Specialty Pharmacy Information Packet March 2023 | Page 25

You may obtain a copy of this Notice at our website , www . uabmedicine . org . To obtain a paper copy of this Notice , contact the Entity Privacy Coordinator .
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 medical 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 in UAB Health System facilities . The Notice will contain the effective date on the first page . In addition , each time you visit UAB Health System to receive services , we will make available a copy of the current Notice in effect .
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions and would like additional information , you may contact the Entity Privacy Coordinator . If you believe your privacy rights have been violated , you may file a complaint with UAB Health System or with the Secretary of the Department of Health and Human Services . To file a complaint with UAB Health System , contact the Entity Privacy Coordinator . All complaints must be submitted in writing . You will not be penalized for filing a
complaint .
NOTICE EFFECTIVE DATE
The effective date of the Notice is April 14 , 2003 , amended on April 1 , 2006 , September 23 , 2013 , and March 1 , 2014 .
ENTITY PRIVACY COORDINATORS
UA Health Services Foundation ( The Kirklin Clinic of UAB Hospital ) Privacy Coordinator 500 22 nd Street South , Suite 504 Birmingham , AL 35233-2023 205-801-8029
UAB Hospital Privacy Coordinator Old Hillman Building , Room 225 619 19th Street South Birmingham , AL 35249-6543 205-975-0585
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