Access to Your Personal Health Information

You have the right to receive a copy and/or inspect much of the personal health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your representative. You may be charged a medical record research and photocopying fee consistent with state law if you request a copy of the information. We will also charge for postage if you request a mailed copy. You may obtain an access request authorization form from Akron General's Medical Records Department, 400 Wabash Ave., Akron, OH 44307.

Amendments to Your Personal Health Information

You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests, in order to be considered by us, must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If an amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. You may obtain an amendment request form from Akron General's Medical Records Department, 400 Wabash Ave., Akron, OH 44307.

Accounting for Disclosures of Your Personal Health Information

You have the right to receive an accounting of certain disclosures made by us of your personal health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from Akron General's Medical Records Department, 400 Wabash Ave., Akron, OH 44307. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12-month period.

Restrictions on Use and Disclosure of Your Personal Health Information

You have the right to request restrictions on certain of our uses and disclosures of your personal health information for treatment, payment, or health care operations. A restriction request form can be obtained from Akron General's Admitting/Registration Department, 400 Wabash Ave., Akron, OH 44307. We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction to sending such termination notice to Akron General's Privacy Officer, Akron General Medical Center, 400 Wabash Ave., Akron, OH 44307 or via email at privacyofficer@agmc.org.

Complaints

If you believe your privacy rights have been violated, you can file a complaint with Akron General's Privacy Officer, Akron General Medical Center, 400 Wabash Ave., Akron, OH 44307 or via email at privacyofficer@agmc.org .You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.

Acknowledgment of Receipt of Notice

You will be asked to sign an acknowledgment form that you received this Notice of Privacy Practices.

For Further Information

If you have questions or need further assistance regarding this Notice, you may contact Akron General's Privacy Officer, Akron General Medical Center, 400 Wabash Ave., Akron, OH 44307 or email at privacyofficer@agmc.org.

As a patient you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means.

Effective Date

This Notice of Privacy Practices is effective April 14, 2003.