Patient forms

ICHS is required by law to maintain the privacy of your health care information, to provide you with a notice of our legal duties and privacy practices, and to follow specific, mandated information practices. You have the right to receive a copy of your health care information, with some limited exceptions. Below are links and information related to your patient rights, privacy and health care information requests.

Patient Rights and Responsibilities

病人的权利和责任
病人的權利和責任
Patient Rights and Responsibilities
환자의 권리와 책임
Derechos y Responsabilidades del Paciente
Quyền hạn và Trách nhiệm của Bệnh nhân

Notice of Privacy Practices

English
Korean
Simplified Chinese
Somali
Tagalog
Traditional Chinese
Vietnamese

Medical information requests

Authorization to Use or Disclose Health Care Information

Advance Directives

Formal Advance Directives are written before a serious illness. They state your choices for health care (Physician Orders for Life Sustaining Treatment) or name someone to make those choices for you (Durable Power of Attorney for Health Care), if you cannot. This booklet provides more information.
Advance Directives
預立醫療指示
Chæ Thò Saép Ñaët Tröôùc

Non-Discrimination Notice

ICHS does not discriminate on the basis of race, color, sex, marital status, sexual orientation, political ideology, age, creed, religion, ancestry, gender identity, genetic information, use of service animals, national origin, veteran status, citizenship status, or the presence of any sensory, mental or physical disability, veterans with disabilities and Vietnam era veterans in accordance with federal, state and local laws and regulations.