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Your Information.

Your Rights.

Our Responsibilities.

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.

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When it comes to your health information, you have certain rights. This section explains your

rights and some of our responsibilities to help you.

Get a copy of your

health and claims records

You can ask to see or get a copy of your health and claims records and other

      health information we have about you. Ask us how to do this.

We will provide a copy or a summary of your health and claims records, usually

     within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct health

and claims records

You can ask us to correct your health and claims records if you think they are

       incorrect or incomplete. Ask us how to do this.

We may say “no” to your request, but we’ll tell you why in writing within

       60 days.

Request confidential


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.

We will consider all reasonable requests, and must say “yes” if you tell us you

      would be in danger if we do not.

Ask us to limit what

we use or share

You can ask us not to use or share certain health information for treatment,

      payment, or our operations.

We are not required to agree to your request, and we may say “no” if it

      would affect your care.

Get a list of those with

whom we’ve shared


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). 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.

Get a copy of this

privacy notice

You can ask for a paper copy of this notice at any time, even if you have

    agreed to receive the notice electronically. We will provide you with a paper

    copy promptly.

Choose someone

to act for you

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.

File a complaint if

you feel your rights

are violated

You can complain if you feel we have violated your rights by contacting us

    using the information on page 1.

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.

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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, talk to us. Tell

us what you want us to do, 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

    payment for your care

Share information in a disaster relief situation

Contact you for fundraising efforts


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.

In these cases we never

share your information

unless you give us

written permission:

Marketing purposes

Sale of your information

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How do we typically use or share your health information? We typically use or share your health

information in the following ways.

Help manage

the health care

treatment you


We can use your health information

    and share it with professionals who are

    treating you.

Example: A doctor sends us information

about your diagnosis and treatment plan

so we can arrange additional services.

Run our


We can use and disclose your

    information to run our organization

    and contact you when necessary.

We are not allowed to use genetic

    information to decide whether

    we will give you coverage and the

    price of that coverage. This does

    not apply to long term care plans.

Example: We use health information

about you to develop better services

for you.

Pay for your

health services

We can use and disclose your health

   information as we pay for your health


Example: We share information about

you with your dental plan to coordinate

payment for your dental work.


your plan

We may disclose your health information

    to your health plan sponsor for plan


Example: Your company contracts with us

to provide a health plan, and we provide

your company with certain statistics to

explain the premiums we charge.

How else can we use or share your health information? 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:

Help with public health

and safety issues

We can share health information about you for certain 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

Do research

We can use or share your information for health research.

Comply with the law

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.

Respond to organ and tissue

donation requests and work

with a medical examiner or

funeral director

We can share health information about you with organ procurement


We can share health information with a coroner, medical examiner, or

    funeral director when an individual dies.

Address workers’

compensation, law

enforcement, and other

government requests

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 authorized by law

   • For special government functions such as military, national security,

        and presidential protective services

Respond to lawsuits and

legal actions

We can share health information about you in response to a court or

      administrative order, or in response to a subpoena.

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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 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.

For more information see:


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, on our web site, and we will mail a copy to you.This Notice of Privacy Practices applies to Freedom Medical Services, Inc. (dba FreedoMed) with an Effective Date of October 1, 2017.
edoMed) with an Effective Date of October 1, 2017.

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