NOTICE OF PRIVACY PRACTICES
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.
Effective Date: April 14, 2003
Revision Date: June 6, 2007
Each time a patient contact is made and treatment is provided, HVFD (hereinafter
referred to as Hualapai Valley Fire District) a healthcare provider, a record is
made which typically contains your symptoms, exam, condition, and treatment.
Hualapai Valley Fire District is required by law to ensure that medical
information that identifies you is kept private and to provide you this notice
as to our legal duties and privacy practices with respect to medical information
about you, and to abide by the terms of this notice.
Hualapai Valley Fire District may release medical information about you for
worker’s compensation or similar programs. These programs provide benefits for
work related injuries or illness.
Hualapai Valley Fire District may release medical information if asked to do so
by a law enforcement official:
In response to a court order, subpoena, warrant, summons or similar process.
To identify or locate a suspect, fugitive, material witness or missing person.
About the victim of a crime if, under certain limited circumstances, we are
unable to obtain the person’s agreement.
About a death we believe may be the result of criminal conduct.
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.
For health oversight activities including audits or government investigations,
inspections, disciplinary proceedings, and other administrative or judicial
actions undertaken by the government ( or their contractors ) by law to oversee
the health care system.
For military, national defense and security and other special government
functions.
To avert a serious threat to health and safety of a person or the public at
large.
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 also use or disclose health information about you in a way that does not
personally identify you or reveal who you are, such as gathering statistical
data.
Additionally, patient information will be provided to an Attorney provided that
the request for information is received on Attorney letterhead and is
accompanied by a signed authorization from the patient.
You have the right to request a restriction on certain uses and disclosures of
your information except those uses and disclosures that we are legally required
or allowed to make. Other uses and disclosures will be made only with your
written authorization and you may revoke such authorization except to the extent
that action has already been taken based on that authorization. You have the
right to get a list of uses and disclosures Hualapai Valley Fire District has
made other than those purposes of quality assurance and compliance with the laws
that affect Hualapai Valley Fire District.
You have the right to ask that we send information to you to an alternate
address or by alternate means. Hualapai Valley Fire District must agree to your
request so long as we can easily provide it in the format you requested.
You have the right to see and receive copies of your medical information we have
in our possession, but you must make the request in writing. If we don’t have
your medical information, but we know who does, we will tell you how to obtain
it. We will respond to you within 30 days after receiving your written request.
The signature on your written request must be notarized.
You have the right to have Hualapai Valley Fire District amend a record about
you in a designated record for as long as the protected health information is
maintained. However, we may deny your request for amendment if we determine the
record that is the subject of your request was not created by Hualapai Valley
Fire District, unless you provide a reasonable basis to believe that the
originator of the record is no longer available to act on the requested
amendment, is not part of the designated record set; would not be available to
you for inspection under right of access; or is accurate and complete. You must
make the request for amendment in writing and provide a reason to support the
requested amendment.
Hualapai Valley Fire District reserves the right to change this notice. We will
post a copy of the current notice in the Administrative Office and at each of
our fire stations.
Any other use or disclosure of private health information, other than 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.
If you believe your privacy rights have been violated, you may file a complaint
with Hualapai Valley Fire District at the address below or with the:
Secretary of the Department of Health and Human Services
200 Independence Ave. SW.
Washington, D.C. 20201
You will not be retaliated against for filing a complaint.
Hualapai Valley Fire District reserves the right to change the terms of this
notice and to make new notice provisions effective for all private health
information Hualapai Valley Fire District maintains. A current notice will be
posted on the district’s website and available at Hualapai Valley Fire District
Administration Office at:
Hualapai Valley Fire District
2470 Butler Avenue
Kingman, AZ 86409
For mailing address please use:
Hualapai Valley Fire District
2470 Butler Avenue
Kingman, AZ 86409
For further information you may contact the Privacy Officer, Division Chief Ken
McLaughlin by phone at (928)757-3151 or by e-mail at
HVFDWEB@YAHOO.COM