Oct 23, 2026 · @Erik

Mt. Shasta Ambulance Service, Inc.
1020 Oak Street, Mount Shasta, CA 96067 · PO Box 1030, Mount Shasta, CA 96067
Phone 530-926-2665 · Fax 530-926-5001 · Privacy@mtshastaambulance.com

Effective date: 10/23/2026

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.

Who this notice covers

This notice applies to Mt. Shasta Ambulance Service, Inc. ("Mt. Shasta Ambulance," "we," "us," or "our") and all of our employees, Paramedics, EMTs, staff, students, and volunteers.

Each time we respond to, assess, treat, or transport you, we create a record of that care. This record is your protected health information (PHI). This notice covers those records. Hospitals and other providers who care for you may have their own notices for the records they keep.

Our duties

We are required by law to:

• Keep your medical information private and secure.

• Give you this notice of our legal duties and privacy practices.

• Follow the terms of the notice currently in effect.

• Notify you if a breach occurs that may have compromised the privacy or security of your information.

We will not use or share your information other than as described here unless you tell us we can in writing.

How we use and share your information

We may use and share your information for the following purposes without your written permission.

Treatment. We share information with the people and facilities that care for you. Example: our Paramedics give your vital signs and the treatment provided to the emergency department staff when we arrive at the hospital, or to an air ambulance crew that takes over your care.

Payment. We use and share information to bill for our services and get paid. Example: we send your name, the date of service, your condition, and the transport details to Medicare, Medi-Cal, your insurance company, or a billing company that works for us. We may also contact the hospital or facility you were taken to for your insurance information.

Health care operations. We use information to run our service and improve the care we give. Example: we review patient care reports for quality assurance, train our Paramedics, EMTs, and students, and meet licensing and accreditation requirements.

Business associates. Some services are provided by outside companies, such as billing and electronic patient care reporting vendors. We share information with them only under a written agreement that requires them to protect it.

Other ways we may share your information

The law allows or requires us to share information in these situations, within the limits the law sets:

• Family and others involved in your care: we may share information with a family member, friend, or caregiver involved in your care or payment, unless you object. If you cannot agree or object, such as when you are unconscious, we will use our professional judgment about what is in your best interest.

• As required by law: when federal, state, or local law requires it.

• Public health and safety: reporting disease, injury, or vital events; reporting to Siskiyou County EMS and the California EMS Authority; reporting problems with medical devices; and preventing a serious threat to the health or safety of you or others.

• Abuse, neglect, or domestic violence: reporting suspected abuse or neglect of a child, elder, or dependent adult to the proper authorities.

• Health oversight: audits, inspections, investigations, and licensing by government agencies.

• Lawsuits and legal proceedings: in response to a court order, subpoena, or other lawful process.

• Law enforcement: for example, to report certain injuries such as gunshot wounds, to respond to a court order or warrant, or about a crime on our premises or against our crews.

• Coroners, medical examiners, and funeral directors: as needed for them to carry out their duties.

• Organ and tissue donation: to organizations that handle organ, eye, or tissue donation and transplantation.

• Research: when a research project has been approved under privacy protections required by law.

• Military, veterans, and national security: as required by military command authorities or for authorized national security and protective services.

• Workers' compensation: as allowed by workers' compensation laws.

• Disaster relief: to organizations helping in a disaster so your family can be notified of your location and condition.

Uses that need your written permission

We will ask for your written authorization before we:

• Use or share your information for marketing.

• Sell your information.

• Use or share psychotherapy notes, if we ever hold them.

• Use or share your information for any purpose not described in this notice.

You may revoke an authorization at any time by writing to our Privacy Officer. Revoking it stops future sharing, but it does not undo anything we already shared while the authorization was in effect.

We do not use your information for fundraising.

California law

California's Confidentiality of Medical Information Act and other state laws may give you more protection than federal law, for example for HIV test results, mental health records, and substance use treatment information. When state law is stricter, we follow state law.

Your rights

To use any of these rights, contact our Privacy Officer. Some requests must be made in writing, and we can give you a form.

• Get a copy of your records. You can ask to see or get a copy of your patient care and billing records, on paper or electronically. Under California law, we will let you inspect records within 5 working days and provide copies within 15 days of your written request. You can fax your request to 530-926-5001. We charge $15 for a paper copy of your records and $6.50 for an electronic copy. There is no charge to inspect your records, and copies are free when California law requires it, such as when you need them to support an appeal for public benefits.

• Ask us to correct your records. If you think information is wrong or incomplete, you can ask us in writing to change it. We may say no, but we will tell you why in writing within 60 days.

• Ask for confidential communications. You can ask us to contact you in a certain way, such as at a different phone number or address. We will agree to reasonable requests.

• Ask us to limit what we use or share. You can ask us not to use or share certain information. We are not required to agree, except that if you pay for a service in full out of pocket, you can ask us not to share that information with your health insurer, and we will agree unless the law requires us to share it.

• Get a list of disclosures. You can ask for a list of the times we shared your information in the past six years, other than for treatment, payment, operations, and certain other purposes. One list per year is free.

• Get a copy of this notice. You can ask for a paper copy at any time, even if you agreed to get it electronically. It is also posted at www.mtshastaambulance.com.

• Choose someone to act for you. If you have given someone medical power of attorney or someone is your legal guardian, that person can use your rights for you.

• File a complaint. See below.

Changes to this notice

We may change this notice, and the changes will apply to all information we have about you. The new notice will be posted at our office and on our website, and you can ask us for a copy at any time.

Complaints

If you believe your privacy rights have been violated, you can file a complaint with us by contacting our Privacy Officer. You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at www.hhs.gov/ocr/complaints, by calling 1-800-368-1019, or by writing to 200 Independence Avenue SW, Washington, DC 20201.

We will not retaliate against you for filing a complaint.

Contact us

Privacy Officer, Mt. Shasta Ambulance Service, Inc.
Physical address: 1020 Oak Street, Mount Shasta, CA 96067
Mailing address: PO Box 1030, Mount Shasta, CA 96067
Phone: 530-926-2665
Fax: 530-926-5001
Email: Privacy@mtshastaambulance.com