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.

Hanover Twp. Community Ambulance ("HTCA") is required to maintain the privacy of certain confidential health information, known as Protected Health Information or PHI, and to provide you with a notice of our legal duties and privacy practices with respect to your PHI. HTCA is also required to abide by the terms of the version of the Notice currently in effect.

Uses and Disclosures of PHI: HTCA may use PHI for the purpose of treatment, payment and health care operations, in most cases without your written permission. Examples of our use of you PHI:

For Treatment: This includes such things as obtaining verbal and written information about your medical condition and treatment from you as well as from others, such as doctors and nurses who give orders to allow us to provide treatment to you. We may give your PHI to other health care providers involved in your treatment, and may transfer your PHI via radio or telephone to the hospital or dispatch center.

For Payment: This includes any activities we must undertake in order to get reimbursed for the services we provide to you, including such things as submitting bills to insurance companies, making medical necessity determinations and collecting outstanding accounts.

For Health Care Operations: This includes quality assurance activities, licensing and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures, as well as certain other management functions.

Reminders for scheduled transports and Information on other services: We may also contact you to provide you with a reminder of any scheduled appointments for non-emergency ambulance and medical transportation, or to provide information about other services we render.

Use and disclosure of PHI without your written authorization: HTCA is permitted to use your PHI without your written authorization, or opportunity to object, in certain situations unless prohibited by a more stringent state law, including:

- For the treatment, payment, or health operations activities of another health care provider who treats you

-For health care and legal compliance activities

-To a family member, other relative, close personal friend, or other individual involved with your care if we obtain verbal agreement to do so or if we give you a opportunity to object to such a disclosure and you do not raise an objection,and in certain other circumstances where we are unable to obtain your agreement and believe the disclosure is in your best interest

-To a public health authority in certain situations as requested by law (such as to report abuse, neglect or domestic violance)

- For health oversight activities including audits or government investigations, inspections, disciplinary proceedings and other administrative or judicial actions undertaken by the government (or their contractors) by law to oversee the health care system.

-For judicial and administrative proceeding as required by a court or administrative order or in some cases to response to a subpoena or other legal process.

-For law enforcement activities in limited situations, such as when responding to a warrant

-For military, national defense, security and other special government functions

-To avert a serious threat to the health and safety of a person or the public at large

-For worker's compensation purposes and in compliance with worker's compensation laws

-To coroners, medical examiners and funeral directors for identifying a deceased person, determining the cause of death or carrying on their duties as authorized by law

-If you are an organ donor, we may release health information to organizations that handle organ procurement, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ donation or transplantation

-For research projects, but this will be subject to strict oversight and approvals

-We may also use and disclose health information about you in a way that does not personally identify you or reveal who you are

Any other use or disclosure of PHI, other than those listed above will be made with your written authorization. You may revoke your authorization at any time, in writing, except to the extent that we have already used or disclosed medical information in reliance on that authorization.

Patient Rights: As a patient, you have a number of rights with respect to your PHI including:

The right to copy or inspect your PHI: This means that you may inspect and copy most of the medical information about you that we maintain. We meay also charge you a reasonable fee for you to copy any medical information that you have the right to access. In limited circumstances, we may deny you access to your medical information, and you may appeal certain types of denials. We have avaliable forms to request access to your PHI and we will provide a written response if we deny you access and let you know your appeal rights. You also have the right to receive confidential communications of your PHI. If you wish to inspect and copy your medical information, you should contact our privacy officer.

The right to ammend your PHI: You have teh right to ask us to ammend written medical information that we may have about you. We will generally amend your request within 60 days of your request and will notify you when we amened the information. We are permitted by law to deny your request to amend your information only in certain circumstances, like when we believe the information you asked us to amend is correct. If you wish to amend the medical information we have about you, you should contact our privacy officer.

The right to request an accounting: You may request an accounting from us of certain disclosures of your medical information that we have made in the six years prior to the date of your request. We are not required to give you an accounting of information we have used or disclosed for the purposes of treatment, payment or health care operations, or when we share your health information with our business associates, like our billing company or a medical facility from/to which we have transported you. We are also not required to give you an accounting of your uses of PHI for which you have already given us written authorization. If you wish to request an accounting contact our privacy officer.

The right to request that we restrict the uses and disclosures of your PHI: You have the right to request that we restrict how we use and disclose your medical informationthat we have about you. HTCA is not required to agree to any restrictions you request, but any restrictions agreed to by HTCA in writing are binding

Internet, Electronic Mail and the Right to Obtain a Paper Copy of Notice on Request: If we maintain a web site, we will prominetly post a copy of this notice on our web site. If you allow us, we will forward this notice by electronic mail instead of on paper and you may always request a paper copy of this notice.

Revisions to this notice: HTCA reserves the right to change the terms of this notice at any time, and the changes will be effective immediately and will apply to all PHI that we maintain. Any changes to the notice will be promptly posted in our facilities and to our web site, if we maintain one. You can get a copy of the latest version of this notice by contacting our privacy officer.

Your Legal Rights and Complaints: You also have the right to complain to us, or to the Secretary of the United States Dept. of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with us or to the government. Should you have any questions, comments or complaints you may direct all inquiries to our privacy officer.

PRIVACY OFFICERS CONTACT INFORMATION:

NAME:

Bernard Gurnari or Chris Woolfolk

COMPANY:

Hanover Township Community Ambulance Assoc. Inc.

ADDRESS:

1001 Center Street., Hanover Township, PA 18706-5034

TELEPHONE NUMBER:

(570) 825-1266

EFFECTIVE DATE OF THIS NOTICE:

APRIL 14, 2003