Patient Rights & Privacy Notices

Read and download this notice in English and Spanish:

• Your information. Your rights. Our responsibilities.

• Su informacion. Sus derechos. Nuestras responsabilidades.

Notice of Program Accessibility to Persons with Disabilities, Section 504

Samaritan Health Services is committed to accessibility by making its programs and activities accessible to and useable by disabled persons, including persons who are deaf, hard of hearing, blind or who have other sensory impairments. Access features include:

• Convenient off-street parking designated specifically for disable persons

• Curb cuts and ramps between parking areas and buildings

• Level access into first floor level with elevator access to all other floors

• Fully accessible offices, meeting rooms, bathrooms, public waiting areas, cafeteria, patient treatment areas, including examining rooms and patient wards
• A full range of assistive and communication aids provided to persons who are deaf, hard of hearing, blind or with other sensory impairments. There is no additional charge for such aids. Some of these aids include:

• Qualified sign language interpreters for persons who are deaf or hard of hearing
• A 24 hour telecommunication device (TTY/TDD) which can connect the caller to all extensions within the facility and/or portable (TTY/TDD) units, for use by persons who are deaf, hard of hearing or speech impaired.
• Readers and taped material for the blind and large print materials for the visually impaired
• Flash cards, alphabet boards and other communication boards
• Assistive devices for persons with impaired manual skills

If you require any of the aids listed above, please let the receptionist or your nurse know.

Rights & Responsibilities of Patients

To review our Rights & Responsibilities of Patients literature, please select the appropriate link for your primary language below:

Rights and responsibilities of patients
Derechos y responsabilidades como paciente

Non-Discrimination

Samaritan Health Services does not discriminate against any person on the basis of race, color national origin, disability, or age in admission, treatment, or publication in its programs, services and activities or in employment.

For further information about this policy,or concerns regarding the appropriate legal non discrimination acts,* please contact:

Samaritan Health Services
SHS Compliance Officer
Telephone: 541-768-4649
TDD/Voice: 1-800-735-2900
AT&T TDD 24 hours: 1-800-855-1155

*Legal acts include:
Title VI of the Civil Rights Act of 1964
Section 504 of the Rehabilitation Act of 1973
Age Discrimination Act of 1975

Page updated February 15, 2016

Get Help in Other Languages

If you need help or speak a non-English language, call 1-800-481-3293 (TTY: 1-800-735-2900), and you will be connected to an interpreter who will assist you at no cost.

Español (Spanish)

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-481-3293 (TTY: 1-800-735-2900).

繁體中文 (Chinese)

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-481-3293（TTY 文字電話：1-800-735-2900）。

Tiếng Việt (Vietnamese)

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-481-3293 (TTY: 1-800-735-2900).

한국어(Korean)

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-481-3293번 (TTY: 1-800-735-2900번)으로 전화하십시오.

Русский (Russian)

ВНИМАНИЕ! Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните по номеру 1-800-481-3293  (телетайп: 1-800-735-2900).

العربية (Arabic)

ملحوظة: إذا كنت تتحدث العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل على الرقم 3293-481-800-1 (هاتف الصم والبكم: 2900-735-800-1)

Français (French)

ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-800-481-3293  (ATS : 1-800-735-2900).

日本語 (Japanese)

注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-481-3293 (TTY: 1-800-735-2900).

Deutsch (German)

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufen Sie uns an unter 1-800-481-3293 (TTY: 1-800-735-2900).

Українська (Ukrainian)

УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-800-481-3293 (телетайп: 1-800-735-2900).

Română (Romanian)

 ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 1-800-481-3293 (TTY: 1-800-735-2900).

ខ្មែរ (Cambodian)

ប្រយ័ត្ន៖  បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, សេវាជំនួយផ្នែកភាសា ដោយមិនគិតឈ្នួល គឺអាចមានសំរាប់បំរើអ្នក។  ចូរ ទូរស័ព្ទ 1-800-481-3293 (TTY: 1-800-735-2900)។ 

فارسی (Farsi)

توجھ: اگر بھ زبان فارسی گفتگو می کنید، تسھیلات زبانی بصورت رایگان برای شما 1-800-481-3293 (TTY: 1-800-735-2900) فراھم می باشد. با تماس بگیرید.

Oromo

XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama.  Bilbilaa 1-800-481-3293 (TTY: 1-800-735-2900).

Rights to Support Persons: Notice for Posting 

Oregon Support Person Legislation: Implications for Patients & Families 

Patients with disabilities have a right to support persons while they are in any Oregon hospital.  The patient may choose at least three support persons to provide assistance and help with the patient’s care including:

• Communicating with hospital staff,
• Making medical decisions, and/or
• Care needs related to activities of daily living.

At least one support person can be with the patient at all times in the emergency department and during the hospital stay.  The Oregon Health Authority will evaluate hospital compliance with these state law requirements related to support persons. 

Important elements of Oregon’s Support Person Law that you should know: 

• Patients with disabilities may pick support persons to stay with them in the hospital when necessary to accommodate their disability. 

• Unless a patient states otherwise, a hospital must make sure that a support person is present for any discussion where the patient is asked to make an end of life decision.  A patient’s legal guardian or authorized representative must be included in those discussions. 

• A hospital can require a support person to follow hospital safety protocols including wearing personal protective equipment provided by the hospital and restricting physical access if the support person is sick or has flu like symptoms.

If you have a concern about your care or if you need a support person based on your disability, please bring it to the attention of your nurse, a nurse leader or a patient advocate in this hospital. 

Please give the hospital the opportunity to quickly help resolve your concern about access to a support person and/or patient care. 

A copy of the hospital’s support person policy can be found here.

Oregon Health Authority 
You may contact the Oregon Health Authority, Health Care Regulation and Quality Improvement division, at www.healthoregon.org/hcrqi, by phone at 971-673-0540, or by email at Mailbox.hclc@state.or.us


Learn More about Your Rights
Disability Rights Oregon’s website:   www.droregon.org/covid-19-rights

References: Oregon Administrative Rules 
Oregon Revised Statues 

This Support Person Notice for Posting shall be posted in the hospital at entry points to the hospital
Version: July 27, 2020

Patient Authorization to Disclose Health Information: English  Spanish

Patient Request for Restriction of Uses and Disclosures: English  Spanish

Patient Request for Accounting and Disclosures: English  Spanish

Patient Request for Amendment of Medical Record: English  Spanish

Patient Request for Confidential Communications: English  Spanish

Patient Authorization to: Discuss Health Information (Verbal) with Friends and Family: English  Spanish

Discharge Plan for Behavioral Health Crisis