Washington Volunteer Fire and Rescue, Inc
Federal Tax ID: 54-1372411
Effective Date: September 1, 2016
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
This Notice describes the privacy practices of the Washington Volunteer Fire and Rescue, Inc
We are required by law to:
- Maintain the privacy of protected health information;
- Give you this notice of our legal duties and privacy practices
Regarding health information about you; and
- Follow the terms of our notice that are currently in effect.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION:
The following categories describe ways that we may use and disclose health information that identifies you (“Health Information”). Some of the categories include examples, but every type of use or disclosure of Health Information in a category is not listed. Except for the purposes described below, we will use and disclose Health Information only with your written permission. If you give us permission to use or disclose Health Information for a purpose not discussed in this Notice, you may revoke that permission, in writing, at any time.
We may use Health Information to treat you or provide you with health care services. We may disclose Health Information to doctors, nurses, technicians, or other personnel, including people outside our facility who may be involved in your medical care. For example, we may tell your primary physician about the care we provided you or give Health Information to a specialist to provide you with additional services.
We may use and disclose Health Information so that we may bill or receive payment from you, an insurance company or a third party for the treatment and services you received. For example, we may give your health plan information about your treatment so that they will pay for such treatment.
For Health Care Operations.
We may use and disclose Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and for our operation and management purposes. For example, we may use Health Information to review the treatment and services we provide to ensure that the care you receive is of the highest quality.
Individuals Involved in Your Care or Payment for Your Care.
We may release Health Information to a person who is involved in your medical care or helps pay for your care, such as a family member or friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.
As Required by Law
We will disclose Health Information when required to do so by international, federal, state or local law.
To Avert a Serious Threat to Health or Safety.
We may use and disclose Health Information when necessary to prevent or lessen a serious threat to
your health and safety or the health and safety of the public or another person. Any disclosure, however, will be to someone who may be able to help prevent the threat.
We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. All of our business associates are obligated, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Organ and Tissue Donation.
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 or tissue donation and transplantation.
Military and Veterans.
If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.
We may release Health Information for workers’ compensation or similar programs. These programs provide benefits for work related injuries or illness.
Public Health Risks.
We may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; track certain products and monitor their use and effectiveness; notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and conduct medical surveillance of the hospital in certain limited circumstances concerning workplace illness or injury. We also may release Health Information to an appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence; however, we will only release this information if you agree or when we are required or authorized by law.
Health Oversight Activities.
We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes.
If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order.
We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
We may release Health Information if asked by a law enforcement official for the following reasons: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3)
about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in emergency circumstances to report a crime, the location of the crime
or victims, or the identity, description, or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors.
We may release Health Information to a coroner or medical examiner. This may be necessary,
for example, to identify a deceased person or determine the cause of death. We also may release Health Information to funeral directors as necessary for their duties.
National Security and Intelligence Activities.
We may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.
Protective Services for the President and Others.
We may disclose Health Information to authorized federal officials so they may provide protection to
the President, other authorized persons or foreign heads of state or conduct special investigations.
Inmates or Individuals in Custody.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the appropriate correctional institution or law enforcement official. This release would be made only if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
You have the following rights regarding Health Information we maintain about you:
Right to inspect and copy.
You have the right to inspect and copy Health Information that may be used to make decisions about your care of payment of your care. You may receive a copy in paper or electronic format, as available.
Right to Amend.
If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us.
Right to an Accounting of Disclosures.
You may request an accounting from us of disclosures of your medical information that we have made in the six years prior to the date of your request. You may request an accounting of information we have used or disclosed for purpose of treatment, payment or health care operations.
Right to Request Restrictions.
You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. In addition, you have the right to request a limit on the Health Information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about your ambulance transport with your spouse. We are not required to agree to your request. If we agree, we will comply with your request unless we need to use the information in certain emergency treatment situations.
Right to Request Confidential Communications.
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 contact you only by mail or at work. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Pay Out of Pocket:
You have the right to pay out of pocket for a service and request no bill be sent to your individual health plan.
Right to a Copy of This Notice.
You have the right to a copy of this notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may obtain a copy of this Notice at our web site, washingtonvolunteerfireandrescue.com .
Right to File a Complaint.
If you believe your privacy rights have been violated, you may file a complaint with us, or to the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W. , Washington, D.C. 20201, calling 1-877-696-6775, or
You will not be retaliated against in any way for filing a complaint with us or to the government.
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for Health Information we already have as well as any information we receive in the future. The Notice will contain the effective date on the first page.
It is our responsibility to promptly notify you in the event of a breach that may have compromised the privacy or security of your information.
To request inspection, copies, amendment, accounting of disclosures, restrictions, confidential communications of your health information, or to register a complaint if you believe your privacy rights have been violated, please contact: Washington Volunteer Fire and Rescue, P.O. Box 238, Washington, VA. 22747 or call 540-675-3615 for information on obtaining.
All requests must be made in writing.