Thank you for visiting Bangs Ambulance's web site and for reviewing Bangs Ambulance's Privacy Policy. Bangs Ambulance is committed to respecting your privacy and collects only the following information as you browse through our web site:

• Who is visiting this site and where they are coming from (generic domain and country information, no personal info).
• Which pages are getting accessed and in what ways.
• When people visit this site and trends that can be seen over time.
• How people are finding these pages, using links, bookmarks, etc.
• Browsers people are using when visiting this site.
• Problems this server encountered while trying to fulfill requests.
• Bangs Ambulance collects this information for statistical purposes and for evaluating this web site to make it more useful to visitors.

If you send an e-mail message to Bangs Ambulance or complete a questionnaire, form, or other online survey found on Bangs Ambulance’s web site, Bangs Ambulance will maintain the information in accordance with applicable federal law.

Bangs Ambulance does not disclose, give, sell, or transfer any personal information about Bangs Ambulance’s web site visitors unless required for law enforcement or otherwise required by law.

Notice of Privacy Practices

IMPORTANT

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

As an essential part of our commitment to you, Bangs Ambulance maintains the privacy of certain confidential health care information about you, known as Protected Health Information or PHI. We are required by law to protect your health care information and to provide you with the attached Notice of Privacy Practices.

The Notice outlines our legal duties and privacy practices with respect to your PHI. It not only describes our privacy practices and your legal rights, but lets you know, among other things, how Bangs Ambulance is permitted to use and disclose PHI about you, how you can access and copy that information, how you may request amendment of that information, and how you may request restrictions on our use and disclosure of your PHI.

Bangs Ambulance is also required to abide by the terms of the version of this Notice currently in effect. In most situations we may use this information as described in this Notice without your permission, but there are some situations where we may use it only after we obtain your written authorization, if we are required by law to do so.

We respect your privacy, and treat all health care information about our patients with care under strict policies of confidentiality that all of our staff is committed to following at all times.

PLEASE READ THE ATTACHED DETAILED NOTICE. IF YOU HAVE ANY QUESTIONS ABOUT IT, PLEASE CONTACT OUR PRIVACY OFFICER, AT 607-273-1161.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Purpose of this Notice : Bangs Ambulance (Bangs) is required by law to maintain the privacy of certain confidential health care 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. Bangs is also required to abide by the terms of the version of this Notice currently in effect.

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

For treatment. This includes such things as 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 collection of 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 provide.

Use and Disclosure of PHI Without Your Authorization. Bangs is permitted to use PHI without your written authorization, or opportunity to object in certain situations, and unless prohibited by a more stringent state law, including:

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

•  For health care and legal compliance activities;

•  To a family member, other relative, partner or close personal friend or other individual involved in your care if we obtain your agreement to do so or if we give you an 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 interests;

•  To a public health authority in certain situations as required by law (such as to report abuse, neglect or domestic violence;

•  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 proceedings as required by a court or administrative order, or in some cases in response to a subpoena or other legal process;

•  For law enforcement activities in limited situations, such as when there is a warrant for the request, or when the information is needed to locate a suspect or stop a crime;

•  For military, national defense and 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 workers' compensation purposes, and in compliance with workers' compensation laws;

•  To coroners, medical examiners, and funeral directors for identifying a deceased person, determining 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 or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ donation and transplantation;

•  For research projects, but this will be subject to strict oversight and approvals and health information will be released only when there is a minimal risk to your privacy and adequate safeguards are in place in accordance with the law;

•  We may use or 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 only 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 the protection of your PHI, including:

The right to access, copy or inspect your PHI . This means you may inspect and copy most of the medical information about you that we maintain. We will normally provide you with access to this information within 30 days of your request. We may 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 available 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 the privacy officer.

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

The right to request an accounting. You may request an accounting from us of all disclosures of your medical information that we have made in the last three years prior to the date of your request. You have the right to request electronic healthcare information in electronic format. If you wish to request an accounting, contact the 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 information that we have about you. Bangs is not required to agree to all requests. If you request that we do not submit your bill to your health care plan, and your request is made prior to our routine submission of claims to that health care plan, and if you agree to be financially responsible for the cost of the services provided Bangs will comply. Any restrictions agreed to by Bangs are binding on Bangs Ambulance.

Breach Notification. Bangs will notify you at your last known address by First Class U.S. Mail, or upon request we will notify you in electronic format, if we discover that there has been, or we reasonably believe there has been a breach in the use, access or disclosure of your PHI. We will notify you as soon as reasonably possible, but in no case later than 60 calendar days after such discovery. We will provide you with a description of the breach, the type of PHI involved, the steps Bangs Ambulance has taken and what steps you should take to protect yourself as well contact procedures to learn more information.

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

Revisions to the Notice: Bangs 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 protected health information that we maintain. Any material changes to the Notice will be promptly posted in our facilities and posted to our web site, if we maintain one. You can get a copy of the latest version of this Notice by contacting the Privacy Officer identified below.

Your Legal Rights and Complaints: You also have the right to complain to us, or to the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated or if you believe Bangs has not complied with the Breach Notification rules. 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 the privacy officer

If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact:

Privacy Officer, Bangs Ambulance

205 W. Green Street

Ithaca, New York 14850

607-277-4911

Effective Date of Notice is January 1, 2010