At Missaukee County EMS we respect the confidentiality of your health information and will protect your information in a responsible and professional manner. 


This notice explains how we protect personal health information we have about you, and how we may use and disclose that information to others to administer our business operations and in other circumstances that are either required or permitted by law.  It also informs you of your rights with respect to your health information and how you can exercise those rights.  When we talk about information or Protected Health Information (PHI) in this notice, we mean individually identifiable health information, which relates to your past, present, or future health, treatment, or payment for health care services.  This information that is collected from you (for example: name, address, and gender), or received from a health care provider (for example: EMS personnel, doctors, and hospitals), your employer, or a health care clearinghouse.


We are required by law to:

  • Maintain the privacy of your health information
  • Provide you with this notice of our legal duties and privacy practices with respect to your Protected Health Information
  • Follow the terms of this notice


We reserve the right to change any of our privacy practices and the terms of this notice, and to make the new notice effective for all Protected Health Information  maintained by us.  Once revised, we will make the new notice available to you and post it on our website.  In cases where state laws further restrict the use or disclosure of the information described below,  we will follow the provisions of the more stringent state laws.




In order to administer our health benefit plans effectively, we will collect, use, and disclose Protected Health Information for the following activities:


Payment: We may use and disclose your Protected Health Information, as necessary, to determine your eligibility for benefits and claim administration purposes.  For instance, we may use information regarding services you receive from health care providers such as physicians, dentists, and hospitals to process reinsurance.  All of these types of uses are referred to as payment in this notice.


Health Care Operations:  We may use and disclose your Protected Health Information as necessary, as permitted by law, for our Health Care Operations which include insurance billing, customer service, coordination of benefits case management, OSHA compliance, Medical Authority, fraud prevention and reporting, auditing, collections, and other functions related to the administration of your insurance payments. 


Business Associates:  We may disclose your Protected Health Information to outside persons or organizations that assist us with our Health Care Operations (for example collections and auditing).  These persons or organizations are our business associates and we contractually require them to appropriately safeguard the privacy of your Protected Health Information.  We will not share your information with these groups or individuals unless they agree to keep it protected.


Others Involved in Your Care:  Unless you object by notifying us in writing at the address enclosed with this notice, we may disclose your Protected Health Information to family members or others that you have identified as being involved in your care.  Such use will be based on how involved the person is in your care, or payment that relates to your care.  We also may disclose your information to an entity assisting in a disaster relief effort so your family may be notified about your condition, status and location.  If you are not present or able to agree to disclosures about your health information, we may, using our professional judgment, determine whether the disclosure is in your best interest.


Other Ways We May Use or Disclose your Personal Health Information:  We are permitted, and in many cases required by law, to make certain other uses and disclosures of your Protected Health Information without your permission:


  • We may use or share your information for certain types of public health or disaster relief efforts.
  • We may use or share your information with an employee benefit plan through which you receive health benefits, provided they certify that they will keep the information protected and not use the information for any manner not permitted by law.
  • We may report information to state and federal agencies that regulate us.
  • We may share information for public health activity investigations.
  • We may report information to public health agencies if we believe there is a serious health or safety threat.
  • We may share information with a health oversight agency for certain oversight activities.
  • We may provide information to a court or administrative agency.
  • We may report information for law enforcement purposes.
  • We may report information to a government authority authorized by law to receive reports of child abuse, neglect, or domestic violence.
  • We may share information with a coroner or medical examiner to identify a deceased person, determine a cause of death, or as authorized by law.  We may also share information with a funeral director as necessary to carry out his or her duties.
  • We may use or share information for procurement, banking, or transplantation of organs, eyes, or tissue.
  • We may share information relative to specialized government functions, such as military and veteran activities, national security and intelligence activities, and for the protection of the President and other authorized persons.
  • We may disclose your Protected Health Information to a correctional institution if you are, or become an inmate of that correctional institution.
  • We may disclose information to comply with workers’ compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.
  • We may disclose our information to non-affiliated organizations or persons such as insurance institutions, agents, law enforcement and governmental authority as necessary to prevent criminal activity, fraud, material misrepresentation, or material non-disclosure in connection with your coverage or application for coverage.




Your rights are explained below.  Any requests to exercise those rights should be in writing and addressed to our Privacy Officer at the address provided at the end of this notice.


Right to Access:  You shave the right to copy and/or inspect Protected Health Information that we retain on your behalf.  All requests must be made in writing and signed by your or your representative.  We may charge a reasonable fee for copies and postage and, in certain limited cases, we may deny your request.  For example, you do not have the right to access certain types of information, including:

  • Information contained in psychotherapy notes
  • Information compiled in reasonable anticipation of, or for use in a civil, criminal, or administrative action or proceeding
  • Information subject to certain federal laws governing biological products and clinical laboratories


If we deny your request, we will notify you in writing and may provide you with the right to have the denial reviewed.


Right to Request a Restriction:  You have the right to ask us to restrict how we use or disclose your information for treatment, payment, or health care operations.  Such requests must be detailed, provided in writing, and signed by you or your representative.  Please note that while we will try to honor your request, we are not required to agree to these restrictions.  We will attempt to accommodate reasonable requests when appropriate.  We retain the right to terminate an agreed-to restriction by notifying you in writing if we believe such termination is appropriate.  You may also terminate an agreed-to restriction by sending us a written request to the address provided below.


Right to Confidential Communications:  If you believe that a disclosure of all or part of your Protected Health Information may endanger or cause harm, you have the right to request that we communicate with you in confidence by alternative means or to alternative locations.  We will accommodate reasonable requests.


Right to Request an Amendment:  you have the right to ask us to correct or amend Protected Health Information we maintain about you if you believe it is incorrect or incomplete.  Your request must be in writing, must include the reason for your request, and must be signed by you or your representative.  We are not obligated to make all requested amendments, but we will give each request careful consideration.   If we make the requested amendment or correction, we will notify you.  We may also notify others who work with us and have copies of the information if we believe such notification is necessary.  If we deny your request we will notify you in writing and you may then file a written statement of disagreement.  In this case, you may request that your written amendment request, our written denial, and your statement of disagreement (and our response if warranted) be included with your information for any future disclosures.


Right to a Paper Copy of This Notice:  You have the right to a paper copy of this notice. 

Contact us:

Missaukee County EMS
PO BOX 800
Lake City, MI 49651




Complaints:  If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer at the address listed above.  You may also notify the Secretary of the US Department of Health and Human Services of your complaint, in writing, within 180 days of a violation of your rights.  We support your right to protect the privacy of your Protected Health Information and will not retaliate against your for filing a complaint.