DVA Ambulance, Inc. Privacy Requirements for Patients. Our staff is bond by State and Federal Regulations regarding Patient's Rights including Confidentiality. Our staff is not permitted to release information regarding a Patient. Ambulance Run Records are also confidential and will not be released unless as required by regulations.

Use this page to obtain further information and resources of our Privacy Practices. All of the information on this site can be obtained in print upon notifing our offices either by calling us at (810) 762-9139 Ext 2 or in writing.

Forms
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• Authorization Form to Bill Insurance
• Notice of Privacy Practices
• Medical Records Release (Patient Only)
• Medical Records Amendment

US Department Health and Human Services Summary of the Privacy Rule; Download.

To obtain your Medical Records, you must submit a "Protected Health Information Authorization" form, which can be downloaded here (PDF format). Please follow the directions contained within this form completely, otherwise it can delay the process.