Important:  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. As an essential part of our commitment to you, Mt. Orab Fire Department, Inc. maintains certain confidential health care information about you, know as Protected Health Information or PHI.  We are required by law to protect your healthcare information and to provide you with this Notice of Privacy Practices. The notice outlines our legal duties and privacy practices with respect to your PHI.  It not only describes our privacy practices and your legal rights, but lets you know, among other things, how Mt. Orab Fire Department is permitted to use and disclose PHI about you, how you may request amendment of that information, and how you may request restrictions on our use and disclosure of your PHI. Who will get this notice? Mt. Orab Fire Department provides emergent care to our patients in cooperation with physicians and healthcare facilities.  The privacy practices in this notice will be followed by:     *All healthcare professionals who           treat and/or transport you.     * All departments of our organization.     * All Staff of our organization.     * Any business associate with whom         we share healthcare information. Our commitment to you We understand that medical information about you is personal.  Our department is committed to protecting your medical information.  This notice applies to all records of your care that we maintain.  When our department is called to provide medical care to you we create a record of all medical care and any services you receive.  This record is started and maintained to assure quality care and permits us to comply with all legal requirements.  It is a legal document, and is confidentially maintained as part of your medical history. Other healthcare facilities may have different policies or notices which apply to their particular practices.  This particular notice only relates to the Mt. Orab Fire Department’s policies and practices.  We are required by law to:     *Keep medical information about you private.     * Give you this notice of our legal duties and         privacy practices with respect to medical         information about you.     *Follow the terms of the privacy notice that is        currently in effect. Changes to this notice We may change our policies at any time.  Changes will apply to medical information we already hold, as well as new information as the change occurs.  Before we make a significant change in our policies, we will change our notice and through other means as they may exist at the time.  You can receive a copy of the current notice at any time by contacting our privacy officer.  The effective date is listed just below the title. We may use and disclose medical information about you We may use and disclose medical information about you for treatment, to provide continued care, to obtain payment for services rendered, for quality improvement programs, and for statistical reporting to federal, state, and local governmental entities. We may use or disclose medical information about you without your prior authorization for several other reasons.  Subject to certain requirements, we may give out medical information about you without prior authorization for public health purposes, abuse or neglect reporting, health oversight audits, or inspections research studies, organ donation, worker’s compensation purposes and emergencies.  We also disclose medical information when required by law, such as in specific accidents or injuries or in response to valid judicial or administrative orders, such as a court order or subpoena.  In an emergency or urgent situation, we may disclose medical information about you to a friend or family member who is involved in your medical care.  We may disclose information to disaster relief authorities so that your family can be notified of your location and condition. Other use of medical information In any other situation not covered by this notice we will ask for your written authorization before using or disclosing medical information about you.  If you choose to authorize use or disclosure, you can later revoke that authorization by notifying our privacy officer in writing of your decision. Your rights regarding medical information about you In most cases, you have the right to look at or get a copy of your medical information that we use to make a decision about your care, when you submit a written request.  If you request copies, we may charge a fee for the cost of copying, mailing, or other related expenses.  If we deny your request to review or obtain a copy, you must submit a written request for review of that decision.  If you believe that information in your record is incorrect or if information is missing, you have the right to request that we correct the records by submitting a request in writing that provides your reason for requesting the amendment.  We could deny the request to amend a record if the information was not created by us, if it is not a part of the medical information maintained by us, or if we determine that the record is accurate.  You may appeal, in writing, a decision by us not to amend a record.  You have the right to a list of those instances where we have disclosed medical information about you, other than for treatment, payment, healthcare operations, or where you specifically authorized a disclosure, when you submit a written request.  The request must state the time period desired for the accounting, which must be less than a six year period and starting after April 14, 2003.  You may receive the list in paper form only.  The first disclosure list in a twelve month period is free.  Other requests may be charged according to our cost of producing the list.  We will inform you of any charges at the time of request.  You have the right to request that medical information about you be communicated in a confidential manner, such as sending mail to an address other than your home, by notifying us in writing of the specific way or location for us to use to communicate with you.  You may request, in writing, that we not use or disclose medical information about you for treatment, payment,  healthcare operations or to  persons involved in your care except when specifically authorized by you, when required by law, or in an emergency.  We will consider your request but we are not legally required to accept it.  We will inform you of our decision on your request. All written requests or appeals should be submitted to our privacy officer.           Complaints If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact:   Mt. Orab Fire Department Attn: Privacy Officer 105 Spice Street, PO Box 454 Mt. Orab, Ohio 45154 Finally, you may send a written complaint to: US Department of Health and Human Services Office of Civil Rights.  Under no circumstance will you be penalized or retaliated against for filing a complaint.