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THIS NOT DISCLOS CAREFU Lafayette care infor legal dutie the versio Uses and LFD may without yo 1) F m w ca ho 2) F se m 3) F p a 4) R yo a Use and D LFD is pe situations 1) F w 2) F 3) T ca a u TICE DESCR SED, AND HO LLY Fire Departm mation, know es and privac on of this Notic d Disclosures use PHI for t our written pe or Treatment— medical condit who give order are providers ospital or disp or Payment— ervices we pr making medica or Health Car rograms to en nd procedure Reminders for ou to provide nd medical tra Disclosure o ermitted to use , and unless or the treatme who treats you or health care o a family me are if we obta disclosure an nable to obta RIBES HOW M OW YOU CAN ment (LFD ) is wn as Protecte y practices w ce currently in s of PHI: he purpose o ermission. Exa —This includ tion and treatm rs to allow us involved in y patch center. —This include rovide to you, al necessity d re Operations nsure that our es, as well as Scheduled T you with a re ansportation, of PHI Witho e PHI without prohibited by ent, payment u. e and legal co ember, other r ain your verba nd you do not in your agree Lafay HIP MEDICAL INF N GET ACCE required by l ed Health Info with respect to n effect. of treatment, p amples of our es such thing ment from yo to provide tre your treatment s any activitie including suc determinations s—This includ r personnel m certain other Transports and eminder of any or to provide out Your Auth t your written a more string or health car ompliance act relative, or clo al agreement t raise an obje ement and bel ette Fir PAA Priva FORMATION ESS TO THIS law to mainta ormation or P your PHI. LF payment, and r use of your P gs as obtainin u as well as f eatment to yo t, and may tra es we must un ch things as s s and collecti des quality as meet our stand managemen d Information y scheduled a er information horization: authorization gent state law re operations tivities. ose personal to do so or if ection, and in lieve the disc e Depa acy Practi N ABOUT YO S INFORMATI ain the privacy HI, and to pro FD is also req health care o PHI: ng verbal and from others, s ou. We may g ansfer your P ndertake in o submitting bill ng outstandin ssurance activ dards of care nt functions. n on Other Se appointments about other s n, or opportun w, including: activities of a friend or othe we give you n certain other losure is in yo rtment ices OU MAY BE U ION. PLEASE y of certain co ovide you with quired to abide operations, in written inform such as docto give your PHI PHI via radio o rder to get re ls to insuranc ng accounts. vities, licensin e and follow es ervices—We m s for non-eme services we p nity to object, another health er individual in an opportunit r circumstanc our best inter USED AND E REVIEW IT onfidential he h a notice of o e by the term n most cases mation about ors and nurse to other healt or telephone t imbursed for ce companies ng, and trainin stablished po may also cont ergent ambula provide. in certain h care provide nvolved in yo ty to object to ces where we ests. T alth our s of your s th to the the , ng olicies tact ance er ur o such e are ---PAGE BREAK--- 4) To a public health authority in certain situations as required by law, such as to report abuse, neglect, or domestic violence. 5) For health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and 6) other administrative or judicial actions undertaken by the government ( or their contractors ) by law to oversee the health care system. 7) 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. 8) For law enforcement activities in limited situations, such as when responding to a warrant. 9) For military, national defense and security and other special government functions. 10) To avert a serious threat to the health and safety of a person or the public at large. 11) For Worker’s Compensation purposes, and in compliance with Worker’s Compensation laws. 12) To coroners, medical examiners, and funeral directors for identifying a deceased person, determining 13) cause of death, or carrying on their duties as authorized by law. 14) 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. 15) For research projects, but this will be subject to strict oversight and approvals. 16) We may also use or disclose health information about you in a way that does not personally identify you or reveal who you are. Any other 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, except to the extent that we have already used or disclosed medical information in reliance on that authorization. Patient Care Rights: As a patient, you have a number of rights with respect to your PHI, including: 1) The right to access, copy or inspect your PHI. This means you may 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. You also have the right to receive confidential communications of your PHI. If you wish to inspect and copy your medical information, you should contact our privacy officer. 2) The right to amend your PHI. You have the right to ask us to amend written medical information that we may have about you. We will generally amend your information 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. ---PAGE BREAK--- 3) The right to request an accounting. You may request an accounting from us to 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 4) when we share your health information with our business associates, like our billing company, if applicable, 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. 5) 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. LFD is not required to agree to any restrictions you request, but any restrictions agreed to by LFD in writing are binding on LFD. 6) 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 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: LFD 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 posted in our facilities and posted to our web site, if we maintain one. You can get a copy of the latest version of the 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. CITY OF LAFAYETTE LAFAYETTE FIRE DEPARTMENT ATTN: Mandy Staley 1290 S Public Rd Lafayette, CO 80026 PHONE: 303-665-588 FAX: [PHONE REDACTED] Effective Date of this Notice is January 1, 2007