We do not sell your PHI to anyone or disclose your PHI to other companies who may want to sell their products to you (e.g. catalog or telemarketing firms). We must have your written authorization to use and disclose your PHI, except for the following uses and disclosures:

· To you and your personal representative: We may use and disclose your PHI to health care providers (doctors, dentists, pharmacies, hospitals, and other care givers) who request it in connection with your 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: We may use and disclose your PHI for our payment-related activities. This includes any activities we must undertake in order to get reimbursed for services we provide to you, including such things as submitting bills to insurance companies, making medical necessary determinations and collecting outstanding accounts.

· Before health care operations: We may use and disclose your PHI for our 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.

· For reminders concerning scheduled transports and information on other services: We may use and disclose your PHI when we contact you to provide you with a reminder of any scheduled appointments for non-emergency ambulance and medical transportation, or to provide information about other services we provide.

· To others involved in your care: We may disclose to a member of your family, a relative, a close friend or any other person you identify the PHI directly relevant to that person's involvement in your health care or payment for health care. Prior to disclosing your PHI to others involved in your care, we will attempt to obtain your verbal agreement or give you an opportunity to object to such disclosure. However, in certain other circumstances where we are unable to obtain your agreement, we may make such disclosure of your PHI that we believe is in your best interest.

· When required by law: We will use and disclose your PHI if we are required to do so by law, including but not limited to:

· To a public health authority such as to report abuse, neglect or domestic violence.
· For health oversight activities including audits or governmental 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 or if you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your PHI to the correctional institution or law enforcement official.
· 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.
· To other individuals or entities when required by the secretary of health and human services and state regulatory authorities.

· For matters in the public interest: We may use or disclose your PHI for matters in the public interest, including but not limited to:

· 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.
· If you are an organ donor, we may disclose your PHI 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: We may use your PHI to perform select research activities subject to strict oversight and approvals established to protect your privacy.

· Disclosures not revealing your identity: We may use or disclose your PHI in a way that does not personally identify you or reveal who you are.

Individual Rights

As a patient receiving City ambulance services, you have a number of rights with respect to your PHI, including but not limited to:

· Access: You have the right to 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 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 if we deny you access and let you know your appeal rights. If you wish to inspect and copy your medical information, you should contact the Charlevoix City Fire Chief at (231) 547-3279.

· Amendment: You have the right to ask us to amend written medical information that we may have about you. We will generally amend your information within 60 days of your request and will notify you when we have amended the information. 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 incorrect. If you wish to request that we amend the medical information that we have about you, you should contact the Charlevoix City Fire Chief at (231) 547-3279.

· Disclosure accounting: You have the right to request an accounting from us of certain disclosures of your PHI 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 PHI with our business associates or a hospital or medical facility from/to which we have transported you. We are also not required to give you an accounting of our uses of PHI for which you have already given us written authorization. If you wish to request an accounting, please contact the Charlevoix City Fire Chief at (231) 547-3279.

· Restriction requests: You have the right to request that we restrict how we use and disclose your PHI that we have about you. We are not, however, required to agree to any restrictions you request. If we agree to any such restrictions, we are bound by our agreement (except as needed for emergency treatment or as required by law), unless we notify you that we are terminating our agreement.

· Confidential communication: You have the right to receive confidential communications of your PHI. For example, you may request that we send all notifications to you at a post office box instead of to your home address. To request confidential communications, please call the Charlevoix City Fire Chief at (231) 547- 3279.

· 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 federal government.

The City of Charlevoix 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 PHI that we maintain. Any material changes to the notice will be promptly posted at the City Hall. You can get a copy of the latest version of this notice by contacting the Charlevoix City Fire Chief at (231) 547-3279.