Notice of Privacy Practices
The Health Insurance Portability and Accountability (HIPAA)
Act was passed into law in August 1996. Bloomfield Township
Fire Department is in full compliance with this law. One key
provision is the Notice Of Privacy Practices that must be
distributed to all patients that access the EMS system in
Bloomfield Township. This notice describes how a patient’s
information may be disclosed and defines the patient’s rights
as they pertain to their medical information. Please review it
carefully. If you have any questions about this Notice,
please contact our privacy officer,
Lt. Richard Watson, at
248.433.7745.
Bloomfield Township Fire Department 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. Bloomfield Township Fire
Department is also required to abide by the terms of the
version of this Notice currently in effect.
Uses and Disclosures of PHI
Uses and Disclosures Without Authorization: Bloomfield
Township Fire Department may use PHI for the purposes of
treatment, payment, and health care operations, without your
authorization. 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 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, as well as
certain other management functions.
Other Uses and Disclosure of PHI Without Your
Authorization
Bloomfield Township Fire Department is permitted to use PHI
without your written authorization, or opportunity to object,
in certain situations, and unless prohibited by a more
stringent state law, including:
For the treatment, payment or health care operations
activities of another health care provider who treats you;
For health care and legal compliance activities;
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, and in certain other circumstances where
we are unable to obtain your agreement and believe the
disclosure is in your best interests;
To a public health authority in certain situations as
required by law (such as to report abuse, neglect or
domestic violence;
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 responding to a warrant;
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;
We may also use or disclose health information about you
in a way that does not personally identify you or reveal who
you are.
Uses and Disclosures With Your Authorization
Any use or disclosure of PHI, other than those listed
above, will only be made with your written authorization. You
may revoke your authorization at any time, in writing.
However, we cannot take back any uses or disclosures that have
already occurred in reliance on your authorization.
Patient Rights
As a patient, you have a number of rights with respect to
your PHI, including those listed below. If you wish to
exercise any of these rights or have any questions about them,
you should contact our privacy officer.
The right to access, copy, or inspect your PHI. You
have the right to 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.
The right to amend your PHI. You have the right to
ask us to amend written medical information that we may have
about you. You must provide a reason that supports your
request for an amendment. 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. We will notify you that we have
either granted or denied it (and provide an explanation of the
reason for denial), usually within 60 days of your request. We
will also notify you when we have amended the information.
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 certain types of disclosures, such as
disclosures for purposes of treatment, payment or health care
operations, disclosures to business associates, like our
billing company or a medical facility from/to which we have
transported you, or disclosures for which you have already
given us written authorization. The first accounting you
request within a 12-month period is free. For additional
accountings, we may charge you for the costs of providing the
list.
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. Bloomfield Township Fire
Department is not required to agree to any restrictions you
request, but any restrictions agreed to by in writing are
binding on Bloomfield Township Fire Department.
The right to request confidential communications of your
PHI. You have the right to request that we communicate
with you about medical matters in a certain way or at a
certain location. For example, you can ask that we only
contact you at work or by mail. We will not ask you the reason
for your request. We will accommodate all reasonable requests.
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.
If you allow us, we may 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
Bloomfield Township Fire Department 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. We will not retaliate against you 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.
Privacy Officer Contact Information
Lt. Richard Watson
EMS Coordinator
Bloomfield Township Fire Department
4200 Telegraph Road
Bloomfield Hills, MI 48302
Phone: 248.433.7745
Fax: 248.433.7787
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Charter Township of Bloomfield
4200 Telegraph Road
P.O. Box 489
Bloomfield Hills, MI 48303-0489
248.433.7700
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