Privacy & Security

Notice of Privacy Practices

Effective April 14, 2003 - Each time you visit a hospital / long-term care facility, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, plan for future care or treatment, and billing-related information. This notice applies to all the records of your care generated by the hospital / long-term care facility, whether made by hospital / long-term care facility personnel, agents of the hospital / long term care facility, or your personal doctor. Your personal healthcare provider may have different policies or notices regarding the  use and disclosure of your medical information created in the office or clinic.

Patient Privacy Forms

Request to Amend Medical Record
Restrict PHI Disclosure

Print, complete and mail applicable form to:

Regional Medical Center
Attn: Privacy Officer
PO Box 359
Manchester, IA 52057

Health Insurance Portability And Accountability Act (HIPAA)

According to the Department of Health and Human Services, the Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety.

Contact the Privacy Officer with questions by calling 563-927-3232 or emailing privacyofficer@regmedctr.org.

Report a Breach

HIPAA Breach Form (Local)

Name of Patient
Patient's Medical Record #
Patient's Visit #
What was disclosed
Where it went
Where it was supposed to go
Who disclosed the information
Send me an email confirmation
Email address
Cell phone number
Home phone number
Additional Information
What is your preferred method of contact?