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- Name <br /> -Address <br /> - Date of birth <br /> - Place of birth <br /> - Social Security Number <br /> - Blood type <br /> -Type of injury <br /> - Date of treatment <br /> -Time of treatment <br /> - Description of distinguishing physical characteristics (i.e. weight, hair color, eye color, <br /> gender,facial hair, scars and tattoos) <br /> Disclosing PHI About Crime Victims <br /> 1. PHI about crime victims may be disclosed to law enforcement only upon request of a <br /> law enforcement official. The disclosure may not be initiated by North State Medical <br /> Transport. <br /> 2. If a law enforcement officer requests PHI about an individual who may be the victim of a <br /> crime, North State Medical Transport staff members should first discern whether the <br /> individual is in fact a victim of a crime. Victims of a crime may include motor accident <br /> victims because often a summary or misdemeanor offense is involved (like when the <br /> accident is the result of the driver of another vehicle violating traffic laws). In many <br /> cases, the determination that a patient is or may be a crime victim can be inferred from <br /> the circumstances and the presence of law enforcement at the scene. <br /> 3. North State Medical Transport may disclose PHI about a crime victim to a law <br /> enforcement official if the individual agrees to the disclosure. If the patient is conscious <br /> and alert, and it would not impede the provision of care, the staff member should ask <br /> the patient if it is acceptable to disclose the PHI to law enforcement. If the patient does <br /> not consent to the disclosure,then PHI should not be disclosed and law enforcement <br /> should be informed of that fact. If the victim does consent to the disclosure, the PHI <br /> may be released in accordance with the patient's wishes. The consent may be verbal, <br /> but it should be documented on a patient care report or other document. <br /> 4. If the patient is unable to consent, due to incapacity or other reason,the staff member <br /> should ask law enforcement if they can wait until the patient is able to consent to the <br /> release of the PHI. If the law enforcement official represents that waiting until the <br /> patient is capable of agreeing to the disclosure would compromise an immediate law <br /> enforcement activity,then PHI may be disclosed to law enforcement provided the <br /> following conditions are met: <br />