Your Rights · Request

Request a record amendment

If something in your records is inaccurate or incomplete, ask us to correct it.

Your Right to Ask Us to Amend Your Health Information

If you believe health information Servants Mission Inc. has about you is incorrect or incomplete, you may ask us to amend it.

How to request. Submit your request in writing using the form on this page and tell us what you would like amended and why.

Timing. We respond within 60 days. If we need more time, we may take one additional 30-day period and will tell you in writing.

If we grant your request. We amend the information, let you know, and, at your request, notify others who have the information and need the amendment.

If we deny your request. We may deny a request if the information was not created by us (unless the originator is no longer available to act on your request), is not part of the records we keep for decisions about your care, is not information you would be permitted to inspect and copy, or is already accurate and complete. If we deny your request, we explain why in writing, and you may submit a written statement of disagreement, which we will include with your information, and ask that your original request and our denial accompany any future disclosures. We may prepare a rebuttal and will give you a copy. Your request, our denial, your statement of disagreement, and any rebuttal are linked to your record and included when that information is later disclosed.

Questions: our Privacy Officer, privacy@servantsmission.net.

45 CFR §164.526

What happens next?

Compliance reviews your request within 5 business days.
We contact you to verify your identity (we'll ask questions only the patient or their authorized representative would know, never your full SSN by email).
We decide and notify you in writing within 60 days (with one 30-day extension if we notify you before the original deadline).

If we deny your request (§164.526(d)(2))

You have the right to file a written statement of disagreement. We attach your statement to the disputed record so anyone receiving the record sees both sides.

Requesting on behalf of someone else?

Per §164.502(g), a personal representative (parent of a minor, legal guardian, or power of attorney) may request amendment for the patient. We need the patient's full name on the form so we can match it to your authorization on file before we process the amendment.