Patient Rights and Responsibilities

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Your Health Record/Information:
Each time you visit a Jefferson County Department Health Clinic, a record of your visit is made. Understanding what is in your record and how that information is used helps you to make decisions about allowing others access to your records, to understand why others need to access your records and to be sure the information is correct.

How We Use Your Information:
We collect information about you and your medical services. This information is needed to be sure we provide quality medical care. Information we collect may include but is not limited to your demographic information (such as name, address, phone #), financial information (proof of residence and income), past and present medical conditions and other information from other healthcare services (X-ray, lab work, etc.). All of this information can be used for treatment (Drs., nurses, medical students, etc.), payment (to bill or collect, etc.), other healthcare operations (audits, surveys, etc.), Public Health activities (to report certain diseases etc.), workers compensation (for workers compensation laws etc.), military/veterans (national security etc.), law enforcement/jail (child abuse, if an inmate of correctional facility), research (medical research etc.), business associates ( contractual employees, outside vendors etc.), inspections (state audits, Joint Commission etc.) and to avoid harm (to avoid serious threat to health or safety). If we allow any others to view your records we must obtain your written permission.

Your Health Information Rights:
Although your health record is the physical property of Jefferson County Department of Health, the information belongs to you. You have the right to:

  • Inspect and/or copy your records upon written request (there may be some limitations if you request psychotherapy records)
  • Request limits regarding others needing to view your records
  • Request changes to your records
  • Obtain a list of those receiving your records
  • Request that we communicate with you about medical matters in a way that you wish
  • Stop your agreement with us to allow others to obtain your records

Our Responsibilities:
The Jefferson County Department of Health is required to:

  • Keep your records private
  • Provide you with a notice regarding what we do with your information
  • Abide by the terms of this notice according to law
  • Notify you if we are unable to abide by your requested limits to your records
  • Abide by your written requests to communicate with you in a certain way

How to Complain About Our Privacy Practices:
If you think that we have violated your privacy rights or you disagree with a decision we have made about access to your records, you may file a complaint or obtain further information with the Quality Management Division of the Jefferson County Department of Health at 205-9301468. You may also send a written complaint to:

Secretary of Health and Human Services
Office for Civil Rights
Attention: Privacy
U.S. Department of HHS
200 Independence Avenue
Room 509F
Washington, D.C. 20201

There will be no retaliation against an individual for filing a complaint.
We reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the medical/financial information we already have. Before we make any important changes to our policies, we will promptly change this notice and post the new notice in patient areas throughout our facilities. You may ask for a copy of this privacy notice from any clerical employee at any time.

EFFECTIVE APRIL 14, 2003