HIPAA Regulations

CHAMBERSBURG FIRE DEPT. AMBULANCE.
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.

Chambersburg Fire Dept: The Chambersburg Fire Dept./Borough Of Chambersburg Ambulance is required by law to maintain the privacy of certain confidential health care information, known as Protected Health Information or PHI, and to provide you with the notice of our legal duties and privacy practices with respect to your PHI. Chambersburg FD is also required to abide by the terms of this Notice currently in effect, and to notify affected individuals following a breach of unsecured PHI.

Uses and Disclosures of PHI: Chambersburg FD may use PHI for the purposes of treatment, payment, and health care operations, in most cases without your written permission. Examples of our use of your PHI:

For treatment: This includes such things as obtaining verbal and written information about your medical condition and treatment from you as well as from others, such as doctors and nurses who give orders to allow us to provide treatment to you. We may give your PHI to other health care providers involved in your treatment, and may transfer your PHI via radio or telephone to the hospital or dispatch center.

For Payment: This includes any activities we must undertake in order to get reimbursed for the services we provide to you, including such things as submitting bills to insurance companies, making medical necessity determinations and collecting outstanding accounts.

For health care operations: This includes quality assurance activities, licensing, and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures, as well as certain other management functions.

SUD Treatment Information: We may receive or maintain substance use disorder (“SUD”) treatment records that originate from certain programs or activities related to substance abuse education, prevention, training, treatment, rehabilitation, or research that are protected under 42 C.F.R. Part 2 (“Part 2 Program”). If we receive or maintain your records from a Part 2 Program pursuant to a general consent that you provided to the Part 2 Program authorizing use and disclosure of your Part 2 Program records for purposes of treatment, payment, or health care operations, we may use and disclose those records for treatment, payment, and health care operations as otherwise described in this Notice, subject to the same rights, restrictions, and protections. If, however, we receive or maintain your Part 2 Program records pursuant to a specific written consent that you provided to us or to another third party, we will use and disclose those records only to the extent expressly permitted by that consent. Any SUD record protected health information that was disclosed may be subject to redisclosure. We will not use or disclose your Part 2 Program records, or testify or provide evidence describing the information contained in those records, in any civil, criminal, administrative, or legislative proceeding conducted by any federal, state or local authority against you, unless such use or disclosure is expressly authorized by your written consent or by a court order issued after notice from you.

Authorization is required for:

Sale of PHI, disclosures of psychotherapy notes, marketing uses and disclosures when we receive payment from a third party.

Use and Disclosure of PHI Without Your Authorization: Chambersburg FD is permitted to use PHI without your written authorization, or opportunity to object, in certain situations, and unless prohibited by more stringent state law, including:

For treatment, payment or health care operations activities of another health care provider who treats you;
For health care and legal compliance activities;
To a family member, other relative, or close personal friend or other individual involved in your care if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection, and in certain other circumstances where we are unable to obtain your agreement and believe the disclosure is in your best interests;
To a public health authority in certain situations as required by law (such as to report disease, abuse, neglect or domestic violence);
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 responding to a warrant;
For certain specialized government functions, such as military, national security and intelligence activities;
To avert a serious threat to the health and safety of a person or the public at large;
As authorized by and to comply with workers’ compensation or similar laws;
To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of death, or other duties as authorized by law;
If you are an organ donor, we may disclose PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissue for the purpose of facilitating such donation or transplantation;
For research projects, but this will be subject to strict oversight and approvals;
We may also use or disclose health information about you 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 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.

Patient Rights: As a patient, you have a number of rights with respect to your PHI, including:

The right to access, copy or inspect your PHI: This means you may inspect and copy most of the medical information about you that we maintain. We will normally provide you with access to this information within 30 days of your request. We may also charge you a reasonable fee for you to copy any medical information that you have the right to access. In limited circumstances, we may deny you access to your medical information, and you may appeal certain types of denials. We have available forms to request access to your PHI and we will provide a written response informing you of your appeal rights if we deny you access. You also have the right to receive confidential communications of your PHI. If you wish to inspect and copy your medical information, you should contact our privacy officer.

The right to amend your PHI: You have the right to ask us to amend written medical information that we may have about you. We will generally act on your request within 60 days and will promptly notify you of our actions. We are permitted by law to deny your request to amend your medical information only 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 the medical information that we have about you, you should contact our privacy officer.

The right to request an accounting: You may request an accounting from us of certain disclosures of your medical information that we have made in the six years prior to the date of your request. We are not required to give you an accounting of information we have used or disclosed for purposes of treatment, payment or health care operations, or when we share your health information with our business associates, like our billing company or a medical facility from/ to which we have transported you. We are also not required to give you an accounting of our uses of protected health information for which you have already given us written authorization. If you wish to request an accounting, contact our privacy officer.

The right to request that we restrict the uses and disclosures of your PHI: You have the right to request that we restrict how we use and disclose your medical information when the patient pays out-of-pocket in full for a service. Chambersburg FD is not required to agree to any restrictions you request, but any restrictions agreed to by Chambersburg FD in writing are binding on Chambersburg FD.

The Right to Get Notice of a Breach: You have a right to be notified upon a breach of any of your secured Protected Health Information.

Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request: If we maintain a website, we will prominently post a copy of this Notice on our website.

If you allow us, we will forward you this Notice by electronic mail instead of on paper and you may always request a paper copy of the Notice.

Revisions to the Notice: Chambersburg FD 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 protected health information that we maintain. Any material changes to the Notice will be promptly posted in our facilities and posted to our website, if we maintain one. You can get a copy of the latest version of this Notice by contacting our privacy officer.

Your Legal Rights and Complaints: You also have the right to complain to us, or to the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with us or to the government. Should you have any questions, comments or complaints you may direct all inquiries to our privacy officer.

Privacy Officer Contact Information:
Melinda Thompson, Privacy Officer
Borough of Chambersburg
100 S. Second St.
Chambersburg, Pa 17201
(717) 251-2414 - Telephone
(717) 261-4783 - Fax

Effective Date of the Notice: April 14, 2003

Revised September 23, 2013

Revised January 21, 2021;

Revised February 16, 2026

Copyright 2003, Page, Wolfberg & Wirth, LLC. Use by individual ambulance services permitted. Any other use or reproduction in any form requires our express written permission.
Contact us at www.pwwemslaw.com

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