Your Rights and Responsibilities
It is our policy to respect the rights of individuals receiving healthcare services at JCDH clinics including the right to privacy. We are committed to providing services in a caring, compassionate, and competent manner with the highest respect for the dignity of the individual. Likewise, JCDH has a right to expect reasonable and respectful behavior from individuals seeking services, their relatives, and friends. For more information on your rights and responsibilities, click the following link:
Patient Rights and Responsibilities (March 1, 2024)
Download: [ English ] [ Español ]
Your Privacy Rights
When providing services, we collect personal health information about our patients. We understand the importance and are committed to maintaining the confidentiality of the information. To see how your information may be used or disclosed and your rights regarding healthcare information about you, review the Notice of Privacy Practices.
Notice of Privacy Practices (March 1, 2024)
Download: [ English ] [ Español ]
The requests below are subject to certain guidelines.
Please review the Notice of Privacy Practices for more information.
Forms:
- To obtain a copy of your healthcare record:
Authorization to Disclose Protected Health Information
Download: [ English ] [ Español ]
- To request an amendment to your health information:
Request for Amendment of Health Information
Download: [ English ] [ Español ]
- To request an accounting of disclosures:
Request for Accounting of Disclosures
Download: [ English ] [ Español ]
- To request restrictions or limits on information we disclose about you:
Request for Restrictions of Use and Disclosures of Health Information
Download: [ English ] [ Español ]
- To request alternative methods of confidential communication:
Request for Alternative Confidential Communications
Download: [ English ] [ Español ]
You can request a form be mailed to you by calling (205) 588-JCDH (5234). Completed forms can be mailed to the Release of Information Division using the address below or sent by secure email to roi.info@jcdh.org or hipaaprivacyofficer@jcdh.org.
ROI Division
Jefferson County Department of Health
1400 6th Avenue South
Birmingham, Alabama 35233