Western Cass Fire Protection District

This notice describes how personal information (PI), personally identifiable information (PII), and protected medical information (PHI) about a recipient of services from the Western Cass Fire Protection District, hereinafter called “District”, may be used and disclosed and how recipients can get access to this information. This Notice should be reviewed carefully.

Purpose of this notice: It is the policy of the District to maintain the privacy of confidential information, known as PI, PII, and PHI, and to provide a notice of the District’s duties and privacy practices with respect to a recipient’s information. This Notice describes rights of a recipient, advises the recipient of the District’s confidentiality and privacy practices, and lets it be known how the District is permitted to use and disclose a recipient’s information

Use and disclosure of PI, PII, and PHI: The District may use PI, PII, and PHI for the purposes of providing services, payment, and other operations in most cases without anyone’s written permission. Examples of our use of a recipient’s PI, PII, and PHI:

For Services: This includes such things as obtaining verbal and written information about a recipient’s property, structures, medical condition and treatment from a recipient as well as from others, such as landlords, but especially doctors and nurses who give orders to allows the District to provide treatment to a recipient. This also includes information the District gives to other health care personnel to whom District transfers a recipient’s care and treatment and includes transfer of PHI via radio or telephone to the hospital as well as providing the hospital with a copy of the written record the District creates in the course of providing a recipient with treatment and transport.

For Payment: This includes any activities the District must undertake in order to get reimbursed for the services the District provides to recipients including such things as organizing a recipient’s PI, PII, or PHI and submitting bills to insurance companies (either directly or through a third-party billing company), management of billed claims for services rendered, necessity determinations and reviews, utilization review, and collection of outstanding accounts.

For Operations: This includes quality assurance activities, licensing, and training programs to ensure that District personnel meet the District’s standards of service or care and follow established policies and procedures or guidelines, obtaining legal and financial services, conducting business planning, processing grievances and complaints, and certain other management functions.

Use and Disclosure of PI, PII, and PHI Without Recipient’s Consent: The District is authorized to use PI, PII, and PHI without a recipient’s consent, authorization, or written permission in certain situations, including:

• Emergency situations (in these situations, the District will attempt to get a recipient’s written consent after the emergency service is provided)
• To a relative, friend or individual involved in a recipient’s care;
• To a relative, friend or individual such as a tenant involved with a recipient’s property;
• To law enforcement and the State Fire Marshal’s Office in certain situations such as reporting accidents, a crime such as arson, death, and unsafe situations,
• To a public health authority in certain situations such as reporting a birth, death, or disease, as part of a public health investigation, to report child or adult abuse or neglect or domestic violence, to report averse events such as product defects, or to notify a person about exposure to a possible communicable disease.
• For oversight activities including audits, or government investigations, inspections, disciplinary proceedings, and other administrative or judicial actions undertaken by the government (or their contractors);
• 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 property, health and safety of a person, or the public at large;
• For workers’ compensation purposes, in compliance with workers’ compensation laws.
• To funeral directors, coroners, and medical examiners, and to organ procurement organizations to facilitate the donation of organs, eyes, and tissue.

Any other use or disclosure of PI, PII, and PHI, other than those listed above will only be made with a recipient’s written consent or an authorization (an authorization specifically identifies the information the District seeks to use or disclose). A recipient may revoke a recipient’s consent or authorization at any time, in writing, except to the extent that the District has already used or disclosed PI, PII, and PHI in reliance on that consent or authorization.

The right to access, copy or inspect a recipient’s PI, PII, and PHI. A recipient may come to the District’s offices and inspect and copy most of the recipient’s PI, PII, and PHI that the District maintains. The District will normally provide a recipient with access to the recipient’s PI, PII, and PHI within thirty (30) days of the recipient’s request. Such period may be extend-ed up to an additional thirty (30) days if extenuating circumstances exist. The District may also charge a recipient a standard fee to copy any PI, PII, and PHI that a recipient has the right to access. In limited circumstances, the District may deny a recipient access to the recipient’s PI, PII, and PHI, and certain types of denials may be appealed. PI, PII, and/or PHI Request or Complaint Form 730-4 is available to request PI, PII, PHI and will provide a written response if the District denies a recipient’s access and let the recipient know the recipient’s appeal rights. If a recipient wishes to inspect and copy the recipient’s PI, PII, and PHI, the recipient should contact the District’s Privacy Officer.

The Right To Amend A Recipient’s PI, PII, and PHI. Recipients have the right to ask the District to amend written PI, PII, and PHI that the District may have about the recipient. The District is permitted to deny a recipient’s request to amend the recipient’s information in certain circumstances, such as when the District believes the information a recipient has asked the District to amend is correct. The District will generally take action on a recipient’s request to amend a recipient’s PI, PII, or PHI within sixty (60) days of the recipient’s request and will notify the recipient of the District’s action. If the District has denied a recipient’s request to amend a recipient’s PI, PII, or PHI, the recipient can appeal the District’s denial. If a recipient wishes to amend the recipient’s PI, PII, and PHI that that the District has about a recipient, the recipient should use PI, PII, and/or PHI Request or Complaint Form 730-4 to contact the District’s Privacy Officer.

The Right To An Accounting Of The District’s Use And Disclosures Of A Recipient’s PI, PII, and PHI. A recipient may request an accounting from the District of certain disclosures of a recipient’s PI, PII, and PHI that the District has made in the last six (6) years prior to the date of the recipient’s request. The District will also provide a recipient either with an accounting of disclosures of the recipient’s PI, PII, and PHI made by any District business associates, or with a list of any District business associates with contact in-formation so that a recipient may contact the District’s business associations. If a recipient wishes to request an accounting of the recipient’s PI, PII, and PHI that the District has or disclosed, the recipient should use PI, PII, and/or PHI Request or Complaint Form 730-4 to contact the District’s Privacy Officer.

The Right To Request That The District Restricts The Uses And Disclosures Of A Recipient’s PI, PII, and PHI. A recipient has the right to request using PI, PII, and/or PHI Request or Complaint Form 730-4 that the District restrict how the District uses and discloses a recipient’s PI, PII, and PHI that the District has about the recipient for services provided, for treatment, payment, or operations, or to restrict the PI, PII, and PHI that is provided to tenants, family, friends, and other individuals involved with the recipient. But if a recipient requests a restriction and the PI, PII, or PHI the recipient asks the District to restrict is needed to provide a recipient with emergency services or treatment, then the District may use the PI, PII, and PHI or disclose the PI, PII, and PHI to others to provide the recipient with emergency services or treatment. The District is not required to agree to any restrictions requested by a recipient, but any restrictions agreed to by the District is binding on the District.

Right To Receive Confidential Communications of PHI. Recipients may ask to receive communications regarding the recipient’s PI, PII, and PHI by alternate means or at an alternate location, if the recipient clearly specifies the alternate address or method of contact using PI, PII, and/or PHI Request or Complaint Form 730-4 . The District will try to accommodate all reasonable requests for alternate communications.

Revisions To This Notice. The District 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 PI, PII, and PHI that the District maintains. Any material changes to this Notice will be posted in the District’s facilities and on the District’s website.

Internet, Email, and the Right to Obtain a Paper Copy of This Notice. The District will prominently post a copy of this Notice on the District’s website. If a recipient allows the District, the District will forward this Notice by email instead of on paper; however, a recipient may always request a paper copy of this Notice.

Legal Rights and Complaints. If a recipient believes the PI, PII, or PHI privacy rights of the recipient has been violated, the recipient has the right to file a complaint using PI, PII, and/or PHI Request or Complaint Form 730-4 with the District. Recipients also have the right to file a complaint regarding PHI with the Secretary of the Federal Department of Health and Human Services. The District will not retaliate against a recipient in any way for filing a complaint with the District or to the state or federal government. Should recipients have any questions, comments or complaints, recipients may direct all inquiries to the District’s Privacy Officer.

PHI Legal Rights and Complaints. If a recipient believes the PHI privacy rights of the recipient has been violated, the recipient has the right to file a complaint with the Secretary of the Federal Department of Health and Human Services.