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
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 email@example.com.