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HIPAA Notice 

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed by PEMA and how you can get access to this information. Please review it carefully.  This notice is written with the subject as “you,” which applies to children under age 18 and their guardians, as well as emancipated minors or patients older than 18 years of age.    


Your Rights


When it comes to your protected health information, you have certain rights:

  • Get an electronic or paper copy of your medical record

  • Ask us to amend your medical record

  • Request confidential communications

  • Ask us to limit what we use or share


You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.  This request must be made in writing to the PEMA Privacy Officer.  We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee for the copying, mailing or other supplies associated with your request.  You can ask us to correct health information about you that you think is incorrect or incomplete.  We may deny your request in certain, limited situations, but we will tell you why in writing within 60 days.  You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.  You can ask us not to use or share certain health information for treatment, payment, or our operations.  You have the right to request restrictions or limitations on the medical information we disclose to someone who is not involved in your child’s care.  We are not required to agree to your request, and we may deny the request if it would affect your care.  If you pay for a service or health care item out- of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.  We will say “yes” unless a law requires us to share that information.

  • You are able to obtain a list of those with whom we’ve shared information

  • Get a copy of this privacy notice

  • Choose someone to act for you

  • File a complaint if you feel your rights are violated


You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.  We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). This request must be made in writing.  We’ll provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.  You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.   If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.  We will make sure the person has this authority and can act for you before we take any action.  You can complain if you feel we have violated your rights by contacting the Privacy Officer in writing at the address below.  You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696- 6775, or visiting  We will not retaliate against you for filing a complaint.


Please Note:  PEMA is a hospital-based provider and as such, other than certain records related to services for which we may bill, the patient’s health records are created and maintained by the hospital in which the patient was treated by a PEMA healthcare provider.  Any requests for records, amendment to records, or limitations on use of information that is held within the hospital’s medical records will be forwarded to the appropriate person within the hospital.    


Your Choices


For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, inform us what you want us to do, in writing, and we will follow your instructions.  In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care

  • Share information in a disaster relief situation

  • Include your information in a hospital directory


If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.                    


Our Uses and Disclosures


We typically use or share your health information in the following ways:

  • For treatment

  • Run our organization

  • Bill for your services


We can use your health information and share it with other professionals who are treating you.  We can use and share your health information to run our practice, improve your care, and contact you when necessary. We can use and share your health information to bill and get payment from health plans or other entities.


We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:


We can share health information about you for certain public health and safety situations such as:

  • Preventing disease

  • Helping with product recalls

  • Reporting adverse reactions to medications

  • Reporting suspected abuse, neglect, or domestic violence

  • Preventing or reducing a serious threat to anyone’s health or safety


We may use or share your information for health research, under certain circumstances.  We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.  We can share health information with a coroner, medical examiner, or funeral director when an individual dies. We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities, and as authorized by law for special government functions such as military, national security, and presidential protective services.  We can share health information about you in response to a court or administrative order, or in response to a subpoena.


Our Responsibilities


  • We are required by law to maintain the privacy and security of your protected health information.

  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

  • We must follow the duties and privacy practices described in this notice and give you a copy of it.

  • We will not use or share your information other than as described here (including for marketing purposes or fundraising activities) unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

  • We may communicate with you about products or services related to your treatment, case management, care coordination, alternative treatments, therapies, healthcare providers, or care settings without your permission.

  • For more information see: understanding/consumers/noticepp.html.


Changes to the Terms of This Notice:


We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, and on our web site.

If you have any questions or concerns about our website or this Privacy Policy, please feel free to contact us by using the "Contact Us" link on this website.

Last Updated: May 2018


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