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East
Brookfield Fire Department Ambulance
AND
DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Uses and Disclosures of PHI:
Any
other use or disclosure of PHI, other then 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.
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.
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, such as 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 out business associates,
such as 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 PHI 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. East Brookfield Ambulance is not required to agree to any restrictions you request, but any restrictions agreed to by East Brookfield Ambulance in writing are binding.
Revisions
to the Notice: East Brookfield Ambulance 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 PHI 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 file
a complaint with 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. Privacy Officer Contact Information:
Effective date of the Notice: APRIL 14,2003
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