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.
