Health Information Privacy – HIPAA Policy

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW THIS NOTICE CAREFULLY.

For More Information, Please Contact Us:

Art Fernandez, Chief Operations Officer
Elaena Price, Health Record Management Supervisor

Glenwood Springs, CO –   1905 Blake Ave. #101
Basalt, CO – 234 Cody Lane
Rifle, CO – 195 W. 14th Street
Edwards, CO – 320 Beard Creek Rd

PHONE (970) 945-2840
FAX (970) 945-2893

HIPAA Privacy Statements

Notice of Privacy Practices English
Notice of Privacy Practices Spanish

 

Your Medical Records and Your Rights

ACCESS

Only you or your personal representative have the right to access your medical record without your written permission. If you would like to have your medical record released, or grant permission MFHC staff to hold verbal conversations with another individual or health care provider, please complete an Authorization to Release PHI and submit to the Health Records Management Department with a photo ID.  You can drop off at any location or  fax it to 970-625-4150.

 

MFHC is able to release your medical information without your permission to your health insurance company for billing and payment purposes.  We are also able to release your medical records to another healthcare provider that we have referred you to, or in emergency situations for treatment purposes.  For other exceptions, please refer to our Notice of Privacy Practices.

PAYMENT

MFHC is not able to withhold your medical records from you due to non payment of services rendered, however, MFHC does have the right to charge you a reasonable amount for the reproduction of your medical records.

CORRECTIONS

You do have the right to request a correction or amendment to your medical record if you feel that there was a mistake.  You must submit any changes in writing to Elaena Price at 195 W. 14th St. Bldg C, Rifle, CO  81650. Your healthcare provider and team will review and notify you if the amendment is approved.  Your health care provider has the right to deny your request.

 

Complaints:

Grievance-Compliment Feedback Form

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services.  You may file a complaint by mail to the address below, or by faxing it to 970-945-2893.

Mountain Family Health Centers
Attention: Don Reuther
1905 Blake Ave. #101
Glenwood Springs, CO 81601

 

Please describe what happened and give us the dates and names of anyone involved.  Please also let us know how to contact you so that we can respond to your complaint.  You will not be penalized for filing a complaint.

 

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