55 Pa. Code § 2070.25 requires providers of medical service to give access to and allow the use and disclosure of information on applicants and clients to: Federal authorities, the Commonwealth, the Department, the county commissioners or county executive, and prime contractors or their authorized agents, if the information is necessary to the administration of the Public Assistance
Transportation Block Grant.
I hereby authorize my representatives to release any and all information required by STEP Transportation for the purpose of determining an appropriate method for the purpose of transporting me to various services.
I hereby authorize and request the disclosure of medical information to the Medical Assistance Transportation Program. I also hereby authorize the release of any information concerning the age, residence, citizenship, employment, education and training activities, and any additional information, including medical information and treatment plans, pertaining to eligibility for Medical Assistance Transportation and /or specific transportation requests under MATP. It is understood that
the information obtained will be used only for purposes directly related to the Medical Assistance Transportation Program or the Shared-Ride Transportation Program.
STEP Transportation reserves the right to verify all information with the Pennsylvania Department of Transportation (PennDOT) as well as the Department of Human Services. Failure to disclose complete and accurate information may result in suspension or termination of MATP/Shared-Ride services.