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Privacy Policy
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.
If you have any questions about this notice, please contact the Fire Chief at
333 W Lake Street, Krum Texas, 76249, (940)482-6257)
WHO WILL FOLLOW THIS NOTICE
This notice describes the information privacy practices followed by our
employees.
YOUR HEALTH INFORMATION
This notice applies to the information and records we have about your health,
health status, and the health care and service you receive by the district. We
are required by law to give you this notice. It will tell you about the ways in
which we may use and disclose health information about you and describes your
rights and our obligations regarding the use and disclosure of that information.
F
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For Treatment We may use health information about you to provide
you with medical treatment or services. We may disclose health information about
you to doctors, nurses, technicians, office staff or other personnel who are
involved in taking care of you and your health.
For example, 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 personnel health information 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.
Different personnel in our office may share information about you and disclose
information to people who do not work in our office in order to coordinate your
care. Family members and other health care providers may be part of your medical
care and may require information about you that we have.
For Payment We may use and disclose health information about you
so that the treatment and services you receive may be billed to and payment may
be collected from you, an insurance company or a third party. For example, we
may need to give your health plan information about a service you received here
so your health plan will pay us or reimburse you for the service. We may also
tell your health plan about a treatment you are going to receive to obtain prior
approval, or to determine whether your plan will cover the treatment. For Health
Care Operations We may use and disclose health information about you for
operations and to make sure that you and our other patients receive quality
care. For example, we may use your health information to evaluate the
performance of our staff in caring for you. We may also use health information
about all or many of our patients to help us decide what additional services we
should offer, how we can become more efficient, or whether certain new
treatments are effective.
SPECIAL SITUATIONS
We may use or disclose health information about you without your permission for
the following purposes, subject to all applicable legal requirements and
limitations:
To Avert a Serious Threat to Health or Safety We may use and
disclose health information about you when necessary to prevent a serious threat
to your health and safety or the health and safety of the public or another
person.
Required By Law We will disclose health information about you when
required to do so by federal, state or local law.
Research We may use and disclose health information about you for
research projects that are subject to a special approval process. We will ask
you for your permission if the researcher will have access to your name, address
or other information that reveals who you are, or will be involved in your care
at the office.
Organ and Tissue Donation 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 such donation and transplantation.
Military, Veterans, National Security and Intelligence If you are
or were a member of the armed forces, or part of the national security or
intelligence communities, we may be required by military command or other
government authorities to release health information about you. We may also
release information about foreign military personnel to the appropriate foreign
military authority.
Workers' Compensation We may release health information about you
for workers' compensation or similar programs. These programs provide benefits
for work-related injuries or illness.
Public Health Risks We may disclose health information about you
for public health reasons in order to prevent or control disease, injury or
disability; or report births, deaths, suspected abuse or neglect, non-accidental
physical injuries, reactions to medications or problems with products.
Health Oversight Activities We may disclose health information to
a health oversight agency for audits, investigations, inspections, or licensing
purposes. These disclosures may be necessary for certain state and federal
agencies to monitor the health care system, government programs, and compliance
with civil rights laws.
Lawsuits and Disputes If you are involved in a lawsuit or a
dispute, we may disclose health information about you in response to a court or
administrative order. Subject to all applicable legal requirements, we may also
disclose health information about you in response to a subpoena.
Law Enforcement We may release health information if asked to do
so by a law enforcement official in response to a court order, subpoena,
warrant, summons or similar process, subject to all applicable legal
requirements.
Coroners, Medical Examiners and Funeral Directors We may release
health information to a coroner or medical examiner. This may be necessary, for
example, to identify a deceased person or determine the cause of death.
Information Not Personally Identifiable We may use or disclose
health information about you in a way that does not personally identify you or
reveal who you are.
Family and Friends We may disclose health information about you to
your family members or friends 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 or friends
if we can infer from the circumstances, based on our professional judgment that
you would not object.
In situations where you are not capable of giving consent (because you are not
present or due to your incapacity or medical emergency), we may, using our
professional judgment, determine that a disclosure to your family member or
friend is in your best interest. In that situation, we will disclose only health
information relevant to the person's involvement in your care.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION
We will not use or disclose your health information for any purpose other than
those identified in the previous sections without your specific, written
Authorization. We must obtain your Authorization separate from any
Consent we may have obtained from you. If you give us Authorization
to use or disclose health information about you, you may revoke that
Authorization, in writing, at any time. If you revoke your Authorization,
we will no longer use or disclose information about you for the reasons covered
by your written Authorization, but we cannot take back any uses or
disclosures already made with your permission. If we have HIV or substance abuse
information about you, we cannot release that information without a special
signed, written authorization (different than the Authorization and
Consent mentioned above) from you. In order to disclose these types of
records for purposes of treatment, payment or health care operations, we will
have to have both your signed Consent and a special written
Authorization that complies with the law governing HIV or substance abuse
records.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information we maintain about
you:
Right to Inspect and Copy You have the right to inspect and copy
your health information, such as medical and billing records, that we use to
make decisions about your care. You must submit a written request to the Deputy
Fire Chief in order to inspect and/or copy your health information. If you
request a copy of the information, we may charge a fee for the costs of copying,
mailing or other associated supplies. We may deny your request to inspect and/or
copy in certain limited circumstances. If you are denied access to your health
information, you may ask that the denial be reviewed. If such a review is
required by law, we will select a licensed health care professional to review
your request and our denial. The person conducting the review will not be the
person who denied your request, and we will comply with the outcome of the
review.
Right to Amend If you believe health information we have about you
is incorrect or incomplete; you may ask us to amend the information. You have
the right to request an amendment as long as this office keeps the information.
To request an amendment, complete and submit a Medical Record
Amendment/Correction Form to the Deputy Fire Chief. We may deny your request for
an amendment if it is not in writing or does not include a reason to support the
request. In addition, we may deny your request if you ask us to amend
information that:
a) We did not create, unless the person or entity that created the information
is no longer available to make the amendment.
b) Is not part of the health information that we keep.
c) You would not be permitted to inspect and copy.
d) Is accurate and complete.
Right to an Accounting of Disclosures You have the right to
request an "accounting of disclosures." This is a list of the disclosures we
made of medical information about you for purposes other than treatment,
payment, and health care operations. To obtain this list, you must submit your
request in writing to the Deputy Fire Chief. It must state a time period, which
may not be longer than six years and may not include dates before April 14,
2003. Your request should indicate in what form you want the list (for example,
on paper, electronically). We may charge you for the costs of providing the
list. We will notify you of the cost involved and you may choose to withdraw or
modify your request at that time before any costs are incurred.
Right to Request Restrictions You have the right to request a
restriction or limitation on the health information we use or disclose about you
for treatment, payment, or health care operations. You also have the right to
request a limit on the health information we disclose about you to someone who
is involved in your care or the payment for it, like a family member or friend.
We are Not Required to Agree to Your Request If we do agree, we
will comply with your request unless the information is needed to provide you
emergency treatment. To request restrictions, you may complete and submit the
Request For Restriction On Use/Disclosure Of Medical Information to the Deputy
Fire Chief.
Right to Request Confidential Communications You have the right to
request that we communicate with you about medical matters in a certain way or
at a certain location. For example, you can ask that we only contact you at work
or by mail. To request confidential communications, you may complete and submit
the Request For Restriction On Use/Disclosure Of Medical Information And/Or
Confidential Communication to the Deputy Fire Chief. We will not ask you the
reason for your request. We will accommodate all reasonable requests. Your
request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice You have the right to a paper
copy of this notice. You may ask us to give you a copy of this notice at any
time. Even if you have agreed to receive it electronically, you are still
entitled to a paper copy. To obtain such a copy, contact the Deputy Fire Chief.
CHANGES TO THIS NOTICE
We reserve the right to change this notice, and to make the revised or changed
notice effective for medical information we already have about you as well as
any information we receive in the future. We will post a summary of the current
notice in the office with its effective date in the top right hand corner. You
are entitled to a copy of the notice currently in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint
with our office or with the Department of State Health Services. To file a
complaint with our office, contact the Assistant Fire Chief at 333 W Lake
Street, Krum Texas, 76249, (940)482-6257
You will not be penalized for filing a complaint.
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