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 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 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. Patients will receive a mailed copy of any
changes to this notice within 60 days of making the changes.
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, Privacy 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 1-800-627-7748
All complaints will be investigated. No personal issue will be raised
for filing a complaint with the hospital.
For further information about this Privacy Notice, please contact:
Sandra Peters
Privacy Officer
334-774-2601
This notice is effective as of October 1, 2002. This date must not be
earlier than the date on which the notice is printed or published.
