WASHINGTON 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.

Your health Information

This notice applies to the information and records the Washington Fire Department maintains about your health, health status and the health care and service you receive from the Washington Fire Department. The Washington Fire Department is required by law to give you this notice. It will tell you about the ways in which the Washington Fire Department may use and disclose health information about you and disclosure of that information.

How we may use and disclose health information about you

For Treatment 

The Washington Fire Department may use health information about you to provide you with medical treatment or services. The Washington Fire Department 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 the Washington Fire Department obtains about you and uses 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 the Washington Fire Department gives to other health care personnel to whom the Washington Fire Department transfers your care and treatment, and includes transfer of personal health information via radio or telephone to the hospital or dispatching center as well as providing the hospital with a copy of the report the Washington Fire Department creates in the course of providing you with treatment and transport. Various personnel at our department may share information about you and disclose information to others who do not work in our department in order to coordinate your care. Family members and other healthcare providers may be part of your medical care and may require information about you that the Washington Fire Department maintains.

For Payment

 The Washington Fire Department may use and disclose health information about you so that the treatment and services provided to you may be billed to and payment may be collected from you, an insurance company or third party payor. For example, the Washington Fire Department may need to give your health plan information about a service you received so that your health plan will reimburse you or the department for the services. 

For Healthcare Operations

 The Washington Fire Department may use and disclose health information about you for operations and to ensure that you and our other patients receive quality care. For example, the Washington Fire Department may use your health information to evaluate the performance of our staff in caring for you. The Washington Fire Department may use health information about all or many of our patients to help us plan for future services, how we may become more efficient, or whether certain treatments are effective. 

Special Situations 

The Washington Fire Department may use and disclose health information about you without your permission for the following reasons, subject to all applicable legal requirements and limitations.

Public Safety

Public Safety The Washington Fire Department may use and disclose health information about you when necessary to prevent a serious threat to you or your health and safety or the health and safety of the public or another person.

Required by Law

The Washington Fire Department will disclose health information about you when required to do so by federal, state or local law.

Research Information

The Washington Fire Department may use and disclose health about you for research projects that are subject to a special approval process. The department will ask you for your permission if the researcher will have access to your name, address or other individually identifiable information that reveals who you are.

Organ and Tissue Donation

If you are an organ/tissue donor, The Washington Fire Department may release 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, The Washington Fire Department may be required by military command or other government authorities to release health information about you. The department may also release information about

foreign military personnel to the appropriate foreign military authority.

Workers' Compensation

The Washington Fire Department 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

The Washington Fire Department 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

The Washington Fire Department 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, The Washington Fire Department. may disclose health information about you in response to a court or administrative order. Subject to all applicable

legal requirements, the department may also disclose health information about you in response to a subpoena.

Law Enforcement

The Washington Fire Department 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

The Washington Fire Department may release 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

The Washington Fire Department 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

The Washington Fire Department may disclose health information about you to your family members or friends if the Washington Fire Department obtains your verbal agreement to do so or if the Washington Fire Department gives you an opportunity to object to such a disclosure and you do not raise an objection. The Washington Fire Department may also disclose information to your family or friends if we can infer from the circumstances, based on our professional judgement 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 of 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

The Washington Fire Department will not use or disclose your health information for any purpose other than those identified in the previous sections without your specific, written authorization. The Washington Fire Department must obtain your authorization separate from any consent the Washington Fire Department 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, the

Washington Fire Department will no longer use or disclose information about you for the reasons covered by your written authorization, however, The Washington Fire Department cannot withdraw any uses or disclosures previously made with your permission. If The Washington Fire Department has substance abuse or HIV information about you, the department cannot release that information without written authorization from you. In order to disclose these types of records for purposes of treatment, payment or healthcare operations, the Washington Fire Department will have to have both signed consent and written authorization that complies with the law governing substance abuse or HIV.

Your Rights Regarding Health Information About You

You have the following rights regarding health information the Washington Fire Department maintains about you:

Right to Inspect and Copy

You have the right to inspect and copy your health information, medical and billing records, that the Washington Fire Department uses to make decisions about your care. You must submit a written request to the Washington Fire Department Privacy Officer in order to inspect and/or copy your health information. The Washington Fire Department may deny your request to inspect and/or copy in certain limited circumstances. The Washington Fire Department may also impose a reasonable fee for copies of healthcare records. 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, the Washington Fire Department will select a licensed healthcare professional to review your request and our denial. The person conducting the review will not be the person who denied your request, and the Washington Fire Department will comply with the outcome of the review.

Right to Amend

If you believe health information the Washington Fire Department has about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by this department. To request an amendment, complete and submit a Compliance, Complaint, Concern Report Form to the Privacy Officer. The Washington Fire Department 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, the Washington Fire Department may deny your request if you ask us to amend information that:

• The Washington Fire Department did not create
• Is not part of the health information this department keeps
• You would not be permitted to inspect and copy
• Is accurate and complete

Accounting of Disclosures

You have the right to an “accounting of disclosures.” This is a list of the disclosures The Washington Fire Department generates of medical information about you for purposes other than treatment, payment and healthcare operations. To obtain this list, you must submit your request in writing to the Privacy Officer. It must state a time period, which may not be longer than six years and may not include dates prior to April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically).

Right to Request Restrictions

You have the right to request a restriction or limitation of the health information the Washington Fire Department uses or discloses about you for treatment, payment or healthcare operations. You also have the right to request a limit on the health information the Washington Fire Department discloses about you to someone who is involved in your care or the payment for it.

The Washington Fire Department is not Required to Agree to Your Request

If The Washington Fire Department agrees, the department will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you may complete and submit the Authorization for Release of Medical Records Form to the Privacy Officer.

Right to Request Confidential Communications

You have the right to request that the Washington Fire Department communicate with you about medical matters in a certain way or at a certain location. For example, you can ask the department to only contact you at work or by mail. To request confidential communications, you may complete and submit the Authorization for Release of Medical Records Form to the Privacy Officer. The Washington Fire Department 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 the department staff to give you a copy of this notice at any time. You may also elect to receive an electronic copy. To obtain such a copy, contact the Privacy Officer.

Changes to this Notice

The Washington Fire Department reserves the right to change this notice, and to make the revised or changed notice effective for medical information the Washington Fire Department already has about you as well as any information the Washington Fire Department receives in the future. The Washington Fire Department will post the current notice with its effective date and you will be entitled to a copy of the current notice.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Washington Fire Department or with the Department of Health and Human Services.