City
of Beech Grove Fire Department Notice of Privacy Practices
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.
The City of Beech Grove Fire Department (BGFD)
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. The
BGFD is also required to abide by the terms of the version of this Notice
currently in effect.
Uses and Disclosures of PHI: BGFD 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 provider 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
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.
Use and
Disclosures of PHI without your Authorization: BGFD 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 of health care operations activities of another healthcare
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 interest;
·
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 advert
a serious threat to the health and safety to a person or the public at large;
·
For
workers’ compensation purposes, and in compliance with workers’
compensations laws;
·
To
coroners, medical examiners, and funeral directors for identifying a deceased
person, determining cause of death, or carrying on their duties authorized by
law;
·
If you are
an organ donor, we may release health information to organizations the 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;
·
We my 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 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 a 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 with a reasonable fee to you for copying any medical
information that you have a 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 you 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 operation, or when we
share your health information with our business associates, like our billing
company or medical facility from/to which we transported you
We are also not required to give you an accounting of our uses of PHI for
which you have already given us written authorizations.
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.
BGFD is not required to agree to any restrictions you request, but any
restrictions agreed to by BGFD in writing are binding on BGFD.
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:
BGFD reserves the right to change the terms of this Notice at anytime,
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 promptly posted in our facilities and posted
to our web site, if we maintain one. You
will 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:
Julie Morical
Beech Grove Fire Department
330 E. Churchman Avenue
Beech Grove, IN 46107
(317) 782-4940
Fax: (317) 782-4952