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<br />DRAFT <br /> <br />. <br /> <br />To the Secretary of the U.S. Department of Health and Human Services to investigate <br />or determine the City's compliance with privacy regulations. <br /> <br />To your family member, other relative, close personal friend, or other person <br />identified by you that is directly involved in your care. Such disclosures will be <br />limited to information relevant to the person's involvement in your care and, except <br />in the case of an emergency or your incapacity, you will be given an opportunity to <br />agree or to object to the disclosure. <br /> <br />For public health activities. <br /> <br />To report suspected abuse, neglect, or domestic violence to public authorities. <br /> <br />To a public oversight agency. <br /> <br />When required for judicial or administrative proceedings. <br /> <br />When required for law enforcement purposes. <br /> <br />To organ procurement organizations or other organizations to facilitate organ, eye, or <br />tissue donation or transplantation. <br /> <br />To a coroner or medical examiner for the purpose of identifying a deceased person, <br />determining a cause of death, or other duties required by law. <br /> <br />To a funeral director when permitted by law and when necessary for the funeral <br />director to carry out hislher duties with respect to the deceased person. <br /> <br />To avert a serious threat to health or safety. <br /> <br />For specialized government functions, as required by law. <br /> <br />When otherwise required by law. <br />Information that has been de-identified. This means that all individual identifiers have <br />been removed and it is reasonable to believe that the organization receiving the <br />information will not be able to identify the person to whom the information belongs. <br /> <br />. <br /> <br />. <br />. <br /> <br />. <br />. <br /> <br />. <br />. <br /> <br />. <br /> <br />. <br /> <br />. <br />. <br /> <br />. <br />. <br /> <br />YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION <br /> <br />You have the right to: <br /> <br />. <br /> <br />. <br /> <br />Request in writing that the City's Privacy Officer not use or disclose your protected <br />health information for certain purposes, unless the use or disclosure is required by <br />law. However, since most of the uses and disclosures made by the City are necessary <br />to administer your health plan, the City does not have to agree to your request. <br /> <br />Request that the City refuse disclosure of your protected health information for any <br />purpose not included in this notice, unless the City first receives your written <br />authorization. To be valid, an authorization must include: the name of the person or <br />organization making the disclosure, the name of the person or organization receiving <br />the disclosure, specifics on the information that may be disclosed, the purpose of the <br />disclosure, and an end date or end event. You may revoke any authorization that you <br /> <br />71 <br /> <br />Rev. 10/27/04 <br />