CROSBY TOWNSHIP FIRE DEPARTMENT
9139 Baughman Road Harrison, Ohio 45030
This notice describes how medical information about you may be used, disclosed and how you can obtain access to this information. Please review this information carefully. If you have any questions, please contact our Privacy Officer at 738-1831.
This Notice of Privacy Practices (NPP) describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control certain confidential health care information about you, known as Protected Health Information (PHI). Examples of PHI include demographic information, physical, mental health, condition and related health care services.
We may change the terms of our notice at any time. The new notice will be effective for PHI that we maintain at the time. Upon your request, we will provide you with any revised Notice of Privacy Practices by calling our station and requesting that a revised copy be sent to you via U.S. mail.
In most cases, we may use your PHI for the purposes of treatment, payment, and health care operations without you permission. Examples for our use of you PHI include:
Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related service. This includes verbal and written information that we obtain about you and use pertaining to your medical condition and treatment rendered by us and other medical personnel involved in your care. It also includes information we give to other health care personnel to whom we transfer your care and treatment. Also included is the transfer of PHI via radio or telephone to the hospital or dispatch center, as well as providing the receiving hospital with a copy of the written record we create in the course of your treatment and transport.
Payment: Your PHI will be used, as needed, to obtain payment for the services we rendered. Activities may include determining your eligibility or coverage for insurance benefits, reviewing services rendered for medical necessity, organizing your PHI, submitting bills to insurance carriers, and collection of outstanding accounts.
Health Care Operations: This includes quality assurance activities, employee review actions, training, and creating or conducting business reviews. We may also share your PHI with “business associates” we have engaged to perform services for us. Whenever an arrangement between our department and a business associate involves the use or disclosure of PHI, a written contract will be signed by the business associate indicating they will abide by our privacy policies.
Fundraising: We may contact you when we are in the process of raising funds for our department.
We are permitted to use your PHI, without your written authorization, or opportunity to object in certain situation, including:
Required by Law: We may use or disclose your PHI to the extent that the law requires the use or disclosure of such information. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any uses or disclosures of your PHI.
Public Health: We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury, or disability. We may also disclose your PHI, if directed by a public health authority, to a foreign government agency that is collaborating with the public health authority.
Communicable Diseases: We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
Abuse or Neglect: We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI if we believe that you have been the victim of abuse, neglect, or domestic violence to the government entity or agency authorized to receive such information. In this case, the disclosure will be made in a manner consistent with the requirements of the applicable federal or state law.
Food and Drug Administration: We may disclose your PHI to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biological product deviations, track products to enable product recalls, to facilitate repairs or replacements or to conduct post marketing surveillance, as required by law.
Legal Proceedings: We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent that such disclosure is expressly authorized) in certain conditions in response to a subpoena, discovery request or other lawful purpose.
Law Enforcement: We may disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes or otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of crime, (4) suspicion that a death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the department, and (6) medical emergency, not occurring on department property and it is likely that a crime has occurred.
Coroners, Funeral Directors, Organ Donation: We may disclose PHI to a coroner or medical examiner for identification purposes, determining the cause of death or for the coroner or medical examiner to perform other duties as required by law. We may also disclose PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out his duties. We may disclose PHI in reasonable anticipation of death. PHI may be used and disclosed for cadaver organ, eye, or tissue donation purposes.
Research: We may disclose your PHI to researchers when their research has been approved by an institution review board, which reviewed the research proposal and established protocols to ensure the privacy of your PHI.
Criminal Activity: Consistent with applicable federal and state law, we may disclose your PHI if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veteran Affairs of your eligibility for benefits or; (3) to foreign military authority if you are a member of that foreign military service. We may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities including the provision of protective services to the President and others legally authorized.
Worker’s Compensation: Phi may be disclosed by us as authorized to comply with worker’s compensation laws and other similar legally established programs.
Inmates: We may use or disclose your PHI if you are an inmate of a correction facility and your physician created or received your PHI in the course of treating you.
Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.
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.
The right to access, copy or inspect your medical record: You may come to our department 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 copying any medical information you have the right to access. In limited circumstances, we may deny you access to your medical information and you may deny certain types of denials. We have forms to request access to your PHI, we will provide you a written response if we deny you access and will inform you of your appeal rights. If you wish to inspect or copy your medical record, you the contact the Privacy Officer or their designee at department headquarters (738-1831).
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 amend your medical information contained in our reports, please contact the Privacy officer or their designee.
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 the purposes of treatment, payment or health operations, or when we share your PHI with our business associates, like our billing service or a medical facility we have transported you to. We are also NOT REQUIRED to give you an accounting of our uses of PHI 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 exempted from the accounting requirement, please contact the Privacy officer or their designee.
The right to restrict the uses and disclosure of your PHI: You have the right to request that we restrict how we use and disclose the 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, or 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 or disclose the PHI to a health care provider to provide you with emergency treatment. Crosby Township Fire Department is not required to agree to any restrictions you request, but any restrictions we agree to will be binding.
Internet, Electronic Mail, and the right to obtain a copy of paper notice on request: If we maintain a web site, we will prominently post a copy of this notice 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. You may always request a copy of this notice.
Revision to Notice: The Crosby Township Fire Department 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 PHI. Any material changes to this Notice will be promptly posted in our facilities and posted on our web site. You may obtain a copy of the latest version of this Notice by contacting the Privacy officer or their designee.
Your legal rights and complaints: You have the right to register a complaint either to us or the Secretary Of the United States Department of Health and Human Services if you believe that your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with us or to the federal government. Should you have any questions please contact the Privacy officer or their designee.
Effective Date: April 14, 2003