Albemarle County Department of Fire Rescue (“ACFR”), Western Albemarle Rescue Squad (“WARS”), and Earlysville Volunteer Fire Company (“EVFC”) are 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 a notice of our legal duties and privacy practices with respect to your PHI. ACFR, WARS, and EVFC are also required to abide by the terms of the version of this Notice currently in effect.

Revisions to the Notice

ACFR, WARS, and EVFC reserve 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 web site, if we maintain one. You can get a copy of the latest version of this Notice by contacting our Privacy Officer.

Effective Date of the Notice: May 2, 2019

Privacy Officer Contact Information

Privacy Officer
Albemarle County Fire Rescue
460 Stagecoach Road, Suite F
Charlottesville, Virginia 22902

Phone: 434-296-5833

Email: ACFRCostRecovery@albemarle.org

ACFR, WARS and EVFC 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 are detailed below.

Using 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.

Using Your PHI 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.

Using Your PHI 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.

ACFR, WARS, and EVFC are permitted to use PHI without your written authorization, or opportunity to object, in certain situations, and unless prohibited by a more stringent state law, including the following.

• For the treatment, payment, or health care operations and activities of another health care provider who treats you;
• As required by law, including reporting for public health purposes;
• 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 and in certain other circumstances where we are unable to obtain your agreement and believe the disclosure to a person involved in your health care is in your best interests;
• To report 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, discovery request, or other legal process;
• For law enforcement activities in limited situations, such as when responding to a warrant;
• 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, we may release 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 donation and 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, including using or disclosing your psychotherapy notes, other than for the purpose of carrying out treatment, payment or health care operations.

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.

For more details on patient rights, please download a copy of the Notice of Privacy Practice Brochure below.

As a patient, you have a number of rights with respect to your PHI, including the following.

• Right to access, copy, or inspect your PHI
• Right to amend your PHI
• Right to request an accounting
• Right to request that we restrict the uses and disclosures of your PHI
• Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request.
• Right to notice of a breach of unsecured protected health information
• Right to request confidential communications

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.

• Notice of Privacy Practices Brochure
• Notice of Privacy Practices Brochure – Spanish