Request for Amendment of Records Under Privacy Law

An individual or personal representative has the right to request an amendment to their medical record. The right to seek an amendment of an individual’s records is a personal right of the individual to whom the information pertains under the Privacy Act of 1974 [5 U.S.C. §552a (d)] [38 C.F.R. 1.579] and an individuals’ health information under the Health Insurance and Portability and Accountability Act (HIPAA) Privacy Rule [45 C.F.R. §164.526]. A personal representative of a deceased individual has a right to request an amendment of the decedent’s records.

Amendment Request Submission Format

A request for an amendment of records must be in writing and adequately describe the specific information the individual believes to be inaccurate, incomplete, irrelevant, or untimely and the reason for the belief. If possible, provide copies of the medical records associated with the amendment request.  You may use the attached form, however, it is not required.  The written request must be forwarded to the facility Privacy Officer.

 Amendment Patient Request Form (PDF)

Forward your signed request to the facility Privacy Officer via:

Mail:  Birmingham VAHCS

           Privacy Officer
           700 South 19th Street
           Birmingham, AL 35233
           Fax:  205-933-3863

Email: VHABIRBirminghamFOIAOffice@va.gov

In-person:  Room 2506