Neptune Fire Company

Purpose of this Notice: Every patient has a right to know what we do with the Protected Health Information (PHI) we gather in the course of providing emergency medical services. We want to assure you that we properly safeguard this information as required by the Health Insurance Portability and Accountability Act (HIPAA) passed by Congress in 1996.

Uses and Disclosures of PHI: Neptune Fire Company QRS may use PHI for the purposes of treatment, payment, and health care operations, in most cases without your written permission. Examples of our use of your PHI:

For Treatment: This includes such things as verbal and written information that we obtain or release about you and use pertaining to your medical condition and treatment provided to you by us and other medical personnel (Including doctors and nurses who give orders to allow us to provide treatment to you).

For Health Care Operations: This includes quality assurance activities, licensing and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints, creating reports that do not individually identify you for data collection purposes, fundraising, and certain marketing activities.

Fundraising: We may contact you when we are in the process of raising funds for the Neptune Fire Company QRS, or to provide you with information about our services.

Use and Disclosure of PHI Without Your Authorization: Neptune Fire Company QRS is permitted to use PHI without your written authorization, or opportunity to object in certain situations, including:

• For health care fraud and abuse detection or for activities related to compliance with the law;
• To a family member, other relative or close personal friend or other individual involved in your care if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and do not raise an objection. We may also disclose health information to your family, relatives or friends if we infer from the circumstances that you would not object. For example, we may assume you agree to our disclosure of your PHI to your spouse when your spouse has activated EMS for you. In situations where you are not capable of objecting (because you are not present or due to your incapacity or medical emergency,) we may, in our professional judgement, determine that a disclosure to your family member, relative, or friend is in your best interest. In that situation, we will disclose only health information relevant to that person’s involvement in your care. For example, we may inform the person who contacted EMS and any relevant family members of your condition while on scene, or en-route to the hospital;
• To a public health authority in certain situations (such as reporting a birth, death or disease as required by law, as part of a public health investigation, to report child or adult abuse or neglect or domestic violence, to report adverse events such as product defects, or to notify a person about exposure to possible communicable disease as required by law;
• For health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and other administrative or judicial actions undertaken by law to oversee the health care system.
• 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;
• For law enforcement activities such as when there is a warrant for the request, or when the information is needed to locate a suspect or stop a crime;
• For military, national defense and security and other special government functions;
• To avert a serious threat to the health and safety of a person or the public at large;
• For workers’ compensation purposes, and in compliance of workers’ compensation laws;

To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of death, or carrying on their duties as authorized by law;

• We may 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 or PHI, other than those listed above will only be made with your written authorization, (the authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to use or disclose it). 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 to that authorization.

Patient Rights: As a patient, you have a number of rights with respect to the protection of your PHI, including:

• The right to inspect your PHI.
• The right to amend your PHI.
• The right to request a list of all requests for disclosure of your PHI for purposes other than treatment, payment and internal use as noted under "Other."
• The rights to restrict disclosure of medical information to other health care providers and family.
• The right to complain to us if you feel your PHI has been compromised.
• The rights to file a complaint with the Federal Department of Health and Human Services if you believe your rights have been violated.

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 the government. Should you have any questions, comments or complaints you may direct all inquiries to the privacy officer listed at the end of this notice.

If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact:

Privacy Officer

Neptune Fire Company

20-22 East Main St.

Richland, PA 17087

(717)-866-2675

Effective Date of this Notice: April 1, 2003