City of Rossford Fire and Rescue Department Privacy Notice
The 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.
There are disclosures of your protected health information we are required or permitted by law to make without your authorization. Included are:
Disclosures required by law.
- Disclosures for public health activities including reporting of vital statistics such as births, death, injury and disease for the purpose of preventing or controlling disease or disability.
- Disclosures about victims of abuse, neglect or domestic violence. We will tell you if we make this disclosure.
- Disclosures for health oversight activities of the health care system, government benefit programs and compliance with programs standards.
- Disclosures for judicial or administrative proceedings in response to a court order or subpoena.
- Disclosures for law enforcement purposes including information to locate a suspect or missing person or related to injuries suspected to be the result of a crime.
- Disclosures about decedents to funeral directors, medical examiners and/or coroners to allow them to carry out the scope of their duties.
- Disclosures for cadaveric organ, eye or tissue donation purposes.
- Disclosures to avert a serious threat to health and safety.
- Disclosures for specialized government functions including matter of national security, military and veteran issues, correctional institutions and protection of the President.
- Disclosures for workers’ compensation to comply with state laws relating to provision of benefits for work-related injuries and/or illness.
- Disclosures for billing to private and governmental insurance companies, as well as, any bill collection communications and agencies used to retrieve payment collections.
There is NO need for consent to disclose information for the following three (3) reasons:
1) It pertains to a patient’s treatment.
2) It involves an entities right to receive payment.
3) It affects Healthcare Operations.
Your rights regarding protected health information
Although your medical record is the physical property of this facility, the information belongs to you. You have certain rights regarding the use and disclosure of this information. To further understand these rights, examples of uses and disclosures of your protected health information are listed above in this document.
Right to See and Obtain Copies Of Your Medical Information
In most cases, you have the right to look at or obtain copies of your medical information that we have, but you must make the request in writing. If we don’t have your information but we know who does, we will tell you how to get it. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you in writing our reasons for the denial and how you can have the denial reviewed. If you request copies of your medical information, we may charge a fee for the copying, mailing, or other supplies associated with your request.
Right to Request Limits on Use and Disclosure of Information
You have the right to ask that we limit how we use and disclose your medical information. We will consider your written request but are not legally required to accept it. If we accept your request, we will abide by its content except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.
Right to Choose How We Send Information To You
You have the right to ask that we send information to you at alternate address or by alternate means. We must agree to your written request so long as we can easily provide it in the format you requested.
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.
How to Amend or Update Your Medical Information
If you believe that there is a mistake in your medical information, or that a piece of information is missing, you have the right to request that we correct the existing information or add the missing information. The request must be made in writing and you provide a reason for the change. We will respond within 60 days of receiving your request. We may deny your request if it is not in writing or does not include a reason to support the request. Also, we may deny your request if the medical information is: correct and complete; not created by us; legally not allowed to be looked at and copied for you; not part of our records. Our written denial will tell you the reasons for the denial and will tell you how to file a written statement of disagreement with the denial.
Right to Obtain An Accounting of Disclosures
You have the right to obtain an accounting of any disclosures we have made regarding your medical record. This accounting will not include uses or disclosures, such as: those made for treatment, payment, health care operations; those made directly by you, authorized by you or to national security/intelligence purposes; law enforcement officials in custodial situations; incidental disclosures, i.e., overheard conversations, etc; those made prior to six years of your request or before April 14, 2003.
We will notify you of the cost involved and you may choose to withdraw or change your request at that time.
Our Organizational Responsibilities
This organization, (including all employed individuals, any volunteers we may involve in your care, and members of our health care providers to whom we’ve extended privileges), is required to: as a requirement of law, maintain the privacy or your health information; provide you with a notice to our legal duties and privacy practices with respect to information we collect and maintain about you; abide by the terms of this notice; notify you if we are unable to agree to a requested restriction; accommodate reasonable requests you may have to communicate health information by alternate means or at alternative locations.
We reserve the right or may be required by law to change our privacy practices, which may result in changes of this notice. We further reserve the right to make the revised or changed privacy practices notice effective for medical information we already have about you as well as any information we receive in the future. The revised notice will be available at our facility with the version number and implementation date included on the notice. Each time you visit our facility, the current version of this notice will be available to you.
Do You Have Questions or Concerns??
If you feel that your privacy rights have been violated in any way, Rossford Fire & Rescue Department encourages you to file a complaint. You will not be retaliated in any way for filing such a complaint. Complaints can be lodged in writing by contacting:
Rossford Fire & Rescue Department
133 Osborn Street
Rossford, OH 43460
(419) 661-4288 fax
You may also make a complaint with the Secretary of the Department of Public Health and Human Services. If you have questions regarding any of the information in this notice or about how you can exercise any of rights attributed to you under the law, please feel free to contact our Privacy Officer, Chief Josh Drouard.
Effective Date 6/30/2003