San Rafael 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 San Rafael Fire Department is required by law to maintain the privacy of certain Protected Health Information or PHI, and to provide you with a notice of our legal duties and privacy practices with respect to your protected health information,
and to abide by the term of the notice currently in effect.
The San Rafael Fire Department may use PHI for the purposes of Treatment, Payment and Health Care Operations. The following are examples of our uses of PHI:
Treatment: This includes oral communication through 911 dispatch regarding your medical condition and certain individually identifiable information such as your name and address. This also includes other oral communication and written records of our treatment provided to the hospital that we transfer your care and treatment.
Payment: This includes any necessary activities to get reimbursement for services provided to you, such as determining medical necessities, submitting claims to insurance carriers and collection of outstanding accounts.
Health Care Operations: This includes continuous quality improvement activities, training program to ensure the quality of our services, survey of your assessment of our services, creating statistical reports that do not identify you individually.
Other use and disclosure of PHI permitted or required by law:
· Under emergency circumstance – to identify a deceased person, or the cause of death.
- Limited law enforcement activities – such as to identify and to locate a suspect or to stop a crime.
- Activities related to national defense and security.
- Oversight of the health care system.
- Legal processing as required by a court or an administrative order, or in response to a subpoena.
- Communicate with individuals that are directly involved in your care.
- Other use and disclosure as permitted or required by law.
All other uses and disclosures of PHI will be made only with your authorization and you have the right to revoke such authorization at any time, in writing, except to the extent that we have already used or disclosed PHI in reliance on that authorization.
As a patient you have certain rights under the privacy rule with respect to your PHI:
· You have the right to access, inspect and make copy of your PHI.
· You have the right to amend your PHI. We do not have to comply with your request if we believe the PHI is accurate and correct.
· You have the right to an accounting of most non-routine use and disclosure of your PHI. We do not have to give you an accounting of PHI we use or disclose to carry out treatment, payment and health care operations, or the use and disclosure of PHI that you have given authorization.
· You have the right to request restrictions on certain uses and disclosure of your PHI. We are not required to agree to a requested restriction.
· You have the right to receive confidential communications of your PHI.
· You have the right to obtain a paper copy of this notice upon request.
You have the legal right to file a complaint with the San Rafael Fire Department and with the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated. You will not suffer retaliation for filing a complaint.
You may contact the following Privacy Office regarding any information identified in this Notice, or to a file complaint, or to exercise any of your rights listed in this Notice.
San Rafael Fire Department
Privacy Office
1039 C Street
San Rafael, CA 94901
(415) 485-3304
Effective Date of this Notice: 4-1-2003
The San Rafael Fire Department reserves the right to change its privacy practices and the terms of this Notice, and to apply the revised practices to PHI previously created or received. You may request a new copy of the Notice by contacting the above Privacy Office.
The Fire Department participates in the manadated privacy notification process under HIPPA. Click on either line below to read the full Privacy Notice text.