Notice of Privacy Practices

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.
We are required by applicable federal and state law to maintain the privacy of your health information and to provide this Notice to you
about our privacy practices, legal duties and your rights concerning your health information. This Notice of Privacy Practices describes
how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for
other purposes that are permitted or required by law. It also describes your rights to access and control your protected health
information. "Protected Health Information" (PHI) is information about you; including demographic information that may identify you
and your past, present, or future physical and/or mental health condition and related health care services. We are required to abide by
the terms of this Notice of Privacy Practices. We may change the terms of our Notice at any time provided applicable law permits the
changes. We reserve the right to make the changes in our privacy practices and the new Notice will be effective for all protected health
information that we maintain at that time. You may request a copy of our notice at any time. To obtain additional copies you can access
our website at www.tvems.com or call the office and request a copy be sent to you in the mail.
We use and disclose health information about you for treatment, payment, and healthcare operations.
Following are examples of the types of uses and disclosures of your PHI that we are permitted to make. These examples are not meant
to be all-inclusive but to describe the types of uses and disclosures that may be made by our office.
In addition to our use of your health information for treatment, payment, or healthcare operations, you may give us written
authorization to use your health information or to disclose it to anyone for any purpose. Unless you give us a written authorization, we
cannot use or disclose your health information for any reason except those described in this Notice. If you give us an authorization, you
may revoke this authorization at any time in writing. Your revocation will not affect any use or disclosures permitted by your
authorization while it was in effect.
Treatment: We may use and disclose your protected health information (PHI) to provide, coordinate, or manage your healthcare and
any related services. For example, we will disclose your PHI, as necessary, to a hospital or physician that provides care to you to
ensure that they have the necessary information to diagnose or treat you.
Payment: Your PHI may be used, as needed, to obtain payment for the services we provide to you. For example, your insurance
company may require PHI before it approves or pays for the healthcare services we provided to you or to determine eligibility or
coverage of insurance benefits.
Healthcare Operations: We may use or disclose, as needed, your PHI in connection with our healthcare operations. These operations
include, but are not limited to, quality assessment activities, employee review activities, training, and licensing. We will also share your
PHI with third party "business associates" that perform various activities for us (e.g., our collection agency, document shredding
services, etc.). Whenever an arrangement between our office and a business associate involves the use or disclosure of your PHI, we
will have a written contract that contains terms that will protect the privacy of your PHI.
Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any
other person you identify, your PHI that directly relates to that person's involvement in your health care. If you are unable to agree or
object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our
professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any
other person that is responsible for your care; of your location, general condition, or death.
Uses and Disclosures of Protected Health Information
Other Permitted and Required Uses and Disclosures That May Be Made Without Your
Authorization or Opportunity to Object
Required By Law: We may use or disclose your PHI when we are required to do so by law. We may disclose PHI in the course of any
judicial or administrative proceeding, in response to an order of a court in certain conditions in response to a subpoena, discovery
request or other lawful process.

Public Health: We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to
collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability.
Communicable Diseases: We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable
disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight Agency: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits,
investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care
system, government benefit programs, other government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or
neglect. In addition, we may disclose your PHI if we believe that you have been a victim of abuse, neglect or domestic violence to the
governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the
requirements of applicable federal and state laws.
Coroners Office: We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death or for
the coroner or medical examiner to perform other duties authorized by law.
Military Activity and National Security: We may disclose to military authorities the health information of Armed Forces personnel under
certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence,
counterintelligence, and other national security activities. We may disclose to correctional institutions or law enforcement officials
having lawful custody, the PHI of inmates or patients under certain circumstances.
Workers' Compensation: we may disclose your PHI as authorized to comply with workers' compensation laws and other similar legally
established programs.

Your Patient Rights
Access: You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of
your PHI we have on file for as long as we maintain the PHI. You must make a request in writing and provide identification to obtain
access to your PHI. You may obtain a form to request access by using the contact information listed at the end of this Notice. Under
federal law, however, we have the right to deny access to your PHI in certain circumstances. For example, you may not inspect or copy
your PHI when it includes psychotherapy notes or if your PHI is being compiled in reasonable anticipation of, or use in, a civil, criminal,
or administrative action or proceeding.
Restriction: You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your
PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed
to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy
Practices. Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply.
You may obtain a form to restrict access by using the contact information listed at the end of this Notice. Under Federal Law, however,
we are not required to agree to a restriction that you may request. If we do agree to the requested restriction, we may not use or
disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment.
Alternative Communication: You have the right to request to receive confidential communications from us by alternative means or at an
alternative location. You have the right to request that we communicate with you about your health information by alternative means or
at alternative locations. You must make your request in writing. We will accommodate reasonable requests. Your request must specify
the alternative means or location and provide satisfactory explanation how payments will be handled under the alternative means or
location you request.
Amendment: You may have the right to have us amend your PHI. In certain cases, we may deny your request for an amendment.
Under federal law we have the right to deny an amendment to your PHI. If we deny your request, you have the right to file a statement
of disagreement with us. You may obtain a form to request an amendment by using the contact information listed at the end of this
Notice.
Disclosure Accounting: You have the right to receive a list of instances in which we have disclosed your PHI for purposes other than
treatment, payment, and healthcare operations. You have the right to receive a list of these disclosures that occurred after April 14,
2003. If you request this accounting more than once in a 12 month period we may charge you a reasonable cost-based fee for
responding to these additional requests.
Electronic Notice: You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this
notice electronically.

Questions and Complaints
If you are concerned that we may have violated your privacy rights or you disagree with a decision we made about access,
amendments, or restrictions to your PHI, you may file a complaint to us in writing or you may submit a complaint to the U.S.
Department of Health and Human Services. You may obtain a form to file a complaint by using the contact information listed at the end
of this Notice. We will not retaliate against you for filing a complaint.

You may contact our Privacy Officer during business hours between 7:00 a.m.-5:00 p.m. Monday-Thursday and 8:00 a.m.-12:00 p.m.
Friday with any questions or concerns.


Company: Thompson Valley Emergency Medical Services
Address: 380 North Wilson Avenue
Loveland CO 80537
Phone: 970-663-6025 Fax: 970-667-0172

This notice was published and becomes effective on April 14, 2003.