This Notice describes how confidential information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment, health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" (PHI), is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. Our practice is dedicated to maintaining the privacy of your protected health information.

We are required to abide by the terms of this Notice of Privacy Practices.

We are permitted or required to use your PHI without your written authorization, or an opportunity to object, in certain circumstances, including:

Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with another health care provider. Essex Rescue providers may use or disclose your PHI in order to treat you or to assist other health care providers in your treatment.

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. We are authorized to release PHI to a 3rd party billing agency. Our billing agency also abides by the same privacy practice requirements and will only share PHI with a patient's insurance company or similar groups involved in making payments.

Health Care Operations: This includes quality assurance activities, licensing, and training programs to ensure that personnel meet our standards of care and follow established policies, procedures and certain other management functions.

Health Care Oversight: Legal compliance activities, including audits or government investigations, disciplinary proceedings and other administrative or judicial actions undertaken by health oversight agencies for oversight of the health care system and governmental benefit programs.

Public Health & Governmental Authorities: To public health authorities charged with preventing or controlling disease, injury or disability, or to appropriate governmental authorities to report abuse, neglect or domestic violence.

Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is required or permitted by law to receive the information. At the direction of a public health authority, this may include disclosure to a foreign government agency that is collaborating with the public health authority.

Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Food and Drug Administration: We may disclose your protected health information as required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.

Maintenance of vital records: We may report data such as births and deaths.

Judicial and Administrative Proceedings: As required by a court or administrative order, or in response to a subpoena or other legal process.

For Law Enforcement: In certain limited circumstances, such as with warrants or where information is needed to locate or respond to a crime or to apprehend an individual who participated in a violent crime or escapee from lawful custody. We may also disclose protected heath information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) Limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) Suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of Essex Rescue, and (6) medical emergency (not on Essex Rescue's premises) and it is likely that a crime has occurred.

Serious Threat to Health or Safety: To prevent or lessen the imminent threat of a person or the public in accordance with federal or state law.

Military Activity / National Security: For certain limited functions or other special government functions.

Organ Donation: If you are an organ donor, to organizations that handle organ procurement / transportation as necessary to facilitate organ donation and transplantation.

Medical Examiner and Funeral Directors: For identifying a deceased person, determining cause of death, or funeral home activities.

Research: We may use and disclose your PHI to researchers when an Institutional Review Board or Privacy Board has reviewed and approved the research proposal, provided that required protocols are in place to ensure the privacy of your PHI.

Employers: To provide information concerning a work-related illness or injury or workplace related medical surveillance in compliance with requirements o the Occupational Safety and Health Administration, the Mine Safety and Health Administration, or similar state agency or law.

Workers Compensation: To comply with workers compensation laws and other similar legally established programs.

De-identified Information: We may use and disclose your health information if it does not personally identify you or reveal who you are.

You will be given an opportunity to agree or object before we use or disclose your PHI in the following circumstances and to the following individuals or entities:

1. To your family, relatives, or friends, or to other persons who you identify where such disclosure is relevant to that person's involvement in your care or payment for your care.
2. For the purpose of notifying (including identifying or locating) family members, personal representatives, or others responsible for your care, of your location, general condition or death.
3. For notification purposes to public or private entities authorized by law or charter to assist in disaster relief efforts.

In these circumstances, your permission in these circumstances may be informal or inferred, and need not be in writing. In emergency circumstances or if you are incapacitated, our staff, in their professional judgment, will determine whether the use or disclosure is in your best interest.

We will obtain your written authorization for any use or disclosure of your PHI that is not for treatment, payment or health care operations, or otherwise described above or permitted or required by law.

Access records - You have a right to request a copy of your PHI. This includes our patient care report and your billing information. To request a copy of your information, please contact our office as follows:

All requests for PHI shall be made in writing to our privacy officer. This can be done by a regular mail request to:

Essex Rescue Privacy Officer
1 Educational Drive
Essex Junction, VT 05452

Patients must indicate their desire to release their PHI in a signed letter. Hired agencies such as law offices must provide a signed consent form from the patient and agree to only use the PHI at the patient's expressed request.

Amendment of your record: You have the right to ask that information in your PHI be amended for accuracy and completeness. We may deny your request to amend information that we believe is correct, but you will have the opportunity to submit documentation of any disagreement in accordance with law.

Accounting for disclosures: You have the right to ask Essex Rescue how we have used and disclosed your PHI. A written request for this disclosure will be answered by our Privacy Officer within 30 days of receipt.

Request restriction on use and disclosure: You have the right to request that we restrict use or disclosure of your PHI. Requests must be made in writing to the privacy officer and PHI already disclosed will be exempt. While we have no obligation to agree to your requests for restrictions, we will agree to do so in appropriate circumstances.

Request communications by alternate means: We are able to transmit your PHI by internet, email, fax or in writing at your request. Please contact the privacy officer for more information.

File a complaint: Essex Rescue is always open to comments or suggestions about how we can improve our services. You may also contact our privacy officer to file a complaint about the handling of your PHI. In addition, you have the right to contact the US Department of Health and Human Services to file a complaint.

Revisions to This Notice: We may revise or amend the terms of our notice, at any time. The new notice will be effective for all protected health information maintained. Any material changes to the Notice will be promptly posted on our website. You may obtain a copy of the latest version by contacting our Privacy Officer.

If you have any questions, please contact:
Maureen Hoague, Privacy Officer (802) 878-4859 Ext 3