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.

Your health information is personal, and Brigham City Fire Department is committed to protecting it. We are required by law to maintain the privacy of health information that could be used to identify you, known as protected health information (PHI). The law requires us to provide you with a copy of this Notice of Privacy Practice, which describes our privacy practices and our legal duties with respect to PHI. Under certain circumstances, we may also be required to notify you following a breach of unsecured PHI.

Treatment. We may use or disclose your PHI in connection with our treatment or transportation of you. For example, we may disclose your PHI to doctors, nurses, technicians, medical students, and any other health care professional involved in taking care of you. We may also provide information about you to a hospital or dispatch center via radio, telephone, or other electronic means. We may provide a hospital or other health care facility with a copy of the medical records created by us while treating or transporting you.

Payment. We may use and disclose your medical information to obtain payment from you, an insurance company, and other third parties. For example, we may provide PHI to your health insurance plan to receive payment for our services.

Health care operations. We may use and disclose your PHI for quality assurance activities, licensing, and training programs to ensure that our personnel meet our standards for care and to ensure that our personnel follow our established policies and procedures. We may also use your information for obtaining legal, financial, or accounting services, conducting business planning, processing complaints, and for creation of reports that do not individually identify you.

Other uses or disclosures that do not require authorization. The law permits us to use or disclose your PHI without your authorization in the following circumstances:

• When required by law, but only to the extent required by law.

• For public health activities, including disclosures to public health authorities authorized by law to collect information for the purpose of preventing or controlling disease, injury, or disability, reporting births and deaths, and the conduct of public health investigations. We may also be required by law to disclose information related to possible child abuse or neglect.

• To a social service or other protective services agency authorized by law to receive reports about victims of abuse, neglect, or domestic violence. We will make every effort to obtain your permission before releasing this information, but in some cases, we may be required or authorized by law to act without your permission.

• For health oversight activities.

• For judicial and administrative proceedings, in response to a court order, subpoena, discovery request, or other lawful process.

• For law enforcement purposes, including disclosures: (1) to comply with laws requiring reporting of certain types of injuries, (2) made pursuant to a court order, warrant, subpoena, grand jury subpoena, or other lawful process, (3) to assist law enforcement in identifying or locating a suspect, fugitive, material witness, or missing person, ( 4) about the victim of a crime, if, under the circumstances, we are unable to obtain your permission, (5) about a death we reasonably believe may be the result of a crime, ( 6) about a crime committed on our premises, or (7) to notify law enforcement of the commission of a crime, the location of a victim, or to identify the perpetrator of a crime, but only in emergency situations.

• To coroners, medical examiners, and funeral directors.

• To organ procurement organizations.

• For approved medical research projects.

• To avert a serious threat to health or safety.

• For military and veteran's activities, national security, and other specialized government functions.

• To comply with laws relating to workers' compensation or similar programs.

Unless you object, we may provide relevant portions of your PHI to a family member, friend, or other person that you indicate is involved in making decisions about your health care or in paying for your health care. We may use or disclose PHI to notify your family member, friends, or personal representative about your condition. In an emergency or when you are not capable of agreeing or objecting to these disclosures, we will disclose your PHI only to the extent we reasonably believe such disclosure to be in your best interest, and we will tell you about such disclosure after the emergency has passed and give you the opportunity to object to future disclosures to family, friends, or personal representatives. Unless you object, we may also disclosure your PHI to people involved in providing disaster relief, for example, the American Red Cross.

Any other use or disclosure of PHI, other than those listed above, will only be made with your written authorization. The law also requires your written authorization before we may use or disclose: (1) psychotherapy notes, other than for the purpose of carrying out our treatment, payment, or health care operations purposes, (2) any PHI for our marketing purposes or (3) any PHI as part of a sale of PHI. You may revoke a previous written authorization in writing at any time. If you elect to revoke a prior written authorization, we will immediately stop any further uses or disclosures of your PHI for the purposes set out in the written authorizations to the extent we have not already acted in reliance on your authorization; however, we will be unable to retract any disclosures previously made with your permission.

You have the following rights with respect to your PHI:

• The right to request restrictions on use and disclosure of your PHI. To exercise this right, you must submit a written request to our privacy officer

• The right to request to receive your PHI in a specific location (for example, at your work address rather than your home) or in a specific manner (for example, by email rather than regular mail).

• The right to inspect and copy your PHI, except in limited circumstances. Any such request should be made in writing to our privacy officer

• The right to request that we amend your PHI to the extent you think it is inaccurate or incomplete. Any such request should be made in writing to our privacy officer and should include the reasons you think your information is inaccurate or incomplete

• The right to receive an accounting of any disclosures of your PHI made within the six years immediately preceding your request.

• The right to receive a paper copy of this notice.

Brigham City Fire Department is required to comply with the terms of this notice as currently in effect. We reserve the right to change or amend our privacy practices at any time in the future and to make any changes applicable to PHI already m our possession. This notice will be revised to reflect any changes in our privacy practices. You may obtain a copy of our revised notice by contacting our privacy officer.

If you have questions or comments about our privacy practices or you would like to obtain additional information about your privacy rights, please contact our privacy officer at: BRIGHAM CITY FIRE DEPARTMENT PO BOX 1005 BRIGHAM CITY, UT 84302.You may also contact our privacy officer by phone at: 435-226-1407.

If you think your privacy rights have been violated, you may file a complaint with Brigham City Fire Department or the secretary of the Department of Health and Human Services (DHHS). To file a complaint with us, please put your complaint in writing and mail it to:

Privacy Officer
Brigham City Fire Department
PO BOX 1005
Brigham City, UT 84302

You may also contact our privacy officer by phone at: 435-226-1407.

To file a complaint with the DHHS, file online at https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf (↗) or put your complaint in writing and mail it to:

Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201

You will not be retaliated against or denied any health services if you elect to file a complaint.