These rights are important for you to know. Federal law sets rules and limits on who can look at and receive your health information.
Below you will find links to detailed information on Marshall Medical's privacy practices, along with forms and instructions to request information related to your personal healthcare information.
Download Notice of Privacy Practices
Download the PDFEnglish and Spanish versions included.
Request Forms
The following request forms are provided for your convenience. To access the forms, please click the links below. Forms may be printed and completed, then mailed or faxed to us.
If you have questions or would like more information please contact the privacy officer at 256-894-6638.
Completed forms may be sent to:
Mail:
Health Information Management
Marshall Medical Centers
227 Brittany Road
Guntersville, AL 35976
Fax:
256.894.6636
- Authorization to Disclose Health Information
This form is to request Marshall Medical Center to release medical information to another individual or facility.
Autorización para Divulgar Información de Salud Este formulario es para solicitar a Marshall Medical Center que divulgue información médica a otra persona o instalación.
- Patient Access Audit Request This form is to request performance of an audit of individuals who have accessed a patient’s electronic medical record.
- Authorization to Request Health Information from Other Facilities This form is to request another facility to release medical information to Marshall Medical Center.
- Request for Amendment of Protected Health Information This form is to request a change to information documented in the patient’s medical record.