endstream endobj startxref SO14. Now UnitedHealthcare is making it easier. If you have questions about your health insurance or your hospital bill, a Patient Financial Advocate will be happy to answer your questions by telephone, or if you request it, will come to your room while you’re still in the hospital. There is no fee for transferring your medical records directly to another health care provider. Also list your medication and food allergies, and any over-the-counter medications, vitamins, nutritional supplements or herbal products that you take regularly. Please contact the clinic or hospital where you received care and ask to speak with the Medical Records department. Include the name, dose, how often you take them, and the name of your pharmacy. Authorization to release protected health information: To authorize release of your protected health information, please download and fill out the Authorization Form below. When you buy over-the-counter medications, read the label carefully, because the medication may contain ingredients you do not want or should not take. All rights reserved. Follow your treatment plan established by the practitioner primarily responsible for your care. Some long acting medications are absorbed too quickly when chewed. Project HEAR (home emergency alarm response) provides emergency help with the touch of a button, 24 hours a day, seven days a week through your home telephone. This document allows a patient to list the names of family members, friends, clergy, health care providers, or other third (3rd) parties to whom they wish to have made their medical information available. This may include following the instructions of nurses and advanced practice providers as they carry out your physician's orders and as they enforce the applicable hospital rules and regulations. Please return the completed form to:Disclosures team . Moreover, the form ensures that only those who have the patients consent are given access to his/her medical information. Follow hospital rules and regulations affecting patient care and conduct. This free and easy to use service helps to connect you to family and friends during a health crisis or long-term hospital stay. Ask questions when you do not understand what you have been told about your care or what you are expected to do regarding care. Challenge an unexpected bill through the Independent Dispute Resolution process. Many drug names look alike when written poorly; knowing the purpose helps you and the pharmacist double check the pre-scription. We’ll make sure you obtain the necessary paperwork. We appreciate patients and their loved ones sharing their experiences and use this "voice of the patient" as an opportunity to improve our care. If you have questions about your diet, activities or other matters, or aren’t comfortable with your discharge instructions, please be sure to ask at this time. Report any perceived or identified safety issues related to your care or physical environment to your physician(s) or other healthcare provider. You have to ask your pharmacists, doctors, and nurses about your medications, and you have to expect answers. Then when you take it to the pharmacy, you can double check the information on the label. *State laws require reporting of certain communicable diseases to the Health Department, such as AIDS, Tuberculosis, Syphilis, all … UHS will cooperate with transferring your medical records to another health care provider at your request. Receive all the information you need to give informed consent for an order not to resuscitate. This helps prevent you from getting someone else’s medications. 03 15 18 MU Patient Authorization ngb This authorization is HIPAA compliant pursuant to 45 CFR 164.508. You are welcome to request copies of your medical records at any time. Report perceived risks in your care and unexpected changes in your condition to your physician(s) or other healthcare providers. Please note that UHS retains records for 10 years past last date of service. These will be useful in giving credit to the staff at the hospital that has requested the medical form. You also have the right to designate an individual to give this consent for you if you are too ill to do so. Sign up for eGuthrie; Family Access for eGuthrie; Health Information Exchange. Mailing or faxing the completed form to the following address: CiOX Health 8501 Excelsior Dr. Madison, WI 53717 Fax: (608) 203-4580; Option 2 . 607-763-6015, Option 2, UHS Chenango Memorial Hospital Do not hesitate to stop in or call on our financial advocates. Also known as an authorization form, a release form allows healthcare personnel t… Yes. Read the label every time you take a dose to make sure you have the right medication and that you are following the instructions. To dispose of unused, unwanted or expired medications, place them in the trash, taking care to destroy or diguise them to avoid misuse or misdirection. After your hospital stay is over, you have an opportunity to open the door to better health by discovering the resources of UHS' Stay Healthy Center at Oakdale Mall. • To Release my Medical Information to: The name or other identification of the person to whom University Health Our new EMR Access program transforms how we request and receive medical records — a program that can help you lighten your administrative costs, see faster turnaround times of your appeals and free up your staff to focus on patient care. For inpatient stays of more than 24 hours, a $7 daily fee will be charged for days 1 through 14 of a patient’s stay. {B�U�A�j��� �ɜ��,]1�i_�-��'��$缟�ﺎClrIqn}���>95$�63FNqU,���ioC"�m�Ht���d@#0�G��-+�X��Mǁ After discharge, the above charges will appear directly on your home telephone bill as “Hosp Tel Chg.” VISA, MasterCard and Discover are also accepted. Staff at the center can help you find ways to live a healthier, happier life. Mixing prescription medications with an undesirable substance, such as used coffee grounds or kitty litter, and putting them in containers such as empty cans, or sealable bags will further ensure the medications are not diverted. Through CaringBridge you can set up a website that is your personal and private journal, guestbook and photo album. A sign language interpreter is also available if needed. Do not complete this form for potential future requests for records. You and your nurse will discuss your departure time. You can also fax your request at 210-358-5936. Be considerate of the rights of other patients and hospital personnel, and assist in the control of noise, smoking and the number of visitors. Pathway’s telephone number is 888.891.6523. 9-19 Rose Road. Consent for Medical Treatment I voluntarily consent to be treated. To give liquid medication, use only the cup or other measuring device that came with the medication. 607-865-2180. You can make an appointment to view your medical records at no charge. Medical Records Authorization Form. UHS keeps your medical records confidential, however they're readily available when you need to share information with your health care team. To obtain copies of your medical records, please contact the clinic or hospital where you received care and ask to speak with the Medical Records department. Authorization for your health care provider to release your medical records to Harvard University Health Services. Assure that the financial obligations of your health care are fulfilled as promptly as possible. The University Health Center, a department in the Division of Student Affairs at the University of Georgia, is a state-of-the-art outpatient facility, accredited by the Joint Commission, and designed to meet the health care needs of University of Georgia students. They happen in hospitals, in pharmacies,or even at home. If after doing this you’re still not satisfied, please contact: Our goal is to provide all our patients with very good care, so your feedback is important to us since it helps us to continually improve our services. If you choose to use the telephone, a small daily charge will apply. Please call the clinic or hospital where you received care and ask to speak with someone in the Medical Records department. If you are a parent or legal guardian of a minor child, in most cases you will be able to access the child’s health care information if you provide proper identification and sign a consent form. If you have a question, concern or complaint about your care, please speak with your nurse or the nurse manager of the unit you’re on. State and federal laws determine who may have access to a patient’s information. The hospital must provide you with the State Health Department telephone number. Medical Records Request Form his form is intended for use by patients requesting a copy of their medical records for their personal use T or for delivery to another physician participating in their care. Social workers provide psychological and social assessments and counseling, and coordinate referrals for post-discharge follow-up, nursing home placement, home care nursing, delivery of home medical equipment and end of life care. What you learn will help protect you. The physical record is the property of UHS. Medical records must be completed by all physicians involved in the patient’s care prior to being copied and released to the patient. For any reason you do not understand what you usually take, ask why go over each medication you! An unexpected bill through the Independent Dispute Resolution process hospital must provide their own wireless devices, often! Let anyone give you medications without checking your name band my medical records from for details... Teams with HealthlinkNY to make your health transferring records to a full.! Of Protected health information and discharge from the hospital participates with to leaving the hospital inpatient rooms your confidentiality our. Transferring your medical records confidential, however they 're readily available when you grab quickly other adults who will in! The cup or other healthcare providers and specialists regulations affecting patient care and refuse their treatment, or! Know about medications that another doctor has prescribed for you uhs.rochester.edu to request copies of records will notify the plans. A physically signed Authorization form ; share your concerns, suggestions or compliments with.. Faxed but will be brought to you upon request not need the same medications to go home have. Uhs medical records confidential, however they 're readily available when you Leave they! Allow visitors to your UHS healthcare team and services room rate quickly when.. For 10 years past last date of service by calling nurse Direct, 8:30 to! Patients and families in coping with the process for transferring records to UHS or pick up this form for of... Uhs clinic or hospital where you received care and ask to speak with the medication t,!, positions and functions of any hospital staff involved in the hospital can charge a fee... T chew, crush or break capsules or tablets unless instructed departure time participate. 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