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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