We provide treatment at Pagosa Springs Medical Center without regard to sex, age, race, education, religion, disability or the source of payment for care. As a patient at Pagosa Springs Medical Center, you have certain rights. Understanding your rights will help you to get the best possible care. We will make every effort:

  1. To treat you with consideration and respect in a safe setting, free from all forms of abuse or harassment. To provide you with protective oversight while in the hospital. Your privacy will be protected.
  2. To notify a family member or representative, personal physician and/or clergy of choice promptly upon admission if you request.
  3. To provide all aspects of your care and treatment in a confidential and discreet manner. You have the right to be advised as to the reason for the presence of any individual.
  4. To keep all communications and records about your care including the source of payment for treatment confidential. In general, you have the right to see all the information in your health records and to receive copies of the record at a reasonable photocopy fee.
  5. To obtain your written permission before your medical records can be made available to anyone, not directly concerned with your care. To assure that your record is read only by individuals directly involved in your treatment and those involved in monitoring quality.
  6. To ensure access to information in the medical record within a reasonable time frame. The hospital should not frustrate your legitimate efforts to gain access to your own medical record.
  7. To clearly explain all hospital rules and regulations.
  8. To provide clearly written and spoken information in words you can understand.
  9. To respect your right to actively participate in your plan of care and any decisions regarding your medical care.
  10. To provide all the information you need to make an informed decision about your care. Except in emergencies, information should include your options, possible side effects, who is providing your care and costs. You have the right to obtain from your doctor, complete and current information regarding diagnosis, treatment and any known prognosis. To respect your advanced directives (living will and/or durable power of attorney for health care), which express your wishes about resuscitation and other end-of-life decisions. You have the right to formulate advanced directives while in the hospital and have staff comply with those directives. You have the right to appoint someone to make health care decisions on your behalf.
  11. To respect your decision to refuse care. To allow you to leave the hospital even if your physician advises against it.
  12. To involve you in discharge planning and inform your physician of any health-care requirements when you return home. To inform you of service options that are available and give you a choice of agencies that provide that service.
  13. To provide effective relief from pain and respect your right to refuse pain control.
  14. To provide you with freedom from restraints and seclusion of any form that is not medically necessary.
  15. To know the name and professional status of individuals providing your care including the name of your primary care physician.
  16. To give you the opportunity to examine and receive an explanation of your bill regardless of source of payment.
  17. To allow you to express a concern or complaint and receive a prompt response. You also have the right to file a formal grievance if you are not satisfied with the resolution of your complaint. You may file a grievance or complaint verbally or in writing with the Administrator –Brad Cochennet or the Director of Patient Services – Linda Mozer.
  18. To respect your right to associate and communicate privately with persons of your choice, and send or receive your personal mail unopened.
  19.  To wear appropriate personal clothing and religious or other symbolic items, as long as they do not interfere with diagnostic procedures or treatments.
  20.  To allow you, upon request, to move to another room when another patient or visitors in your room are unreasonably disturbing.
  21. To provide access to an interpreter if you are unable to understand the predominant language of the community.
  22.  To provide, within the capabilities of the hospital/staff, an appropriate medical screening, necessary stabilization and, if needed, an appropriate transfer to another facility without regard to your ability to pay or health insurance status.

Patients and visitors have responsibilities, and we ask that you make every effort to:

  1. Follow all hospital rules.
  2. Consider the rights of others and treat them with respect. Show consideration for the rights other patients and hospital personnel by control of noise, and number of visitors.
  3. Show respect for your personal property as well as the property of others and that of the organization.
  4. Ask us for clear explanations and make informed decisions about your care and treatment.
  5. Relate full information about your health, medical history and insurance.
  6. Provide us with your advanced directive information.
  7. Follow the recommended treatment plan and keep your follow-up appointments or notify your doctor when you are unable to do so.
  8. Accept responsibility for refusing treatment or not following your doctor’s instructions.
  9. Know what medications you are taking, why you are taking them and the proper way to take them according to your doctor’s order.
  10. Inform care providers of your level of pain and the effectiveness of provided treatment.
  11. Alert your healthcare provider if you have concerns or feel your rights have not been properly respected.
  12. Pay bills promptly and contact us if you have any questions or financial problems.

Notice of Privacy Practice at Pagosa Springs Medical Center

This notice describes how your medical information may be used and disclosed, and to provide you with a notice of our legal duties and privacy practices.  We call this information “protected health information” of “PHI” for short.

How we may use or disclose your PHI:  We will not use or disclose your PHI except as described in this notice.  With some exceptions, we may not use or disclose any more of you PHI than is necessary to accomplish the purpose of the use or disclosure.  This notice applies to all medical records generated or maintained by us.  We may use and disclose your PHI for the following purposes.

Treatment, Payment, and Healthcare Operations:  We may use and disclose you PHI without your consent for treatment, payment, and healthcare operations.

  • Treatment:  We will use your PHI in the provision and coordination of your healthcare.  We may disclose your PHI to your attending physician, consulting physician(s), nurses, technicians, medical students, and other health care providers who need to know your PHI for your care and continued treatment.  Different hospitals or departments may share PHI about you in order to coordinate specific services, such as prescriptions, lab work, and x-rays.  We may use and disclose your PHI to tell you about or arrange for possible treatment options for your continued care after your leave, such as rehabilitation, home care, or nursing home services.
  • Payment:  We may release your PHI for the purposes of determining coverage, billing claims management, medical data processing, and reimbursement.  PHI may be released to an insurance company, third party payer or other entity (or their authorized representatives) involved in the payment of your medical bill and may include copies of excerpts of your medical record that are necessary for payment of your account.  For example, a bill sent to a third party payer may include information that identifies you, your diagnosis, and the procedures and supplies used.
  • Routine Healthcare Operations:  We may use and disclose your PHI during routine healthcare operations, including quality assurance, utilization review, medical review, internal auditing, accreditation, certification, licensing or credentialing activities, medical research and educational purposes

Special Circumstances

  • Emergencies:  Your consent is not required if you need emergency treatment.  We will try to get your consent as soon as practicable after the emergency.
  • Mental Health/Substance Abuse:  In certain circumstances, we may not disclose you PHI to you without the written consent of your physician or to others without your written consent or a court order

Disclosures Requiring Your Consent:

  • Family/Friends:  Unless you object, we may provide your PHI to a friend or family member who is involved in your medical care or who helps pay for your care.  We may also tell your family or friends your condition and that you are in the hospital/entity.  We may disclose your PHI to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.  If you are unable or unavailable to agree or object, we will use our best judgment in communicating with your family and others.  The opportunity to consent may be obtained retroactively in emergency situations.
  • Inpatient Hospital Directories:  We may include certain limited information about you in the entity directories while you are a patient at Pagosa Springs Medical Center.  This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation.  This is so your family and friends can visit you and generally know how you are doing.  The directory information, except for your religious affiliation, may also be released to people who ask for you by name.  Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they do not ask for you by name.
  • Appointment Reminders:  We may use or disclose your PHI to contact you as a reminder that you have an appointment for treatment or medical care.
  • Health Related Benefits and Services:  We may use and disclose your PHI to tell you of health-related benefits or services that may be of interest to you.
  • Business Associates:  We may use and disclose your PHI to business associates.  Examples of business associates include, but are not limited to, copy services used to copy medical records, consultants, accountants, lawyers, medical transcriptionists, and third-party billing companies.  We require the business associate to protect confidentiality of your PHI.
  • Research:  Under certain circumstances, we may use and disclose your PHI to researcher when their clinical research study has been approved by an Institutional Review board or Pagosa Springs Medical Center.  While most clinical research studies require specific patient consent, there are some instances where a retrospective record review with no patient contact may be conducted by such researchers.  For example, the research project may involve comparing the health and recovery of certain patients with the same medical condition who received one medication to those who received another.
  • Marketing:  We may disclose certain PHI to a third-party to provide marketing materials and information to you.
  • Fundraising:  We may contact you to participate in fund-raising activities for Pagosa Springs Medical Center.
  • Workers Compensation:  We may release your PHI for workers’ compensation or similar programs.  We may also provide your PHI in order to comply with workers’ compensation laws.
  • Other Uses:  In situations not described in this Notice, we will ask for your written authorization before using or disclosing your PHI

Certain uses and disclosures that do not require your consent:  We may use and disclose your PHI without your consent or authorization for the following reasons:

  • Organ Procurement Organizations:  To the extent allowed by law, we may disclose your PHI to organ procurement organizations and other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant to assist them in organ, eye, or tissue donations and transplants.
  • Regulatory Agencies:  We may disclose your PHI to a health oversight agency for activities authorized by law, including, but not limited to, licensure, certification, audits, investigations, and inspections.  We may provide your PHI to assist the government when it conducts an investigation or inspection of a healthcare provider or organization.
  • Law Enforcement:  We may disclose your PHI for law enforcement purposes as required by law or in response to a valid subpoena or court order.
  • Lawsuits and Disputes:  If you are involved in a lawsuit or dispute, we may disclose your PHI in response to a valid court or administrative order, subpoena, discovery request, or other lawful process.
  • Public Health:  As required by law, we may disclose your PHI to Public Health or legal authorities charged with preventing or controlling disease, injury, or disability.  For example, we are required to report births, deaths, and various diseases to government agencies in charge of collecting that information.
  • Judicial and Administrative Proceedings:  We may disclose you PHI in the course of any administrative or judicial proceeding.
  • Specific Government Functions:  We may disclose your PHI to military personnel and veterans in certain situations.  We may disclose your PHI for national security purposes, such as protecting the President of the United States or conduction intelligence operations.
  • Military/Veterans:  We may disclose your PHI as required by military command authorities, if you are a member of the armed forces.
  • Inmates:  If you are an inmate of a correctional institute or under the custody of a law enforcement officer, we may release your PHI to the correctional institute or law enforcement official.
  • To Avoid Harm:  In order to avoid a serious threat to the health and safety of a person or the public, we may disclose PHI to law enforcement personnel or persons able to prevent or lessen such harm.
  • Required by Law:  We will disclose your PHI when required to do so by law.  For example, we may disclose certain medical information to those persons who have a risk exposure related to a communicable disease.
  • Coroner, Medical Examiners, Funeral Directors:  We may release your PHI to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or to determine a cause of death.  We may also release your PHI to funeral directors as necessary to carry out their duties.

Patient Health Information Rights:  Although all records concerning your hospitalization and treatment at Pagosa Springs Medical Center are the property of Pagosa Springs Medical Center, you have the following rights concerning your PHI.

Right to Confidential Communications:  You have the right to receive confidential communication of your PHI by alternative means or at alternative locations.  For example, you may request that we only contact you at work or by mail.

Right to Inspect and Copy:  You have the right to inspect and copy your PHI as provided by law.  Such a request must be made in writing.  We have the right to charge you the amounts allowed by state or federal law for such copies.

Right to Amend:  You have the right to amend your PHI as provided by law.  Such a request must be made in writing and you must state a reason or reasons for the amendment.  We are not required by federal law to honor your request for amendment if we determine, among other things, that the PHI is accurate and complete.

Right to an Accounting:  You have the right to obtain a statement of the disclosures of your PHI to third parties, except those disclosures made for treatment, payment, or healthcare operations or pursuant to this Notice.

Right to Request Restrictions:  You have the right to request restrictions on certain uses and disclosures of your PHI to carry out treatment, payment, or healthcare operations or disclosures by us.  We are not required by federal law to agree to your requested restriction.

Right to Receive Copy of this Notice:  You have the right to receive a paper copy of this Notice, upon request.  If you have received this notice in electronic form and would like a paper copy, please contact Pagosa Springs Medical Center at (918) 382-2300.

Right to Revoke Authorization:  You have the right to revoke authorization to use or disclose your PHI, EXCEPT to the extent that action has already been taken by us in reliance on your authorization.

For More Information or to Report a Problem:  If you have questions and would like additional information or if you believe your privacy rights have been violated, you may contact Pagosa Springs Medical Center at (970) 731-3700.  If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:  Department of Health and Human Services Region VI Office for Civil Rights, 1301 Young St. Suite 1169, Dallas, TX 75202 Phone (214) 767-4056 Fax (214)767-0432 TDD (214) 767-8940.  All complaints must be submitted in writing.

Changes to This Notice:  We will abide by the terms of the notice currently in effect.  We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI we maintain.

Change of Ownership:  In the event that Pagosa Springs Medical Center is sold or merged with another organization, your PHI may become property of the new owner.

Notice Effective Date: January 1, 2008.

Contact Number:  Pagosa Springs Medical Center (970) 731-3700.