PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES FOR LIFECARE AMBULANCE SERVICE, INC.

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.

This notice took effect on April 14, 2003 and remains in effect until we replace it.

The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our organization. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about ways we may use and share medical information about you. We also describe your right and certain duties we have regarding the use and disclosure of medical information.

I. LEGAL DUTY

law requires us to:

Keep your medical information private
Give you a notice describing our legal duties, privacy practices, and your rights regarding your medical information.
Follow the terms of the current notice.

We have the right to:

Change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law.
Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.

Notice of change to privacy practices:

Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.

II. USES AND DISCLOSURE: The following section describes different ways that we use and disclose medical information. We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization.

For Treatment: We may use medical information about your to provide you with medical treatment or services. We may disclose medical information about you to your doctors, nurses, technicians, medical students, or other people who are taking care of you. We may also share medical information about you to your other health care providers to assist them in treating you.

For Payment: We may use and disclose your medical information for payment purposes. A bill may be sent to you or a third-party. The information on the bill may include your medical information.

For Health Care Operations: We may use and disclose your medical information for our health care operations.

Additional Uses and Disclosures: In addition to using and disclosing your medical information for treatment, payment, and heath care operations, we may use and disclose medical information for the following purposes:

Facility Directory: Unless you notify you object, the following will be placed on file at our office directory: your name; your location in our facility; your condition (general terms).

Notification: We may use and disclose medical information to notify or help notify: a family member, your personal representative or another person responsible for your care. We will share information about your location, general condition or death. In case of emergency we will share only the health information that is directly related to your health care.

Funeral Director, Coroner, Medical Examiner: To help them carry out their duties, we may share the medical information of a person who has died with a coroner, medical examiner, funeral director, or an organ procedure organization.

Court Orders and Judicial and Administrative Proceedings: We may disclose medical information in response to a court or administrative order, subpoena, discovery request, or other lawful processes, under certain circumstances. Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we may share your medical information with law enforcement officials.

Workers Compensation: We may disclose health information when authorized or necessary to comply with laws relating to corkers compensation or other similar programs.

III. YOUR INDIVIDUAL RIGHTS

You have a right to look at or get copies of your medical information.
You have a right to request a list of all the times we shared your medical information for purposes other than treatment, payment, and health care operations.
You have the right to request that we change certain parts of your medical information.
If you have viewed this notice electronically, and wish to receive a paper copy, you have the right to obtain a paper copy by making a request to our company.

IV. QUESTIONS AND COMPLAINTS

If you have any questions about this notice or if you think that we may have violated your privacy rights, please contact our office. You may also submit a complaint to the U. S. Department of Health and Human Services.