Notice of Privacy Practices

Pasco County Board of County Commissioners Fire Rescue Department 

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. 

Who will follow this notice? • Any health care professional authorized to enter information into your Agency chart. • All health related departments and programs of the Agency. • Any member of a volunteer group we allow to help you while you are a health care client of the agency. • All employees, staff and other Agency personnel. All entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share health information with each other for treatment, payment or health care operations purposes described in this notice. 

Our pledge regarding health care information. Your health information is personal, and Pasco County Board of County Commissioners - Fire Rescue is committed to protecting it. We create a record of the care and services you receive as a health care client of our Agency. We need this record to provide you with quality care and to comply with additional legal requirements. This notice applies to all of the records of your care generated by the Agency, whether made by Agency personnel, a provider or a business associate whom we contract with. We are required by law to keep your personal health information (PHI) private. The law requires us to provide you with a copy of this Notice of Privacy Practices, which describes our privacy practices and our legal duties with respect to PHI. Under certain circumstances, we may be required to notify you following a breach of unsecured PHI. 

How we may use or disclose your phi. We may use your health information to provide you with health treatment or services. We may disclose your health information to doctors, nurses, counselors, health care students, or other persons providing health services to you. For example, a doctor treating you may need to know if you have had a history of adverse side effects to a particular class of medication prior to prescribing a similar one. This information would be useful in selecting the most appropriate medication or course of treatment for you. Different programs of the agency may share your health information in order to coordinate the different things you need, such as prescriptions, and lab work. We also may disclose your health information to people outside the agency who may be involved in your health, e.g., home health agencies or your private physician. For the disclosure of your health information outside a particular Behavioral Health program, and for some Health programs, your authorization will always be obtained. Payment. We may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third party payer, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment. Health Care Operations. We may use and disclose your health information for operational purposes. These uses and disclosures are necessary to operate the agency and make sure that all of our patients, clients, and participants receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many agency patients, clients, and participants to decide what additional services the agency should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, counselors, health care students, and other agency personnel for review and continuous quality improvement purposes. We may also combine the health information we have with health information from other agencies to compare how we are doing and see where we can make improvements in the care and services we offer. Appointment Reminders. We may use your health information to contact you as a reminder that you have an appointment for treatment or health care at the agency. Treatment Alternatives. We may use your health information to provide you with information about or recommend possible treatment options or alternatives that may be of interest to you. Health-Related Products and Services. We may use your health information to provide you with information about our health-related products or services that may be of interest to you. Individuals Involved in Your Care or Payment for Your Care. We will disclose your health information to a friend, family member or significant other who is involved in your health care or who helps pay for your care only if we obtain your written authorization. Your written authorization should be provided on the Disclosing Health Information to Family Members or Those Involved In a Client’s Care form. This form can be obtained from and then submitted to the Chief Privacy Officer. Research. We may use your health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research. Your authorization will always be obtained if the researcher will have access to your name, address or other information that reveals who you are. Effective Date 09/06/13 2 As Required By Law. We may disclose your health information when required to do so by federal, state or local law. For example, the agency may disclose information for the following purposes: • Court orders and court-ordered warrants; • Subpoenas or summons issued by a court, grand jury, a governmental or tribal inspector general, or an administrative body authorized to require the production of information; • A civil or an authorized investigative demand; • Medicare conditions of participation with respect to health care provider participation in • the program; • Statutes or regulations that require the production of information, including statues or regulations that require such information if payment is sought under a government program providing public benefits; To Avert A Serious Threat to Health or Safety. We may disclose your health information when necessary to prevent a serious and imminent danger of violence to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to the target of the threat or to someone able to help prevent the threat. Organ and Tissue Donations. We may disclose your 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. Military and Veterans. If you are a member of the armed forces, we may disclose your health information as required by military command authorities. We may also disclose health information about foreign military personnel to the appropriate foreign military authority. Workers' Compensation. We may disclose your health information for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness. Public Health Related Activities. We may disclose your health information for public health activities. These activities generally include the following: • To prevent or control disease • To report the abuse or neglect of children, elders, and dependent adults; • To report reactions to medications or problems with products; • To notify people of recalls of products they may be using; • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading disease or condition Victims of Abuse, Neglect or Domestic Violence. We may disclose your health information to a government authority if asked to do so by a law enforcement official and the disclosure is required by law, necessary to prevent serious harm to the individual or other potential victims, or if you agree. If such a disclosure is made, we will make every effort to promptly inform you, with certain exceptions. Health Oversight Activities. We may disclose your 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 law. Law Enforcement. We may disclose your health 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; • About criminal conduct at the Agency; and • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the persons who committed the crime. Coroners, Medical Examiners and Funeral Directors. We may disclose your 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 may also disclose your health information to funeral directors as necessary to carry out their duties. Specialized Governmental Functions. We may disclose your health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. We may disclose your health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state to conduct authorized investigations. 

Other uses of your health information. Other uses and disclosures of your health information not covered by this notice or the laws that apply to us will be made only with your written authorization. The law also requires your written authorization before we may use or disclose: (i) psychotherapy notes, other than for the purpose of carrying out our treatment, payment or health care operations purposes, (ii) any PHI for our marketing purposes or (iii) any PHI as part of a sale of PHI. If you provide us with authorization to use or disclose your health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, this will stop any further use or disclosure of your health information for the purposes covered by your written authorization, except if we have already acted in reliance on your authorization. 

Your rights with respect to your phi. Right to Inspect and Copy. You have the right to inspect and copy your health information that is used to make decisions about your care. Usually, this includes health and billing records, but may not include some mental health information. To inspect and copy health information that is used to make decisions about you, you must submit your request in writing to the Chief Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to Effective Date 09/06/13 3 inspect and copy in certain very limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed. Another licensed health care professional chosen by the agency will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Right to Amend. If you feel that your health information 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 the agency. To request an amendment, your request must be made in writing on the Agency’s Request to Amend Health Information form. This form can be obtained from and then submitted to the Chief Privacy Officer. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment; • Is not part of the medical information kept by or for the agency, i.e., not part of your medical record; • Is not part of the information which you would be permitted to inspect and copy; or • Is accurate and complete; • Even if we deny your request for amendment, you have the right to submit a written addendum, not to exceed 250 words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly indicate in writing that you want the addendum to be made part of your medical record we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect. Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures. This is a list of the disclosures we made of your health information other than our own uses for treatment, payment and health care operations, (as those functions are described above) and with other expectations pursuant to the law, e.g., disclosures that you have authorized. To request this list or accounting of disclosures, you must submit your request in writing on the Agency’s Request for an Accounting of Disclosures form. This form can be obtained from and then submitted to the Chief Privacy Officer, Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period will be free. For additional lists, we will charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Right to Request Restrictions. You have the right to request a restriction of the use or disclosure of your health information to carry out treatment, payment or health care operations. - We are not, however, required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. Notwithstanding the foregoing, we must agree to a restriction on the use or disclosure of your PHI if: (i) the disclosure is for our payment or health care operations purposes and is not otherwise required by law and (ii) you or another person acting on your behalf has paid for our services in full. To request a restriction, you must make your request in writing on the Agency’s Request for Restriction on the Use or Disclosure of Health Information. This form can be obtained from and then submitted to the Chief Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse. 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 only contact you at work or by mail. To request confidential communications, you must make your request in writing on the Agency’s Request for Restriction on the Manner/Method of Confidential Communication form. This form can be obtained from and then submitted to the Chief Privacy Officer, We will not ask you the reason for your request and we will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. 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 obtain a paper copy of this notice contact the Chief Privacy Officer. 

Changes to this notice. Pasco County Fire Rescue is required to comply with the terms of this Notice as currently in effect. We reserve the right to change or amend our privacy practices at any time in the future, and to make any changes applicable to PHI already in our possession. This Notice will be revised to reflect any changes in our privacy practices. You may obtain a copy of our revised Notice by contacting our Chief Privacy Office.  CONTACT If you have questions or comments about our privacy practices, or if you would like to obtain additional information regarding your privacy rights, please contact our Chief Privacy Officer at: Pasco County, West Pasco Government Center, 7530 Little Road, New Port Richey, Florida 34654. Telephone: 727-847-8103 COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with Pasco County or with the Secretary of the Department of Health and Human Services (DHHS). To file a complaint with us, please put your complaint in writing and mail it to the following address: Chief Privacy Officer, West Pasco Government Center, 7530 Little Road, New Port Richey, Florida 34654. You may also contact our Privacy Officer by phone at: 727-847-8103. To file a complaint with the DHHS, you must put your complaint in writing and mail it to: Office of Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201. You will not be retaliated against or denied any health services if you elect to file a complaint.