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  1. We are required by law to maintain the privacy of Protected Health Information and to provide you with this Notice of our legal duties and privacy practices with respect to Protected Health Information. Protected Health Information is information maintained in any form that identifies an individual and relates to the physical or mental condition of an individual, the provision of health care or the payment for health care for that individual.

  2. With your prior written consent, we are permitted to disclose your Protected Health Information for purposes of treatment, payment and health care operations. For example, we may disclose: a. information to the hospital where you are transported about your medical status or treatment during the transport; b. information including medical reasons for your transport to obtain payment from your insurance company or other third party payer; c. information to an auditor about services we rendered to you for purposes of quality assurance.

  3. We also may use the information we obtain about you to contact you to provide information concerning health related services that may be of interest to you and for certain forms of marketing that are permitted by law without your authorization. We also may use Personal Health Information to contact you to raise funds for this organization or to ask you to become a member of this organization.

  4. We may disclose Personal health Information in an emergency without your prior written consent. In certain other instances we may use or disclose Protected Health Information without your written consent or authorization. If we inform you in advance verbally and you have the opportunity to agree or disagree verbally, we may make disclosures to your family member, other relative, close personal friend or other person identified by you. We may disclose Personal Health Information to notify a family member, personal representative or other person responsible for your care. We will attempt to obtain your agreement, if possible. We may use or disclose Personal Health Information without obtaining consent, authorization or providing an opportunity to agree or disagree to the extent required by law and for public health and oversight activities, law enforcement activities, judicial and administrative proceedings and in the event of death to the coroner, medical examiner" or funeral director.

  5. Any other uses and disclosures will be made only with your written authorization. You may revoke any such authorization that you give, provided your revocation is in writing and we have not already taken any action in reliance on the authorization.

  6. To the extent Pennsylvania law may have more stringent requirements as to the use or disclosure of information that a patient has Acquired Immune Deficiency Syndrome (AIDS), about a patient's HIV status, information regarding drug and alcohol use or dependency, or mental health records, it is our policy to abide by the more stringent requirements of the State law.

  7. You have the right to request restrictions to certain uses and disclosures of your protected health information that are for purposes of carrying out treatment, payment or health care operations. You also have the right to request restrictions to certain permitted disclosures to family members, other relatives, close personal friends or individuals identified by you. We are not required to agree to such restrictions, but will advise you of our decision.

  8. You have the right to request receipt of confidential communications of protected health information by alternative means or at an alternative location. We will accommodate reasonable requests made by you. Your request must be made in writing.

  9. You have the right to inspect and copy your protected health information except as otherwise restricted by law and regulation.

  10. 1You have the right to request that we amend your protected health information. Your request must be made in writing and you must provide a reason to support your requested change.

  11. You have the right to receive an accounting from us of certain disclosures of your protected health information upon your written request without charge in any twelve month period. We may charge for a subsequent request within the twelve month period.

  12. If you received this Notice electronically you have the right to obtain a paper copy of this Notice upon request.

  13. We are required to abide by the terms of this Notice as it is currently in effect.

  14. We reserve the right to change the terms of this Notice and to make the new. Notice provisions effective for all Protected Health Information that we maintain.

  15. You may complain to us and to the Secretary of the Department of Health and Human Services of the United States of America if you believe that your privacy rights have been violated. You may file your complaint with us by sending a written complaint to Central Bucks Ambulance, 455 East Street, Doylestown, PA   18901.    We will not retaliate against you for filing a complaint.

  16. You may obtain further information about this Notice by contacting our office at 215-348-8380.

  17. The Effective Date of this Notice is April 25, 2002.

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