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PATIENT PRIVACY • For more information visit You have the right to complain to the Get Copies Of WHAT Are Advance LIVING WILL: OUTLINES THE ADVANCE DIRECTIVES
here unless you tell us we can in
TREATMENT you want to receive at
writing. If you tell us we can, you may
hospital if you believe your rights to
Directives?
Your X-rays
the end of life such as:
privacy have been violated.
change your mind at any time. Let us
• Do you want CPR if your heart
If you feel your privacy rights have been
know in writing if you change your
stops beating?
They are legal documents that state
Visit or call the Radiology Dept.
violated, please mail your complaint to
mind.
• Do you want a ventilator if you
your choices about your healthcare
West Calcasieu Cameron Hospital
(M-F, 8 a.m.-5 p.m.) at 337-527-
if you cannot speak for yourself
stop breathing?
hhs.gov/privacy
4256, complete an authorization
Attn: Privacy Officer • 701 Cypress St.
We can change the terms of this
IV if you cannot eat or drink?
decisions. You do not need a
picture I.D.. For safety and security
notice, and the changes will apply to Sulphur, LA 70663 to release information, present or are unable to make your own • Do you want a feeding tube or
• All complaints will be investigated.
lawyer in order to complete
of information reasons, records will
all information we have about you. • No personal issue will be raised for not be released without I.D.. For Advance Directives. WHY Do You Need
• The new notice will be available filing a complaint with the hospital. release of information to a third
upon request, on our website, and party, please call 337-527-4256 • The hospital will provide you with Advance Directives?
we will mail a copy to you. Your protected healthcare for instructions. information regarding Advance
• Effective Date of this Notice: information may NOT be released Directives and will assist you with the Discussing the healthcare you want
September 23, 2013 for any other purpose than that development of an Advance Directive. if you can't speak for yourself due to
• The hospital will abide by the terms which is identified in this notice. Get Copies of Your • The hospital will provide you with illness or end of life, helps to relieve
of this notice. The hospital reserves Your protected healthcare information Medical Records information regarding Organ Donation the stress and worry created by not
the right to make changes to this may be released only after receiving and will assist you with decisions being prepared.
notice and continue to maintain written authorization from you. Visit or call the Medical Records concerning the donation of organs.
the confidentiality of all healthcare You may revoke your permission to Department (M-F, 8a.m.-5p.m.) • We will honor your wishes regarding • Bring your Advance Directives with you Visit CaringInfo.org for more
information. The current notice will release protected healthcare information at 337-527-4113, complete your end-of-life decisions. every time you come to the hospital. information on how to download
be available from the Admitting at any time. an authorization to release your Advance Directive forms.
Office, from the Privacy Officer, on For further information please call information and present picture POWER OF ATTORNEY FOR • Discuss your Advance Directives with
the website and posted throughout the Privacy Officer at 337-528-7891, I.D.. Test results will be available HEALTHCARE: NAMES THE PERSON your advocate or loved ones, and
the hospital. or you may call the Compliance three business days from the time you have chosen to make medical review your forms regularly to be sure
Confidential Line at 337-528-4168. the test or screening is performed. decisions for you if you are unable to they are still up-to-date with your
make them for yourself. healthcare choices.
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