Mehlville Fire Protection District – Privacy Practices Notice

Mehlville Fire Protection District is required by law to maintain the privacy of certain confidential health care information, known as Protected Health
Information (PHI), and to provide you with a notice of our legal duties and privacy practices with respect to your PHI. This Privacy Practices Notice
(Notice) describes your legal rights, advises you of our privacy practices and lets you know how Mehlville Fire Protection District is permitted to use and disclose your PHI.

Mehlville Fire Protection District is also required to abide by the terms of the version of this Notice currently in effect. In most situations we may use and disclose your PHI as described in this Notice without your permission, but there are some situations where we may use it only after we obtain your permission, if we are required by law to do so.

Mehlville Fire Protection District reserves the right to change the terms of this Notice at any time. Such changes will be effective immediately and will apply to all PHI that we maintain. Any material changes to this Notice will be promptly posted in our facilities and posted to our website, if we maintain one. You can request a copy of the latest version of this Notice by contacting the Privacy Officer identified below.

The following categories describe different ways that we may use and disclose your PHI, and include some examples to explain such uses and disclosures. Not every use or disclosure in a category will be listed.

Treatment. We may use or disclose your PHI to doctors, nurses, emergency medical technicians, and other persons necessary to provide you with medical treatment or services, For example, we may receive or transfer PHI via radio or telephone to the hospital or dispatch center, as well as discuss your PHI with nurses and doctors who give us orders to provide emergency treatment to you. In addition, we may disclose your PHI to other health care personnel when we transfer your care and treatment as well as provide the hospital with a copy of the written record we create in the course of providing you with treatment and transport. We may also follow-up with the hospital to find out how you are doing. We may also disclose your PHI to health care providers that treat you later on after the emergency situation, such as your personal physician.

Payment. We may use or disclose your PHI so that we may bill and be reimbursed for the treatment and services we provide to you. For example, we may need to use or disclose your PHI when we submit bills to insurance companies (either directly or through a third party billing), address insurance companies= inquiries about medical necessity determinations, and or institute collection activities on outstanding accounts. We may also provide your PHI to another health care provider or entity for their payment activities (such as the hospital that provides you treatment).

Health Care Operations. We may use or disclose your PHI as necessary to operate the Mehlville Fire Protection District and to make sure that you receive quality care. For example, we may use or disclose your PHI for 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, and fundraising, and certain marketing activities (such as newsletters). There are also some circumstances that we are permitted to disclose your PHI to another health care provider (such as the hospital to which you are transported) for its own health care operations.

Business Associates. We may use or disclose your PHI to certain individuals and companies that we contract with (our Abusiness associates@) so that they can perform the job we have asked then to do. For example, we contract with a billing company to assist us with billing insurance companies and third party payors. To protect your PHI, however, we require our business associates to appropriately safeguard your PHI and to meet the same confidentiality standards that we are required to meet.

Fundraising. We may contact you when we are in the process of raising funds for Mehlville Fire Protection District or to provide you with information about tax or bond proposals. If we contact you for such purposes, we will give you the opportunity to tell us that you do not want us to contact you again in the future.

Individuals Involved in Your Care or Payment for Your Care. We may disclose PHI to your family, a close personal friend or other individual involved in your care if we obtain your verbal agreement to do so or 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 called the ambulance 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 judgment, determine that a disclosure to your family member, relative, or friend is in your best interest. In that situation, we will disclose only PHI relevant to that person's involvement in your care. In addition, we may disclose your PHI to an entity assisting in a disaster relief effort (for example, the American Red Cross) so your family can be notified about your condition, status or location.

Special Circumstances. We may also use or disclose your PHI to specific individuals or entities for the following specific purposes:

• If federal, state or local law requires that we do so;
• For health care fraud and abuse detection or for activities related to compliance with the law;
• For certain public health activities 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 a 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 the government (or their contractors) 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 in limited situations, 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 with 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;
• If you are an organ donor, to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ donation and transplantation;
• For research projects (such disclosures will be subject to strict oversight and approvals and PHI will be released only when there is a minimal risk to your privacy and adequate safeguards are in place in accordance with the law); and
• If you are an inmate or under the custody of a law enforcement official, as necessary (1) for a correctional institution to provide you with health care, (2) to protect your health or safety or the health and safety of others, or (3) for the safety and security of the correctional institution or law enforcement.

We may also use or disclose your health information in a way that does not personally identify you or reveal who you are. Any other use or disclosure of PHI, other than those listed above, will only be made with your specific written authorization. You may revoke your authorization at any time, in writing, except to the extent that we have already used or disclosed your PHI in reliance of that authorization.

Although the PHI that we create, receive and maintain is the physical property of the Mehlville Fire Protection District, you have the following rights with respect to your PHI that we maintain.

The Right to Inspect and Receive a Copy of Your PHI. You have the right to inspect and obtain a copy of your PHI that we maintain. If you wish to inspect or obtain a copy of your PHI that we maintain, you should contact the Privacy Officer listed at the end of this Notice. We may charge you a reasonable copying fee. In limited circumstances, we may deny you access to your PHI; however, depending upon the reason for the denial, you may have the right to appeal our decision.

The Right to Amend Your PHI. You have the right to request that we amend (correct) your PHI that we maintain if you believe that the PHI is incorrect or incomplete. We are permitted by law to deny your request in certain circumstances, like when we believe the information you have asked us to amend is correct. If you wish to request that we amend your PHI that we maintain, you should contact the Privacy Officer listed at the end of this Notice.

The Right to Request an Accounting of Our Disclosures of your PHI. You may request an accounting (a Alist@) from us of disclosures of your PHI that we have made in the last six years prior to the date of your request, but after April 14, 2003. We are not required to give you an accounting of certain disclosures, such as disclosures for purposes of treatment, payment or health care operations, disclosures to our business associates, or disclosures that are pursuant to your written authorization. If you wish to request an accounting of disclosures that are not exempted from the accounting requirement, you should contact the Privacy Officer listed at the end of this Notice.

The Right to Request Restrictions on the Uses and Disclosures of Your PHI. You have the right to request that we restrict how we use and disclose your PHI for treatment, payment or health care operations, or to restrict the information that is provided to family, friends and other individuals involved in your health care. We are not required to agree to any restrictions you request, but if we do, we comply with your request unless the PHI is needed to provide you with emergency treatment. If you wish to request a restriction, you should contact the Privacy Officer listed at the end of this Notice.

The Right to Request Confidential Communications. You have the right to request that you receive confidential communications regarding your PHI in a certain form or at a certain location. For example, you may request that we only contact you by mail. To request confidential communication, you should contact the Privacy Officer listed at the end of this Notice.

The Right to Obtain Copy of Paper Notice on Request. You have the right to receive a paper copy of this Notice at any time, by contacting the Privacy Officer listed at the end of this Notice. If we maintain a website, 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.

If you believe your privacy rights have been violated, you may file a written complaint with us or the Secretary of the United States Department of Health and Human Services. Any complaint must be in writing, state the nature of the complaint and how to contact you. You will not be retaliated against in any way for filing a complaint, and your complaint will not affect any treatment that we provide to you.

If you have any questions about this Notice, or want to file a written complaint, please contact our Privacy Officer:

EMS Administrator Craig P. Walk
Mehlville Fire Protection District
11020 Mueller Road
St. Louis, MO 63123
314.894.0420 x 1707

Effective Date of the Notice: April 14, 2003