Coal Creek Canyon Fire Protection District
IMPORTANT: 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.
As an essential part of our commitment to you, Coal
Creek Canyon Fire Protection District (CCCFPD) maintains the privacy of certain
confidential health care information about you, known as Protected Health
Information or PHI. We are required by law to protect your health care
information and to provide you with the attached Notice of Privacy Practices.
The Notice outlines our legal duties and privacy
practices respect to your PHI. It not only describes our privacy practices and
your legal rights, but lets you know, among other things, how CCCFPD is
permitted to use and disclose PHI about you, how you can access and copy that
information, how you may request amendment of that information, and how you may
request restrictions on our use and disclosure of your PHI.
CCCFPD is also required to abide by the terms of the
version of this Notice currently in effect. In most situations we may use this
information as described in this Notice without your permission, but there are
some situations where we may use it only after we obtain your written
authorization, if we are required by law to do so.
We respect your privacy, and treat all health care
information about our patients with care under strict policies of
confidentiality that all of our staff are committed to following at all times.
PLEASE READ THE ATTACHED DETAILED NOTICE. IF YOU
HAVE ANY QUESTIONS ABOUT IT, PLEASE CONTACT JANICE JANDRT MIKULICH, OUR PRIVACY
OFFICER, AT 303-642-3121.
Revised
March 27, 2003
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: CCCFPD 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. This Notice
describes your legal rights, advises you of our privacy practices, and lets you
know how CCCFPD is permitted to use and disclose PHI about you.
CCCFPD is also required to abide by the terms of the
version of this Notice currently in effect. In most situations we may use this
information as described in this Notice without your permission, but there are
some situations where we may use it only after we obtain your written
authorization, if we are required by law to do so.
Uses and
Disclosures of PHI: CCCFPD 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 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 PHI 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.
* 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 organizing your PHI and submitting bills to insurance companies
(either directly or through a third party billing company), management of
billed claims for services rendered, medical necessity determinations and
reviews, utilization review, and collection of 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, obtaining
legal and financial services, conducting business planning, processing
grievances and complaints, creating reports that do not individually identify
you for data collection purposes, fundraising, and certain marketing
activities.
* Fundraising. We may contact you when we are in the
process of raising funds for CCCFPD, or to provide you with information about our
annual subscription program.
* Reminders for Scheduled Transports and Information on Other Services. We
may also contact you to provide you with a reminder of any scheduled
appointments for non-emergency ambulance and medical transportation, or for
other information about alternative services we provide or other health-related
benefits and services that may be of interest to you.
Use and
Disclosure of PHI Without Your Authorization. CCCFPD is permitted to use
PHI without your written
authorization, or opportunity to object in certain situations, including:
* For CCCFPD’s use in
treating you or in obtaining payment for services provided to you or in other
health care operations;
* For the treatment
activities of another health care provider;
* To another health care
provider or entity for the payment activities of the provider or entity that
receives the information (such as your hospital or insurance company);
* To another health care
provider (such as the hospital to which you are transported) for the health
care operations activities of the entity that receives the information as long
as the entity receiving the information has or has had a relationship with you
and the PHI pertains to that relationship;
* For health care fraud and
abuse detection or for activities related to compliance with the law;
* 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. We may also
disclose health information to your family, relatives, or friends if we infer
from the circumstances that you would not object. For example, we may assume
you agree to our disclosure of your personal health information to your spouse
when your spouse has called the ambulance for you. In situations where you are
not capable of objecting (because you are not present or due to your incapacity
or medical emergency), we may, in our professional judgment, determine that a
disclosure to your family member, relative, or friend is in your best interest.
In that situation, we will disclose only health information relevant to that
person's involvement in your care. For example, we may inform the person who
accompanied you in the ambulance that you have certain symptoms and we may give
that person an update on your vital signs and treatment that is being administered
by our ambulance crew;
* To a public health
authority in certain situations (such as 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 or domestic violence, to report adverse events such as
product defects, or to notify a person about exposure to a possible communicable
disease as required by law;
* 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 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 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;
* For research projects, but
this will be subject to strict oversight and approvals and health information
will be released only when there is a minimal risk to your privacy and adequate
safeguards are in place in accordance with the law;
* We may 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, (the
authorization must specifically identify the information we seek to use or
disclose, as well as when and how we seek to use or disclose it). 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 the protection of your PHI, including:
* The right to access, copy, or inspect your PHI. This means you may
come to our offices and 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. If you wish to inspect and copy your medical
information, you should contact the Privacy Officer listed at the end of this
Notice.
* 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 the Privacy Officer listed at the end of this Notice.
* The right to request an accounting of our use and disclosure of your
PHI. You may request an accounting from us of certain disclosures of your
medical information that we have made in the last 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 of
the medical information about you that we have used or disclosed that is not
exempted from the accounting requirement, you should contact the Privacy Officer
listed at the end of this Notice.
* 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 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. But if you
request a restriction and the information you asked us to restrict is needed to
provide you with emergency treatment, then we may use the PHI or disclose the
PHI to a health care provider to provide you with emergency treatment. CCCFPD
is not required to agree to any restrictions you request, but any restrictions
agreed to by CCCFPD are binding on CCCFPD.
* 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 and
make the Notice available electronically through the 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: CCCFPD
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 the
Privacy Officer identified below.
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 the Privacy Officer listed at the
end of this Notice. Individuals will not be retaliated against for filing a
complaint.
If you have any questions or if you wish to file a
complaint or exercise any rights listed in this Notice, please contact:
Janice Jandrt Mikulich, Privacy
Officer
Coal Creek Canyon Fire Protection
District
Post Office Box 7187 Crescent Branch
Golden, CO 80403
303-642-3121
Effective Date
of the Notice:
April 14, 2003