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Grays Harbor Fire District 5
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.
Grays Harbor Fire District 5
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.
Grays Harbor Fire District 5
is also required to abide by the terms of the version of this Notice currently in effect.
Uses and Disclosures of PHI
:
Grays Harbor Fire District 5
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 obtaining verbal and written information about your medical condition and treatment from you as well as from others, such as doctors and nurses who give orders to allow us to provide treatment to you. We may give your PHI to other health care providers involved in your treatment, and may transfer your PHI via radio or telephone to the hospital or dispatch center.
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 submitting bills to insurance companies, making medical necessity determinations and collecting
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:
Grays Harbor Fire District 5
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 our privacy officer.
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 our privacy officer.
The right to request amendment to your medical informatinon.
You may request that revisions or amendments be made to your medical information if you feel that information in your health care record is incorrect. Grays Harbor Fire District 5 will contact you
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 our privacy officer.
The right to request an accounting
. You may request an accounting from us of certain disclosures of your medical information that we have made in the 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, contact our privacy officer.
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.
Grays Harbor Fire District 5
is not required to agree to any restrictions you request, but any restrictions agreed to by
Grays Harbor Fire District 5
in writing are binding on
Grays Harbor Fire District 5
.
Privacy Officer Contact Information:
Brad Peckham
Grays Harbor
Fire District 5
PO Box 717
Elma
, WA98541
TELEPHONE NUMBER (
360) 482-6266
FAX NUMBER
(
360
)
482-3152
Effective Date of the Notice
:
January 1, 2005
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