Notice of Privacy Practices

Effective Date: August 2026

The Town of Cedar Lake Fire Department Emergency Medical Services (EMS) is committed to protecting the privacy and confidentiality of our patients’ health information. This Notice of Privacy Practices explains how medical information about you may be used and disclosed, what rights you have regarding your health information, and how you can exercise those rights.

We maintain patient records and other information necessary to provide quality emergency medical care and comply with legal requirements. We protect this information in accordance with the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, Indiana state laws, and applicable federal regulations.

Our Responsibilities

The Town of Cedar Lake Fire Department is required by law to:

• Maintain the privacy and security of your Protected Health Information (PHI).
• Provide you with this Notice of Privacy Practices describing our legal duties and privacy practices with respect to your health information.
• Follow the terms of this Notice currently in effect.
• Notify you within 60 days following a breach of unsecured Protected Health Information, as required by 45 CFR § 164.404.
• Obtain your written authorization before using or disclosing your health information for purposes not described in this Notice or otherwise permitted by law.

We reserve the right to change the terms of this Notice and to make the new provisions effective for all Protected Health Information we maintain. If we make a material change to this Notice, we will make the revised Notice available upon request and will post the updated version on the Town of Cedar Lake website and at the Fire Department.

How We May Use and Disclose Your Information

We may use or disclose your health information without your written authorization for the following purposes:

Treatment

We may use and share your information to provide, coordinate, or manage your medical care. For example, we may share your patient care report with the hospital emergency department that receives you so that they can continue your treatment. This includes sharing patient information with hospitals, physicians, nurses, and other healthcare providers; transmitting patient care reports to receiving medical facilities; and consulting with medical control physicians regarding treatment decisions.

Payment

We may use and disclose your information to obtain payment for services provided. For example, we may send a bill to you or your insurance company that contains information identifying you, your diagnosis, and the treatment provided. This includes billing insurance companies, processing Medicare or Medicaid claims, and providing necessary documentation to our billing service company.

Healthcare Operations

We may use and disclose information for operational purposes. For example, we may use your health information to conduct quality assessment and improvement activities, or to evaluate the performance of our EMS personnel. This includes training and education, compliance reviews and audits, and accreditation and licensing activities.

Additional Permitted Uses and Disclosures

We may disclose information, when required or permitted by law, for the following purposes:

• Public Health: Reporting communicable diseases, births, deaths, and certain injuries; reporting abuse, neglect, or domestic violence as required by law.
• Health Oversight: Notifying government agencies responsible for overseeing healthcare systems, licensing, compliance, and investigations.
• Law Enforcement: Responding to valid legal processes such as court orders, warrants, and subpoenas, or reporting crimes occurring on our premises.
• Serious Threats: In emergency situations when necessary to prevent or lessen a serious and imminent threat to health or safety.
• Coroners, Medical Examiners, and Funeral Directors: When needed to identify a deceased person, determine cause of death, or carry out related duties.
• Workers’ Compensation: In compliance with workers’ compensation laws and regulations.
• Military and National Security Activities: When required by federal law or authorized government agencies.
• Required by Law: When a use or disclosure is required by federal, state, or local law.

Uses Requiring Your Authorization

Except as described in this Notice, we will not use or disclose your information without your written authorization. This includes most uses and disclosures involving marketing purposes, sale of health information, and certain disclosures of psychotherapy notes, if applicable.

Any other uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke an authorization at any time in writing, except to the extent we have already acted upon it. To revoke an authorization, submit your request in writing to the Privacy Officer at the address listed at the end of this Notice.

Your Rights Regarding Your Health Information

You have the following rights with respect to your Protected Health Information. To exercise any of these rights, submit a written request to the Privacy Officer at the address listed at the end of this Notice.

Right to Request Restrictions

You have the right to request that we restrict certain uses and disclosures of your health information for treatment, payment, or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone involved in your care or the payment for your care. To request a restriction, submit your request in writing to the Privacy Officer. Your request must state the specific restriction you are requesting and to whom the restriction applies. We are not required to agree to your request, except in the following circumstance: if you pay for a service or item out of pocket in full and request that we not disclose information related to that service to your health plan for payment or operations purposes, we are required to honor that request.

Right to Receive Confidential Communications

You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. For example, you may ask that we contact you only at a certain phone number or send correspondence to a different address. To request confidential communications, submit your request in writing to the Privacy Officer. We will accommodate all reasonable requests.

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your health information maintained by the Fire Department, including medical records and billing records. To request access, submit your request in writing to the Privacy Officer. We will respond to your request within 30 days. If we need additional time, we may extend the response period by up to 30 additional days, provided we give you a written explanation of the reason for the delay and the date by which we will complete your request. A reasonable, cost-based fee may be charged for copies. We may deny your request to inspect and copy in certain limited circumstances. If your request is denied, you will be informed in writing of the reason for the denial and your right to request a review of the denial.

Right to Request an Amendment

You have the right to request that we amend your health information if you believe it is incorrect or incomplete. To request an amendment, submit your request in writing to the Privacy Officer. Your request must include the reason you believe the information is incorrect or incomplete. We will respond within 60 days of receiving your request. We may deny your request if the information was not created by the Fire Department, is not part of the records maintained by the Fire Department, is not part of the information you would be permitted to inspect and copy, or is accurate and complete.

Right to an Accounting of Disclosures

You have the right to request a list (accounting) of certain disclosures we have made of your health information. The accounting will cover disclosures made in the six years prior to your request, except for disclosures made for treatment, payment, or healthcare operations, or disclosures made with your written authorization. To request an accounting, submit your request in writing to the Privacy Officer. The first accounting in any 12-month period will be provided free of charge. A reasonable fee may be charged for additional accountings within the same period, and we will inform you of the cost in advance.

Right to Obtain a Paper Copy of This Notice

You have the right to obtain a paper copy of this Notice at any time, even if you have previously received a copy or agreed to receive this Notice electronically. To obtain a paper copy, contact the Privacy Officer at the address or phone number listed at the end of this Notice.

EMS-Specific Communications

During emergency response operations, EMS personnel may share necessary patient information with receiving hospitals and healthcare facilities, air medical transport providers, mutual aid EMS agencies, medical control physicians, or other emergency responders when required for patient care or scene safety. Only the minimum necessary information will be shared when applicable.

Protection of Electronic Health Information

The Town of Cedar Lake Fire Department employs administrative, technical, and physical safeguards to protect electronic patient information, including secure EMS reporting systems, password-protected devices, access controls and auditing, encryption where appropriate, and workforce training on privacy and security practices.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer at:

Town of Cedar Lake Fire Department
PO BOX 707
9430 W 133rd Ave, Cedar Lake, IN 46303
Phone: 219.374.5961
Email: hipaa@cedarlakein.gov

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by visiting https://www.hhs.gov/ocr or by calling 1-877-696-6775.

You will not be retaliated against for filing a complaint.

Contact Information

For more information about this Notice or to exercise any of your rights, contact:

Privacy Officer
Town of Cedar Lake Fire Department
PO BOX 707
9430 W 133rd Ave, Cedar Lake, IN 46303
Phone: 219.374.5961
Email: hipaa@cedarlakein.gov

Acknowledgment of Receipt

The Town of Cedar Lake Fire Department will make a good-faith effort to obtain written acknowledgment of receipt of this Notice of Privacy Practices from each individual to whom we provide emergency medical services. In emergency situations where obtaining written acknowledgment is not practicable at the time of service, the Department will provide the Notice and attempt to obtain acknowledgment as soon as reasonably possible thereafter. If written acknowledgment cannot be obtained, the Department will document its good-faith efforts and the reason acknowledgment was not obtained.