Notice of Privacy Practices
Below you can find the Privacy Practices Notices for Fisher County Hospital District in English and Spanish.
A continuación puede encontrar los Avisos de prácticas de privacidad del Distrito Hospitalario del Condado de Fisher en inglés y español.
Notice of Non-Discrimination
DISCRIMINATION IS AGAINST THE LAW!
Fisher County Hospital District complies with applicable Federal civil rights laws and does not discriminate based on race, color, national origin, age, disability, or sex.
Fisher County Hospital does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Fisher County Hospital provides free aid/services to patients with disabilities and free language interpreters. We also provide information written in other languages as needed.
If you need these services, contact the Quality Department at (325) 735-2256 EXT 222
If you believe that Fisher County Hospital has failed to provide these services or discriminated in another way based on race, color, national origin, age, disability, or sex, you can file a grievance with:
Grievance Coordinator 774 State Hwy 70 Rotan, TX 79546 Phone: (325) 735-2256 EXT 222 Fax: 325-735-3070 Attention: Grievance Coordinator [email protected]
You can file a grievance in person, by mail, fax, or by email. If you need help filing a grievance, our grievance coordinator is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services 200 Independence Avenue SW Room 509F, HHH Building Washington, DC 20201 1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Compliance Program
It is our priority at Fisher County Hospital District to prioritize compliance. We prioritize taking the proper and ethical steps to solve problems, as well as demonstrating privacy and confidentiality.
Please contact our Compliance Department if you have any questions or concerns at (325) 735-2256 EXT 222.
Anonymous Reporting Hotline: 325-735-2663
Report HIPAA Privacy and compliance concerns, including suspected fraud, waste, abuse, or other potential violations through mail to:
Fisher County Hospital District — Compliance Department
774 State Hwy 70 N Rotan, Texas 79546
Grievance Procedure
It is the policy of Fisher County Hospital District not to discriminate on the basis of race, color, national origin, sex (including pregnancy, sexual orientation, and gender identity), age, or disability. Fisher County Hospital has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. § 18116) and its implementing regulations at 45 C.F.R. pt. 92, issued by the U.S. Department of Health and Human Services. Section 1557 prohibits discrimination based on race, color, national origin, sex (including pregnancy, sexual orientation, and gender identity), age, or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Grievance Coordinator who has been designated to coordinate the efforts of FCHD to comply with section 1557.
We encourage you or your representative to first speak to your primary care provider or supervisor. If there are billing issues, please contact billing.
If you or your representative feel as though the issue cannot be handled informally, please reach out to our Grievance Coordinator to file a patient grievance.
1. Contact the Grievance Coordinator at (325) 735-2663 during normal business hours (or)
2. After hours, please leave a message by phone, or send an email at [email protected]
Any person who believes someone has been subjected to discrimination based on race, color, national origin, sex (including pregnancy, sexual orientation, and gender identity), age, or disability may file a grievance under this procedure. It is against the law for Fisher County Hospital District to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. To lodge a complaint with the Texas Department of State Health Services, call 1-888-973-0022.
FCHD encourages all patients to express all concerns or complaints. This will assist in resolution, identifying patterns, and improving the overall care and service provided by FCHD. No discrimination for voicing concerns or change of care provided by FCHD will be affected.
If the patient chooses to, they may file a grievance with:
U.S. Department of Health and Human Services
200 Independence Avenue, SW, Room 509F, HHH Building
Washington D.C. 20201
To lodge a complaint with the Texas Department of State Health Services, call 1-888-973-0022. (You may contact the state agency directly, regardless of whether you have first used the FCHD grievance process.)
To submit a written complaint:
Customer Service Representative, Texas Department of State Health Services
P.O. Box 149347
Austin, Texas 78756
Email: [email protected]
To fax a complaint, call 1-512-834-6653
Medical Records/Health Information Management
Medical Records/Health Information Management helps keep your medical records accurate, secure, and private. Our team makes sure your health information is available to support your care, billing, and follow-up, while protecting your privacy in accordance with state and federal laws. Your Protected Health Information (PHI) will not be released without the patient’s written consent, except as required by law.
Requesting Personal Health Information from Fisher County Hospital District:
- If you would like to electronically access your PHI, you can sign up for our patient portal here or by calling 325-735-2256 EXT 205.
- If you would like a paper copy of your PHI, print out and then complete and sign the Release of Information form. Completed forms may be submitted in person, mailed, or faxed to FCHD Medical Records.
Requesting Personal Health Information from Clearfork Health Center:
- If you would like to electronically access your PHI, you can sign up for our patient portal here or by calling 325-735-2256 EXT 226.
- If you would like a paper copy of your PHI, print out and then complete and sign the Release of Information form. Completed forms may be submitted in person, mailed, or faxed to Clearfork Medical Records.
To help us process your request, please be prepared to:
- Show a current, valid photo ID (such as a driver’s license or other government-issued ID)
- Sign a valid authorization form
Most requests are completed within 2 business days, depending on record availability, completeness, and the number of records requested.
Medical records may be faxed directly to your physician for medical care when allowed by law. For privacy reasons, the hospital policy does not allow records to be accessed for non-medical reasons.
Requesting Records for Someone Else:
If you are requesting medical records for another person, we must verify both your identity and your legal authority to receive the information.
- Acceptable documentation includes:
- A signed Authorization for Use or Disclosure of Protected Health Information
- A Power of Attorney that allows access to medical information
- A Durable Power of Attorney for Health Care naming you as the agent (This becomes effective only if the patient has been determined by a physician to be incapacitated or incompetent.)
Medical Records for Minors (Under Age 18)
Medical records for minors may be released under the following conditions:
- Authorization must be provided by a biological parent, custodial, or non-custodial parent, or legal guardian, along with documentation showing legal authority to access the records.
- Records may also be released to an emancipated minor.
Need Help?
If you have any questions, need help understanding these requirements, or need assistance completing an authorization form, our Medical Records team is happy to assist you.
Fisher County Hospital District – Medical Records
774 State Hwy 70 N
Rotan, Texas 79546
325-735-2256 EXT 205
Fax: 325-735-3070
Clearfork Health Center – Medical Records
774 State Hwy 70 N
Rotan, Texas 79546
325-735-2211 EXT 226
Fax: 833-449-1354
If you have any questions, need help reading or understanding the form, or would like assistance completing the Release of Information (ROI), our Medical Records team is happy to help. Please call the phone number listed for assistance.
Office Hours
Monday – Friday
8:00 AM – 5:00 PM
Closed on the weekends and holidays.