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Clymer Volunteer Fire Company
PATIENT
PRIVACY NOTICE
CLYMER
VOLUNTEER FIRE COMPANY IS NOT A PRIMARY EMERGENCY MEDICAL TREATMENT
PROVIDER OR TRANSPORTER, BUT MAY BE CALLED UPON TO ASSIST EMERGENCY
MEDICAL SERVICES IN THE TREATMENT AND EXTRICATION AT EMERGENCY
INCIDENTS. FOR
DOCUMENTATION PURPOSES AS REQUIRED BY THE POLICIES OF CLYMER VOLUNTEER
FIRE COMPANY AND AS APPLICABLE BY LAW, YOUR PROTECTED HEALTH
INFORMATION MAY BE OBTAINED. 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: Clymer
Volunteer Fire Company (CVFC) is required by law to maintain the
privacy of your confidential medical record and to provide you with a
notice of our legal duties and privacy practices with respect to your
information. This Notice
describes your legal rights, advises you of our privacy practices, and
lets you know how CVFC is permitted to use and disclose this
information.
Uses
and Disclosures of PHI: CVFC may use your patient information for the purposes of
treatment, payment, and other health care operations. The law permits CVFC to use your confidential information for
these areas without your consent.
Examples
are as follows:
Treatment:
This includes 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
physicians 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 information 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.
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 information and submitting bills to insurance
companies (either directly or via third party billing), management of
billed claims for services rendered, medical necessity determinations
and reviews, utilization review, and collection of outstanding
accounts.
Health
Care Operations: This
includes quality assurance activities, licensing, and training
programs to ensure that our personnel meet our standards of care,
obtaining financial and legal services, conducting business planning,
processing grievances and complaints, creating reports that do not
individually identify you for data collection purposes.
Use
and Disclosure of Information Without Your Consent:
CVFC is authorized to use your medical record without your
consent, authorization, or written permission in certain situations,
including:
-
Emergencies:
if your medical condition is such that time is of the
essence and attempting to obtain consent would present an
obstruction to timely care, or if your condition is such that you
are unable to effectively and competently give consent.
In these situations we will attempt to get your written
consent after the emergency.
-
To
a relative, friend or individual involved in your care
-
To
public health authorities in certain situations (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,
to report domestic violence, to report product defects, or to
notify someone about exposure to infectious disease as required by
law).
-
For
health oversight activities, such as audits, government
investigations
-
Response
to judicial and legal proceedings, such as response to subpoena or
other legal process, after reasonable attempts to notify you of
the subpoena.
-
For
law enforcement activity in limited circumstances, 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
-
To
avert a serious threat to a person or the public at large
-
For
worker’s compensation proceedings as required by law
Any
other use of your confidential patient record will require your signed
consent in advance.
Patient
Rights: As a patient,
you have a number of rights:
The
right to access, copy or to inspect your medical record:
This means you may come to our offices during regular business
hours and copy most of the information about you that we maintain.
Prior appointment must have been made.
We will normally provide you with access to this information
within 30 days of your request.
We may charge a reasonable fee for you to make such copies.
We may deny you access to your information in some
circumstances. Certain types of denials may be appealed.
We have forms available to request access to your information,
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 record, you should contact
the privacy officer listed at the end of this notice.
The
right to amend your medical record:
You may ask us to amend written medical information we have
about you. This would
generally occur within 60 days of your request and will notify you
when this occurs. We are
permitted under the law to deny your request under certain
circumstances, like when we believe the information you are asking us
to amend is correct. This
denial can be appealed. If
you wish to amend the medical information we have about you, contact
the privacy officer at the end of this notice.
The
right to request an accounting of our use and disclosures of your
medical record: You may
request an accounting of our use and disclosure of your medical
information we have made in the last six years prior to the date of
your request. We are not
required to provide uses and disclosures of your PHI for purposes of
treatment, payment or health care operations, or uses and disclosures
made prior to April 14, 2003. If
you wish an accounting of your medical record, contact the privacy
officer listed at the end of this notice.
The
right to request restrictions on uses and disclosures of your medical
record: You have the
right to request restrictions on 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.
However, if you request a restriction, and that information is
needed to provide you with emergency care, then we may use the
information or disclose the information to a health care provider to
provide you with emergency treatment. CVFC is not required to agree to any restrictions you
request, but any restrictions agreed to by CVFC are binding on CVFC.
Legal
Rights and Complaints: Notice
of any changes in CVFC privacy policy may be shown directly on the
consent form and this Notice will be updated when any significant
changes occur. CVFC
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
medical records 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 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 the government. Should you have any questions, comments or complaints you may
direct all inquiries to the privacy officer listed below:
Clymer
Volunteer Fire Company
Attention: President
550 Sherman Street
Clymer, PA 15728
724-254-9565
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