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HIPAA Privacy Notice

When the El Segundo Fire Department responds to an emergency call requesting medical assistance, we are required to send affected individuals an informational notice as part of a federal privacy requirement. The federal government published regulations that create a national standard to protect individuals' medical records and other personal health information. These privacy regulations, part of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), are known as the "Privacy Rule" and went into effect April 14, 2003. As part of these new requirements, the following "Notice Of Privacy Practices" that describes our responsibilities and individual rights under these new regulations, are sent to out.

Additional information is available on the Department of Health & Human Services website: http://www.hhs.gov/ocr/hipaa/.

Kevin Smith
Fire Chief
El Segundo Fire Department
314 Main Street
El Segundo, California 90245
(310) 524-2395

NOTICE OF PRIVACY PRACTICES
OUR RESPONSIBILITIES
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION
SPECIAL CIRCUMSTANCES
YOUR RIGHTS
COMPLAINTS

NOTICE OF PRIVACY PRACTICES

This notice describes the privacy practices of the El Segundo Fire Department. It describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

This Notice of Privacy Practices ("Notice") describes how we may use and disclose your health information to carry out payment and health care operations, and for other purposes that are permitted or required by law. It also sets out our legal obligations concerning your protected health information. Additionally, this Notice describes your rights to access and control your protected health information.


Effective Date: April 14, 2003

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OUR RESPONSIBILITIES
We are required by law to maintain the privacy of your protected health information. We are obligated to give you this Notice of our legal duties and privacy practices regarding health information about you. And we must abide by the terms of this Notice. We reserve the right to change the provisions of our Notice and make the new provisions effective for all protected health information that we maintain. If we make a material change to our Notice, we will mail a revised Notice to the address that we have on record for you.

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HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION
The following categories describe ways that we can 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 at any time by sending your notice, in writing, to El Segundo Fire Department, HIPAA Privacy Officer, 314 Main Street, El Segundo, CA 90245.

  • For Treatment. 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 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.
  • For Payment. We may use and disclose Health Information so that we, or others, 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.

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SPECIAL CIRCUMSTANCES

  • Required by Law. We must disclose Health Information when required to do so by international, federal, state or local law. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested
  • Business Associates. 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. For example, we may use another company to perform billing services on our behalf. 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.
  • 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.
  • 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.
  • Workers' Compensation. 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 reactions to medications or problems with products; notify people of recalls of products they may be using; and notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. 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.
  • Law Enforcement. 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.
  • 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.
  • To Avert a Serious Threat to Health or Safety. Consistent with applicable federal and state laws, we may use and disclose Health Information when necessary to prevent or lessen a serious and imminent threat to your health and safety or the health and safety of the public or another person.

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YOUR RIGHTS
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 or payment for your care. To inspect and copy this Health Information, you must make your request in writing. We may deny your request to inspect and copy your protected health information in certain limited circumstances. If you are denied access to your information, you may request that the denial be reviewed.
  • 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. To request an amendment, you must make your request in writing and should include the reason the amendment is necessary.
  • Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures of Health Information we made that are for reasons other than payment or health care operations. You may request an accounting by submitting your request in writing. Your request may be for disclosures made up to six (6) years before the date of your request, but in no event, for disclosures made before April 14, 2003.
  • 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 surgery with your spouse. To request a restriction, you must make your request in writing. We are not required to agree to any restriction that you may request. If we agree, we will comply with your request unless we need to use the information to provide emergency treatment to you.
  • 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. To request confidential communications, you must make your request in writing and your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
  • Right to a Paper Copy of This Notice. You have the right to a paper 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.

To fulfill any of the above requests, send the description of your request to:
El Segundo Fire Department, Attention: HIPAA Privacy Officer, 314 Main Street, El Segundo, CA 90245

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COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of the Department of Health and Human Services. You may file a complaint with us by writing to El Segundo Fire Department, Attention: HIPAA Privacy Officer, 314 Main Street, El Segundo, CA 90245.
Complaints filed directly with the Secretary must: (1) be in writing; (2) contain the name of the entity against which the complaint is lodged; (3) describe the relevant problems; and (4) be filed within 180 days of the time you became or should have become aware of the problem.
You will not be penalized for filing a complaint with the Secretary or with us.

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