| Notice
of Privacy Practices |
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Troy Fire Department
Notice of Privacy Practices
IMPORTANT: THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
As an essential part of our commitment to you, Troy
Fire Department maintains the privacy of certain
confidential health care information about you,
known as Protected Health Information or PHI. We are
required by law to protect your health care
information and to provide you with the attached
Notice of Privacy Practices.
The Notice outlines our legal duties and privacy
practices respect to your PHI. It not only describes
our privacy practices and your legal rights, but
lets you know, among other things, how Troy Fire
Department is permitted to use and disclose PHI
about you, how you can access and copy that
information, how you may request amendment of that
information, and how you may request restrictions on
our use and disclosure of your PHI.
Troy Fire Department is also required to abide by
the terms of the version of this Notice currently in
effect. In most situations we may use this
information as described in this Notice without your
permission, but there are some situations where we
may use it only after we obtain your written
authorization, if we are required by law to do so.
We respect your privacy, and treat all health care
information about our patients with care under
strict policies of confidentiality that all of our
staff are committed to following at all times.
PLEASE READ THE ATTACHED DETAILED NOTICE. IF YOU
HAVE ANY QUESTIONS ABOUT IT, PLEASE CONTACT
ASSISTANT CHIEF CHRIS BOEHRINGER, OUR PRIVACY
OFFICER, AT 19 E. RACE ST., TROY OHIO 45373, (937)
335-5678.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
Purpose of this Notice: Troy 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. This Notice
describes your legal rights, advises you of our
privacy practices, and lets you know how Troy Fire
Department is permitted to use and disclose PHI
about you.
Troy Fire Department is also required to abide by
the terms of the version of this Notice currently in
effect. In most situations we may use this
information as described in this Notice without your
permission, but there are some situations where we
may use it only after we obtain your written
authorization, if we are required by law to do so.
Uses and Disclosures of PHI: Troy Fire Department
may use PHI for the purposes of treatment, payment,
and health care operations, in most cases without
your written permission.
Patient Rights: As a patient, you have a number of
rights with respect to the protection of your PHI,
including:
The right to access, copy or inspect your PHI.
The right to amend your PHI.
The right to request an accounting of our use and
disclosure of your PHI.
The right to request that we restrict the uses and
disclosures of your PHI.
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 and make the Notice available
electronically through the 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: Troy 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 the Privacy
Officer identified below.
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.
If you have any questions or if you wish to file a
complaint or exercise any rights listed in this
Notice, please contact: Assistant Chief Chris
Boehringer.
Effective Date of Notice: 5 May 2003 |
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