Neither ACMC nor its Affiliated
Providers will use or disclose your medical information unless you
allow us to do so in
writing. If you do give us permission to use or disclose your medical
information for another purpose, you have the right to change your
mind and revoke the permission at any time.
Your privacy rights
- You may request that
ACMC and its Affiliated Providers not use your medical information
in certain ways or for certain purposes.
You may
also request that ACMC and its Affiliated Providers not provide
your medical information to certain people. However, ACMC and
its Affiliated
Providers have the right to refuse your request, and ACMC and its
Affiliated Providers may use or disclose your medical information
in situations
requiring emergency treatment, in which case we will ask the person(s)
who receive the information not to further use or disclose the
information.
- You may request that ACMC and its Affiliated
Providers provide you with your medical information in a confidential
manner. For example,
you can request that we send your appointment reminders, bills,
and other mailings to a different address or that we notify you of
this
kind of information in another way, such as by a phone call. You
must make this request in writing and specify another address or
means of
communication. We may also ask you to give us information on how
you will pay your bills.
- You may ask to see and copy your medical
records, unless that information is protected by law. You must
make these requests in writing.
If your request to look at or copy your medical records is denied,
you have the right to have the denial reviewed by a health care
professional. We will act upon your request within 30 days, and we
may charge you
a legally acceptable amount for copying costs.
- You may ask ACMC and its Affiliated Providers
to change information in your medical records. If your request
is denied, you can write a
statement of disagreement with the denial that we will keep with
your medical information.
- You may ask ACMC and its Affiliated Providers
to provide you with information about certain disclosures of
your medical information
in the past.
- If you have received this notice of your
medical information privacy rights electronically, you may ask
ACMC and its Affiliated
Providers to provide you with a paper copy.
- If you feel your medical information privacy
rights have been violated, you may file a complaint with the
Secretary of Health and
Human Services, and/or with ACMC and its Affiliated Providers contact
person listed below. Filing a complaint will not affect the quality
of the services you receive from ACMC and physicians on its staff
and you will not be retaliated against for filing a complaint.
You can contact the designated
privacy official
Name: Terry Tone
Title: Administrator
Phone Number: 320-231-5000
Address: ACMC-Willmar, 101 Willmar Avenue SW, Willmar MN 56201
ACMC and its Affiliated Providers are required by law to maintain
the privacy of protected health information and to provide individuals
with this notice of its legal duties and privacy practices with respect
to health information. ACMC and its Affiliated Providers are required
to abide by the terms of the notice currently in effect. ACMC and its
Affiliated Providers reserve the right to change the terms of this
notice and to make a new notice provisions effective for all protected
health information maintained by ACMC and/or its Affiliated Providers.
If the terms of this notice are changed, ACMC and/or its Affiliated
Providers will provide individuals with a revised notice upon request
and by posting the revised notice in designated locations at ACMC.
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