Plymouth Township Fire Department
Privacy Notice To Our Patients - This Notice Describes How Information About You May Be Used and Disclosed And How You Can Get Access To The Information
Effective April 12, 2003)
Plymouth Township Fire Department
PRIVACY NOTICE TO OUR PATIENTS
Effective April 12, 2003
This Notice Describes How Information About you May Be Used And Disclosed And How You Can Get Access To The Information.
Please Review It Carefully!
If you have any questions, please contact our Administrative Assistant, Nancy Jowsey, who serves as our privacy manager at 734-354-3221.
What is the Purpose of this Notice? Plymouth Township Fire department is required by law to maintain the privacy of certain confidential health information, which we will refer to as your “Information”. We are required to tell you in this “Notice” how we use and disclose your information and to describe your legal and privacy rights. This notice may change from time to time and will abide to the version that is then currently in effect. If we make changes to this Notice, we will take steps to notify you of the changes and give you a copy of the revised Notice by mail or other permitted means.
We are required by Law to: Maintain the privacy of your Information and to provide you this Notice.
How We May Use and Disclose Your Information: The following categories describe different ways that we may use and disclose your Information. We will explain what we mean and give you some examples of what is covered.
For Treatment: We may use and disclose your Information to provide you with our treatment or services. We may use and disclose your Information to others who are treating or taking care of you, i.e. hospitals and other healthcare workers.
For Payment: We may use and disclose your Information so that payment may be collected from you, your insurance company or a third party for the treatment and services you have received. For example, either before or after we render a service, we may need to use or disclose your health plan Information so that your health plan will pay us or reimburse you for our service.
For Health Care Operations: The law permits us to use and disclose your Information for operations of Plymouth Township Fire Department and others involved in your treatment. For example, we may use and disclose your Information to your other healthcare providers and persons involved with your care including family and friends and those who may help with payment for your treatment.
As Required by Law: We will disclose your information when required to do so by Federal, State, or local law.
Organ and Tissue Donation: If you are an organ donor, we may disclose your Information to organizations that handle organ procurement, banking or transplantation, to facilitate organ or tissue donation and transplantation.
Military and Veterans: If you are a member of the Armed Forces, we may disclose your Information to Military Commanders.
Workers Compensation: We may disclose your Information for Workers Compensation or similar programs. These programs provide benefits for work-related injury or illness.
Public Health Risks: We may disclose your Information for public health activities, which may include the following:
- To prevent or control, disease, injury or disability.
- To report births and deaths.
- To report child or adult abuse, neglect or exploitation.
- To report reactions to medications or problems with a product.
- To notify people of recalls of products that they may be using.
- To notify a person who may have been exposed to a disease or may be at risk for contacting or spreading a disease or condition.
- To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
- When necessary to prevent a serious threat to your health and safety or the health and safety of another person or the public.
Health Oversight Activities: We may disclose your information to a health oversight agency for activities authorized by law. For example, audits investigations, inspections, and licensure.
Lawsuits and Disputes: We may disclose your Information in response to a court or administrative order, subpoena, discovery request or other lawful process.
Law Enforcement: We may disclose your Information if asked to do so by a law enforcement official for legitimate law enforcement purposes.
Coroners, Medical Examiners, Funeral Directors: We may disclose your Information to identify a deceased person or determine the cause of death.
National Security and Intelligence Activities: We may disclose your Information to authorized officials for intelligence, counter-intelligence, and other national security activities, including for purposes of the protection of the President of the United States.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your Information to the correctional institution or law enforcement official.
Research: Under certain circumstances, we may be asked to disclose your Information for research projects. We ask for your specific authorization if your Information will identify you personally.
Your Rights Regarding Your Information
You have the following rights regarding your information.
Right to Inspect and Copy: You have the right to inspect and copy your information. To inspect and copy your Information, you must submit your request in writing to our Administrative Assistant. We may charge a fee for cost of copying, mailing or other supplies and staff time associated with your request. We may deny your request to inspect and copy in certain limited circumstances. If we deny your request, you may request a review. We will comply with the outcome of the review.
Right to Amend: If you feel that your Information is incorrect or incomplete, you may ask us to amend it. You have the right to request an amendment for as long as we keep your Information. To request an amendment, you should submit your request and reasons to us in writing to our Administrative Assistant. We may agree with your request or we may deny it, depending on your reasons and the type of Information you submit.
Right to an Accounting of Disclosures: You may ask us to give you a list of all of the uses and disclosures of your Information that were not related to treatment, payment, or health care operations. You must submit your request in writing to our Administrative Assistant. Your request should not cover more than six years. You are entitled to the list once without charge. You must be charged for subsequent lists. You will be told the cost involved, and may withdraw or modify your request.
Right to Request Restrictions: You have the right to request a restriction or limit on our use and disclosure of your Information. We are not required to agree to your request. If we do agree, we will comply with your request unless your Information is needed for emergency treatment. To request such restrictions, you must make your request in writing to our Administrative Assistant. In your request you must tell us:
- What information you want limited
- Whether your limitations include use, disclosure or both
- To whom you want the limits to apply, for example, disclosures to a particular family member
- The reason for your request
Right to Request Confidential Communications: You have the right to request that we communicate with you confidentially. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to our Administrative Assistant. It is not necessary for you to give a reason for this request. Your request must specify how or were you wish to be contacted. We will accommodate your request if it is reasonable.
Right to a Paper Copy of this Notice: You have a right to paper copy of this notice. You may ask us to give you a copy of this Notice at any time. Simply ask any of our employees for a copy.
Changes to this Notice: We reserve the right to change this Notice and make changes effective for the handling of your Information. We will post a copy of the Notice that is in effect in the office and have a copy of the current Notice available for you upon request.
Complaints: You have a right to file a complaint without being penalized. Our service cares about you and your rights. We have trained our staff and reviewed our office procedures to protect your Information. If you believe your privacy rights have been violated, you may send a written complaint to our office Administrative Assistant at 9955 Haggerty Road, Plymouth MI. 48170. We take your concerns very seriously and will try to resolve them. You have a right to file a complaint with the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated.
Other Uses of Medical Information: Other disclosures of your Information not covered by this Notice or permitted by law will be made only with your written permission. You may revoke that permission in writing at ant time. We will be unable to take back any disclosures we have already made with your permission.