126 Hospital Avenue | Ozark, Alabama 36360 Phone: 334-774-2601

Privacy Statement

DALE MEDICAL CENTER

OZARK, ALABAMA

PRIVACY NOTICE


THE FOLLOWING NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE INFORMATION CAREFULLY.

Your confidential healthcare information may be released to other healthcare professionals within the hospital for the purpose of providing you with quality healthcare.

Your confidential healthcare information may be released to your insurance provider for the purpose of the hospital receiving payment for providing you with needed healthcare services.

Your confidential healthcare information may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.

Your confidential healthcare information may be released to other healthcare providers in the event you need emergency care.

Your confidential healthcare information may be released to a public health organization or federal organization in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication).

Your confidential healthcare information may not be released for any other purpose than that which is identified in this notice.

Your confidential healthcare information may be released only after receiving written authorization from you. You may revoke your permission to release confidential healthcare information at any time.

You may be contacted by the hospital for the purpose of raising funds to support the hospital's operation.

You have the right to opt-out of fundraising communications.

You may be contacted by the hospital to remind you of any appointments, healthcare treatment options or other health services that may be of interest to you.

You have the right to restrict the use of your confidential healthcare information. However, the hospital may choose to refuse your restriction if it is in conflict of providing you with quality healthcare or in the event of an emergency situation.

You have the right to receive confidential communication about your health status.

You have the right to review and photocopy any/all portions of your healthcare information.

You have the right to make changes to your healthcare information.

You have the right to know who has accessed your confidential healthcare information and for what purpose.

You have the right to notification if a breach of your medical information occurs.

You have the right to possess a copy of this Privacy Notice upon request. This copy can be in the form of an electronic transmission or on paper.

The hospital is required by law to protect the privacy of its patients. It will keep confidential any and all patient healthcare information and will provide patients with a list of duties or practices that protect confidential healthcare information.

The hospital will abide by the terms of this notice. The hospital reserves the right to make changes to this notice and continue to maintain the confidentiality of all healthcare information. We will post a copy of the current notice in the hospital and on our website.

You have the right to complain to the hospital if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail you complaint to the hospital.

ATTN: Sandra Peters, HIPAA Compliance Officer
Dale Medical Center
126 Hospital Ave.
Ozark, Al 36360

If you believe your privacy rights have been violated, you may contact or submit your complaint in writing to Sandra Peters, RN, HIPPA Compliance Officer at (334) 774-2601, Ext 1427 at the hospital. If we cannot resolve your concern, you also have the right to file a written complaint with the Secretary of the Department of Health and Human Services. The Secretary of the Department of Health and Human Services may be contacted at 200 Independence Avenue, S.W.; Washington, D.C. 20201 or you may call 1-877-696-6775.

All complaints will be investigated. No personal issue will be raised for filing a complaint with the hospital.

For further information or to receive a full copy of DMC's Privacy Notice, please contact:

Sandra Peters
HIPAA Compliance Officer
334-774-2601

This notice is effective as of August 1, 2013.

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