How medical information about you may be used and disclosed and how you can get access to this information: Tri-Hampton Rescue Squad (THRS) is required by law to maintain the privacy of Protected Health Information (PHI) and to provide you with this Notice of our legal duties and privacy practices with respect to PHI. Protected Health Information is information maintained in any form that identifies an individual and relates to the physical or mental condition of that individual, the provision of health care or the payment for health care for that individual.

(THRS) may use and disclose your PHI for purposes of your treatment, our obtaining payment for services rendered to you and for health care operations. For example, we may disclose: a.) Information to the hospital where we transport you concerning your medical condition; b.) Information including medical reasons for your transport to obtain payment from your insurance company or other third party payor; c.) Information to our billing company to process your claim for payment; d.) Information to an auditor about services rendered to you for purposes of the determining quality of care we provided.

(THRS) 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. We may also use your PHI to contact you to raise funds for our organization or to ask you to become a member of our organization.

(THRS) also may use or disclose your PHI without your written consent or authorization, in accordance with and as otherwise restricted or limited by law or regulation, in the following circumstances:

1. If we inform you in advance verbally and you have the opportunity to agree, prohibit or restrict verbally, we may make disclosures to your family member, other relative, close personal friend or other person identified by you directly relevant to such person’s involvement with your care or payment of care, or we may disclose PHI to notify a family member, personal representative or other person responsible for your care of your location, general condition or death. If you are unavailable or incapacitated, we may exercise professional judgment and disclose your PHI to the above named individuals, if we determine it to be in your best interest. We may similarly make disclosures to entities involved in disaster relief activities who are involved in notification of family members

2. To your personal representative, i.e. the person who under state law has authority to act on your behalf in making decisions related to health care;

3. To the extent required by law;

4. For public health and oversight activities;

5. For certain law enforcement activities;

6. For judicial and administrative proceedings;

7. To the coroner, medical examiner, or funeral director consistent with applicable law or as authorized by law;

8. To prevent or lessen a serious and imminent threat to the health or safety of a person or the public;

9. For specialized government functions including but not limited to national security;

10. To comply with laws relating to worker’s compensation or other similar programs;

11. For research in certain limited circumstances.

Any other uses and disclosures of your PHI 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.

To the extent Pennsylvania law may have more stringent requirements as to the use or disclosure of information that a patient as 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 more stringent requirements of the State law.

You have the right to request restrictions to certain uses and disclosures of your PHI that are for purposes of carrying out treatments, 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 advice you of our decision. We may nevertheless release restricted information in certain emergency situations.

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

You have the right to inspect and copy your PHI except as otherwise restricted by law. You must make your request in writing. We may charge a reasonable fee for the copies that you request.

You have the right to request that we amend your PHI except as otherwise restricted by law and regulation. You must make your request in writing and you must provide a reason to support your requested change. We must respond to your request no later than sixty (60) days after receipt of your request.

You have the right to request and receive an accounting from us of certain disclosures of your PHI upon written request without charge in any twelve-month period. We may charge for a subsequent request within the twelve-month period. We must respond to your request for an accounting no later that sixty (60) days after receipt of your request.

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

We are required by law to abide by the terms of this Notice as it is currently in effect. We reserve the right to change the terms of this Notice and make the new Notice provisions effective for all PHI that we maintain. We will provide a revised Notice to you upon your request by mail.

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: Executive Board Chair, Tri-Hampton Rescue Squad, PO Box 659 , Richboro , PA 18954. We will not retaliate against you for filing a complaint.

To exercise you rights referenced in this Notice, or if you have any questions concerning the in formation contained in this Notice you should contact our Privacy Officer at 215-357-0473 for further information.

The Effective date of this Notice is April 14th 2003

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