or those for whom a representative has made a request if the patient is unable to do so, must receive a medical screening examination (MSE) to determine whether an emergency medical condition (EMC) exists. The participating hospital cannot delay examination and treatment to inquire about methods of payment or insurance coverage, or a patient's citizenship or legal status. The hospital may start the process of payment inquiry and billing only once they have ensured that doing so will not interfere with or otherwise compromise patient care. When an emergency department determines that an individual has an EMC, the hospital must provide further treatment and examination until the EMC is resolved or stabilized and the patient can provide self-care following discharge, or if unable to do so, can receive needed continual care. Inpatient care provided must be at an equal level for all patients, regardless of ability to pay. Hospitals cannot discharge a patient prior to stabilization if the patient's insurance is canceled or otherwise discontinues payment during course of stay. If the hospital does not have the capability to treat the condition, the hospital must make an "appropriate" transfer of the patient to another hospital with such capability. That includes a long-term care or rehabilitation facilities for patients unable to provide self-care. Hospitals with specialized capabilities must accept such transfers and may not discharge a patient until the condition is resolved and the patient is able to provide self-care or is transferred to another facility. Hospitals have no obligation under EMTALA to provide uncompensated services beyond the screening exam unless it determines that the patient has an emergency medical condition. Amendments Since its original passage, Congress has passed several amendments to the act. Additionally, state and local laws in some places have imposed additional requirements on hospitals. These amendments include the following: A patient is defined as "stable", therefore ending a hospital's EMTALA obligations, if: The patient is conscious, alert, and oriented. The cause of all symptoms reported by the patient or representative, and all potentially life-threatening, limb-threatening, or organ-threatening symptoms discovered by hospital staff, has been ascertained to the best of the hospital's ability. Any conditions that are immediately life-threatening, limb-threatening, or organ-threatening have been treated to the best of the hospital's ability to ensure the patient does not need further inpatient care. The patient is able to care for himself or herself, with or without special equipment, which