HIPAA  NOTICE  OF  
PRIVACY  PRACTICES
Effective Date:  March 4, 2004
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
If you have any questions about this notice, please contact the Privacy Officer at
815-436-5335
This notice describes our agencies practices and that of any health care professional
authorized to enter information into your medical report. All departments and units of the fire
department. Any member of a volunteer group we allow to help you while you are in the care of
Plainfield Fire Department. All employees, staff and other personnel. Our creditors follow the
terms of this notice. In addition, they may share medical information with themselves for
treatment, payment of Plainfield Fire Department operational purposes described in this notice.

OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are
committed to protecting medical information about you. We create a record of the care and
services you receive from the Plainfield Fire Department. We need this record to provide you
with quality care and to comply with certain legal requirements. This notice applies to all of the
records of your care generated by the Plainfield Fire Department, whether made by Plainfield
Fire Department personnel or your personal physician. Your personal physician may have
different policies or notices regarding the physician's use and disclosure of your medical
information created in the physician's office or clinic. This notice will tell you about the ways in
which we may use and disclose medical information about you. We also describe your rights
and certain obligations we have regarding the use and disclosure of medical information. We
are required by law to: Make sure that medical information that identifies you is kept private;
Give you this notice of your legal duties and privacy practices with respect to medical
information about you; and Follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose medical information.
For each category of uses or disclosures we will explain what we mean and try to give some
examples. Not every use or disclosure in a category will be listed. However, all of the ways we
are permitted to use and disclose information will fall within one of the categories.

For Treatment. We may use medical information about you to provide you with medical
treatment or services. We may disclose medical information about you to doctors, nurses,
technicians, medical students, or other hospital personnel who are involved in taking care of
you at the hospital. For example, an Emergency Room Physician treating you for a broken leg
may need to know if you have diabetes because diabetes may slow the healing process.
Different agencies may share medical information about you for other purposes such as
Quality Assurance. We also may disclose medical information about to people outside the
hospital who may be involved in your medical care after you leave the hospital, such as family
members, clergy or others we use to provide services that are part of your care.

For Payment. We may use and disclose medical information about you so that the treatment
and services you receive from the Plainfield Fire Department may be billed to and payment
may be collected from you, an insurance company or a third party. For example, we may need
to give your health plan information about care received by the paramedics so your health plan
will plan will pay us or reimburse you for the service.

For Health Care Operations. We may use and disclose medical information about you for
Plainfield Fire Department operations. These uses and disclosures are necessary to run the
fire department and make sure that all of our patients receive quality care. For example, we
may use medical information to review our treatment and services and to evaluate the
performance of our staff in caring for you.
Plainfield, Illinois