PROUDLY SERVING SINCE 1941
7 NEWENT ROAD
LISBON, CT 06351
HIPPA PRIVACY NOTICE
(Health
Insurance Portability and Accountability Act of 1996)
The Lisbon Fire Department is also required to abide by the terms of the
version of this Notice currently in effect.
Uses and Disclosures of PHI.
The Lisbon Fire Department 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.
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 within 60 days of your request and will notify you when we have
amended the information.
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.
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.
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.
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 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.
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.
Use and Disclosure of PHI Without Your Authorization.
The Lisbon Fire Department 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;
Revisions to the Notice. The
Lisbon 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
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. If you believe your privacy rights have been violated, you may file a
complaint in writing with us or with the Office of Civil Rights in the U.S.
Department of Health and Human Services at Government Center, J. F. Kennedy
Federal Building, Room 1875, Boston, MA 02203. Phone (617) 565-1340; Fax (617)
565-3809; TTY (617) 565-1343.
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
Lisbon Fire Department
7 Newent Road
Lisbon, CT 06351
860-376-2558
Effective Date of the Notice: February 1, 2004.