Effective Date: April 14, 2003
This notice describes how medical information about you may be used, disclosed and how you can get access to this information.
PLEASE REVIEW IT CAREFULLY.
If you have any questions about this Notice, please contact:
PO Box 609, 201 S. Main St
CHANGES TO THIS NOTICE
We reserve the right to change this notice.
We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future.
We will post a copy of the current notice at our facility and on our website.
You will be asked to provide a written acknowledgment of your receipt of this Notice.
We are required by law to make a good faith effort to provide you with our Notice and obtain such acknowledgment from you.
However, your receipt of care and treatment from the DONIPHAN CO. HEALTH DEPT. / HOME HEALTH AGENCY is not conditioned upon your providing the written acknowledgment.