may 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, (the authorization must specifically identify
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 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
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 copies of 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. 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
notify you when we have amended the information. We are
permitted by law to deny your request to amend your medical
information 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 the privacy
officer listed at the end of this Notice.
The right to request an accounting of our use and disclosure
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 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 of the
medical information about you that we have used or disclosed
that is not exempt from the accounting requirement, 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 request that we restrict how we use
and disclose your medical information 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
that is protecting you for emergency treatment. Hampton
Fire/Rescue is not required to agree to any restrictions you
request, but any restrictions agreed to by Hampton
Fire/Rescue are binding on Hampton Fire/Rescue.
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 and
make the Notice available electronically through the 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:
Hampton Fire/Rescue 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 the Privacy Officer identified
below.
Your Legal Rights and Complaints:
You also have the right to complain to us, or to the
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.
Individuals will not be retaliated against for filing a
complaint.
If you have any questions or if you wish
to file a complaint or exercise any rights listed in this
Notice, please contact:
Hampton
Fire/Rescue
64
Ashworth Avenue
Hampton, New Hampshire 03842
603-926-3316
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