Refusal to Use a Wheelchair to Ride the Mobility Lift



I,                                                            , select not to sit in a wheelchair to use the mobility lift

provided for entering and exiting the vehicle being used to provide my transportation.

I have been instructed by HKP Non Emergency Medical Transportation LLC of the possible

dangers associated with standing on the mobility lift while entering and exiting the vehicle.


I fully realize I am solely responsible for my actions to refuse to cooperate for safety reasons.
I understand that this Duty to Inform notification form has been approved by HKP Non

Emergency Medical Transportation LLC.I have read and fully agree to all contents of this Duty

to Inform notification form.


Passenger assistance provided shall be considered door-to-door service.


The following parameters shall be followed by all drivers.


  1. For the safety and protection of both the driver and the passenger, the driver will NOT go

into a private residence for any reason.

  1. At health care facilities or other public buildings the driver may enter the building into the

common area only.

  • Passengers will be brought to the common area or received at the common area by facility staff.
  • The driver will NOT go beyond the common area to retrieve the passenger.
  1. If requested, the passenger will be assisted when entering and exiting the vehicle.
  2. The driver will secure any mobility device utilized by the passenger.
  3. The driver will assist securing the passenger with the available passenger restraint system.



The vehicle operator is responsible for adhering to this policy and providing service as described

herein.This means the driver will meet the passenger at the door of his or her pick-up location and

then assist the passenger to the door of the destination location.




Passenger Securement Policy:


All passengers, both ambulatory and non-ambulatory, shall properly utilize the passenger restraint system provided at their seat location.


Properly utilizing the passenger restraint system means:

  1. Ambulatory passengers shall wear the lap/shoulder restraint system provided at seating

locations.

  • Should the seat location only have a lap belt available, (e.g. the center seat of a 3 person seat may only have a lap belt) then the passenger will wear only the lap belt because that is what is available.
  1. Non-ambulatory passengers that are being transported in their mobility device shall be secured SEPARATELY from their mobility device.
  • The personal securement device that may be part of the passenger’s mobility device is NOT acceptable.
  • Each mobility device securement location also has a separate lap/shoulder passenger restraint system available that shall be used.
  • This separate passenger restraint system shall have 1 attachment point on the wall of the vehicle, plus 2 separate attachments points on the floor, behind the mobility device.
  • This configuration duplicates the lap/shoulder passenger restraint system found as part of an ambulatory seat placement.
  • This passenger lap/shoulder restraint system shall be used in conjunction with the mobility device securement, NOT in lieu of it.
  1. Passengers transferring from their mobility device to an ambulatory seat shall utilize the passenger restraint system available at the seat location they transfer to.
  2. Any passenger refusing to properly utilize the passenger restraint system available at their seat location shall not be transported.
  3. The driver shall ensure that the passenger restraint system for each occupied passenger location has been properly utilized before moving the vehicle.



Policies

Policies


Accidents

All drivers involved in an accident must perform the following actions:

  1. Check for personal injury.
  2. Check all passengers for injury.
  3. For all accidents involving secondary vehicles, check the driver and passengers of second vehicle for injury.
  4. If vehicle(s) is in operational condition, move to a safe area not obstructing the flow of traffic.
  5. Notify dispatch of the accident.
  • If the driver has a cellular telephone, either business or personal, notify local law enforcement and if emergency services personnel.
  • If the driver does not have a cellular telephone, inform dispatch that local law enforcement and, if required, emergency necessary location information.
  1. Remain at the scene until released by law enforcement or emergency services personnel.
  2. If necessary, make towing arrangements.
  • If the vehicle requires tow services, the responding supervisor/director will make arrangements.
  • If an involved secondary vehicle(s) requires tow services, the driver/owner of that vehicle will be responsible for arrangements.
  • If no supervisor/director is able to respond, inform the dispatcher that tow services are required.
  1. Complete any required accident investigation documentation.


Incidents
All drivers are required to report all incidents to the supervisor/director as they occur. If it is not possible to report the incidents as they are occurring, the incident must be reported when the driver returns to base or within 24 hours from occurrence, whichever is most feasible.


All drivers involved in an incident must perform the following actions:


  1. Check for personal injuries.
  2. Check all passengers for injury.
  3. Notify dispatch of the incident. If required, inform dispatch that local law enforcement and emergency services personnel are required and provide all necessary location information.
  4. If the driver is unable to contact dispatch and the driver has a cellular telephone, either business or personal, notify local law enforcement and, if required, emergency services personnel.
  5. If passengers are on board and the vehicle is operational:
  • Complete assigned trips, informing dispatch that a vehicle incident has occurred.
  • After the final passenger has disembarked, park the vehicle in an area as not to obstruct the flow of traffic.
  • Complete an Incident Report form.
  • Submit the Incident Report form with all manifests at the end of the shift.
  1. If no passengers are on board and the vehicle is operational:
  • Park the vehicle in an area so as not to obstruct the flow of traffic.
  • Complete an Incident Report form.
  • Submit the Incident Report form with all manifests at the end of the shift.
  1. If the vehicle is inoperative
  • Inform the dispatcher that a vehicle incident has occurred.
  • Request a back-up vehicle.
  • Inform the dispatcher that tow services are required.Complete an Incident Report form.
  • Submit the Incident Report from with all manifests at the end of the shift.


RESPONSIBILITIES:
It is the responsibility of all drivers to ensure that accidents/incidents are reported to the appropriate agency personnel in a timely manner.


Policy Manual
Policy Manual


Passenger Assistance: Curb-to-Curb

Passenger assistance provided shall be considered curb-to-curb
The following parameters shall be followed by all drivers.

  1. The driver will NOT assist a passenger beyond the curb.
  • If the passenger needs assistance beyond the curb it should be pre-arranged to coincide with the pick-up and drop-off times.
  1. If requested, the passenger will be assisted when entering and exiting the vehicleThe driver will secure any mobility device utilized by the passenger.
  2. The driver will assist securing the passenger with the available passenger restraint system.


The vehicle operator is responsible for sticking to this policy and providing service as described herein. This means the driver will meet the passenger at the curb or just outside the vehicle where no curb exists, at the pick-up and destination locations.






Rights & Responsibilities for Passenger


 The passenger has the right to:

  1. Safe, pleasant, and respectful service.
  2. On-time service as scheduled by the dispatcher.
  3. Information presented in a suitable format.
  4. Appeal any actions that result in a denial of service.


 The passenger has the responsibility to:

  1. Be ready for the driver by the scheduled pick-up time.
  2. Inform the dispatcher of any special assistance needs.
  3. Cancel pick-up by 4:00 p.m. the day before the scheduled trip.
  4. Inform HKP Non-Emergency Medical Transportation LLC of any service

​​             problems (or impeccable service).





Registering the Personal Care Attendant:

Individuals who needs extensive assistance in traveling (beyond that which our driver can provide),

including lifting, carrying, support during the ride, and behavior control, must arrange for a Personal Care

Attendant to accompany and assist them.A Personal Care Attendant is allowed to ride with the passenger free

of charge providing the passenger has registered his/her Personal Care Attendant prior to bringing them

on-board the vehicle.

To register their Personal Care Attendant, a passenger must contact our offices at least 24 hours in advance of

the first ride where this assistance is required. Name of the Personal Care Attendant is preferred but not

required as the individual providing the assistance may change depending upon availability or level of care

needed on a given day. It is not necessary for the passenger or the Personal Care Attendant to contact our office

if the person providing the services of the Personal Care Attendant has changed


HKP Non-Emergency Medical Transportation LLC

HKP Medical Transport

All mobility devices transported on vehicles operated by HKP Non Emergency Medical

Transportation shall be secured using the (4) point securement system located on the vehicle.


  1. Mobility device securement shall include:
  • Securing the mobility device in the designated area. The designated area is defined as a

location on  the vehicle that:

  • Has a clear floor space of 30 inches by 48 inches.
  • Has 4 securement locations for each placement.
  • Two securement locations for the rear of the mobility device.
  • Two securement locations for the front of the mobility device.
  • Does not obstruct passage of ambulatory passengers.
  1. The mobility device shall be secured utilizing 4 attachment straps that meet all applicable

Federal Motor Vehicle Safety Standards (FMVSS) for passenger transportation.

  1. Should a passenger refuse securement of their mobility device, the device will NOT be

transported.

  • Non-securement of the device creates a situation in which the safety of the driver and all

other passengers will be jeopardized.

  • A mobility device not secured during transport may become a flying projectile in the event of

emergency braking or an accident.