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Dear Patient & Family Members:

I would like to take this opportunity to thank you personally for selecting I-70 Community Hospital as your healthcare provider.

As a healthcare provider, we are dedicated to providing you quality care in a compassionate and caring environment. Your questions, suggestions, comments and complaints about your care will be used to identify areas that need improvement. Please be assured that your comments will not interfere with your present or future care at I-70 Community Hospital.

Our primary responsibility is to provide the appropriate care for your physical and mental well being, whether you are a patient of the hospital, or of our family clinic. We strive to protect the confidentiality of your medical records and realize how sensitive patients are about their personal rights or privacy.

At the time of your dismissal from the hospital you will be given a survey to record your thoughts. The surveys are used to gather information about patient satisfaction with the services being provided by the hospital or our family clinic.

We appreciate the time you spend in assisting us. I assure you that your comments will receive our full attention and will be used to improve our health care processes. We genuinely want to provide you with quality care. I would like to thank you and encourage you to respond by using our patient surveys or simply call me at (660) 335-7408 with your questions or comments.

Sincerely,

Chief Executive Officer, I-70 Community Hospital

NONDISCRIMINATION POLICY

 

 

As a recipient of Federal financial assistance, the I-70 Community Hospital does not exclude, deny benefits to, or otherwise discriminate against any person on the grounds of race, color, or national origin, or on the basis of disability or age in admission to, participation in, or receipt of the services and benefits of any of its programs and activities or in employment therein, whether carried out by the I-70 Community Hospital directly or through a contractor or any other entity with whom the I-70 Community Hospital arranges to carry out its programs and activities.

 

This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Regulations of the U.S. Department of Health and Human Services issued pursuant to the Acts, Title 45 Code of Federal Regulations Part 80, 84 and 91. (Other Federal Laws and Regulations provide similar protection against discrimination of grounds of sex and creed.)

 

To obtain additional information about your rights under Title VI/ADA, contact I-70 Community Hospital.

If you believe you have been discriminated against on the basis of race, color, or national origin by I-70 Community Hospital, you may file a Title VI/ADA complaint by completing, signing, and submitting the agency’s Title VI/ADA Complaint Form.

How to file a Title VI/ADA complaint with I-70 Community Hospital:

1.        To obtain a Complaint Form, contact I-70 Community Hospital, 105 Hospital Drive, Sweet Springs, MO 65351 in writing, by telephone at 660-335-7413, or by downloading the form at www.i70hospital.com.

2.     In addition to the complaint process at I-70 Community Hospital, complaints may be filed directly with the Federal Transit Administration, Office of Civil Rights, Region VII, 901 Locust Street, Suite 404, Kansas City, MO  64106.

3.     Complaints must be filed within 180 days following the date of the alleged discriminatory occurrence and should contain as much detailed information about the alleged discrimination as possible.

4.      The form must be signed and dated, and include your contact information.

If information is needed in another language, contact Administration at 660-335-7413.


I-70 COMMUNITY HOSPITAL TITLE VI COMPLAINT FORM

For non-emergency situations and outpatient visits, please report to the admissions desk in the business office. You will be asked the following:

  • Basic information, such as Name, Address, Date of Birth, Social Security Number, Emergency contacts, place of employment, etc.
  • If the service is related to an accident or injury.
  • For insurance cards or records.
    • If the service is related to an auto accident you will need YOUR auto insurance information.
    • If the service is related to an accident on someone's property, you will need the insurance from THE HOMEOWNER OR BUSINESS where the accident occurred.
  • Medicare patients will be asked to complete a Medicare questionnaire to determine if another insurance should be billed.
  • You are encouraged to bring essential personal items such as:
      • a comb
      • a hair brush
      • deodorant
      • shaving articles
      • toothbrush and toothpaste
      • shampoo
      • lotion
      • soap
      • sleeping apparel
      • slippers
      • a robe

We will be glad to furnish personal items if you choose not to bring them. Medicare and most insurances will not pay for them, you will be responsible for the cost of these items.

  • A list of the medications you are currently taking at home.
  • Medical insurance cards or insurance coverage information.
  • If you have a Living Will or a Durable Power of Attorney for Health Care Decisions bring a copy if you are not sure that it is already on file at the hospital.
  • Please, leave your valuables at home
    We ask that you do not keep more than $5.00 cash in your room. We also ask, for safekeeping, that you send valuables home if at all possible.

Hospital personnel are required to respect your privacy and treat all information in strict confidence. Information in your patient record is available to the staff providing your care on a need to know basis only. We ask for your assistance in respecting the privacy of other patients as well. Please do not ask the staff about other patients, as staff is required to respect their privacy as well as yours.



Your Patient Rights

As a patient at I-70 Community Hospital you have the right to:
  • Suitable treatment and services regardless of your age, gender, national origin, culture, disability, economic status, educational background of the source or payment for your care.
  • Considerable and respectful care from qualified personnel.
  • The name of the physician who is responsible for your care and information about your condition.
  • Information necessary to allow you to actively participate in decisions regarding your medical care.
  • Request a change in physicians or transfer to another health facility for religious or other reasons.
  • Information contained in your medical record within the limits of the law.
  • Request a specialist or an option from another physician at your own expense.
  • Confidentiality pertaining to your diagnosis, care and method of payment.
  • Be informed about the hospital charges for services and available payment methods.
  • Communicate with people outside the hospital by having personal visits and verbal or written communication.
  • Information about medical procedures or treatments that require your consent, including explanation of risks, probable success al alternative treatments.
  • Expectation of reasonable safety while receiving services at the hospital.
  • Be free of restraints, except as ordered by the physician.
  • To refuse treatment. You will be informed of medical consequences for refusing treatment.
  • Care that promotes your physical, emotional and spiritual comfort and dignity.
  • A grievance process.
It is your responsibility to:
  • Provide accurate and complete information about matters relating to your health.
  • Follow your treatment plan.
  • Provide information need to file your insurance claims and work with the hospital to make payment arrangements.
  • Follow hospital rules and regulations, including the No Smoking policy.
  • Be considerate of the rights of other patients, staff and physicians.
  • Be responsible for your actions if you refuse treatment or do not follow the practitioner's instructions.
  • Provide the hospital with a copy of your written advance directives, if you have one.
  • Make complaints known so that concerns can be addressed.
Patient Medical Forms can be found here.

 

 
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