If you decide to become one of our patients, you should know that you have rights. And we respect those rights. We want you to have all the tools and information you need to exercise those rights. Because in the end, we are partners, and partnerships are built on trust.
This section provides all the information about your rights on the following:
- The right to respectful and considerate care
- The right to be included in all facets of your care
- The right to exclude any or all members of your family from participating in your healthcare decisions
- The right to communicate without language, hearing, visual or learning barriers
- The right to be fully informed about your condition, treatment options and likely outcome
- The right to know the positions, title and names of the people treating you
- The right to appropriate management and assessment of pain
- The right to approve or reject treatment, as permitted by law (If you refuse treatment, we will provide alternative treatment when possible.)
- The right to create an advance directive, such as a healthcare proxy or living will (These are documents that instruct healthcare providers about your care or names someone to decide on your behalf if you cannot speak for yourself. If you have a written advance directive, please provided a copy to your doctor.)
- The right to a reasonable level of privacy
- The right to your confidential treatment of your medical information unless you provide written authorization
- The right to access information in your medical records or have the information explained, except when restricted by law
- The right to receive your hospital services in accordance with the terms of your admission and necessary emergency care as required by law
- The right to information about partnerships with outside parties that is applicable to your care and treatment
- The right to decline or consent to participate in research influencing your care (If you decide not to participate, you will receive appropriate care the hospital provides otherwise.)
- The right to healthcare alternatives when hospital care is no longer appropriate
- The right to know hospital rules that influence and impact your treatment and billing
- The right to participate in the development of your plan of treatment
- The right to receive care in a secure and safe environment
- The right to file a grievance about your stay at our hospital
To file a complaint, contact Risk Management at (561) 650-6259 or visit the office at:
Good Samaritan Medical Center
1309 N. Flagler Dr.
West Palm Beach, FL 33401
- You are solely responsible for providing the correct information about your health that includes, current conditions, past illnesses and treatments, hospital stays and use of medication.
- You are responsible for educating yourself by asking questions when you do not understand instructions.
- You are responsible for communicating to your doctor if you believe you can’t follow through with your treatment.
- You are responsible for providing your insurance information and for working with your doctor and hospital to make payments.
- You are responsible for the effects of your lifestyle on your health. (Your health is the product not just of the treatment you receive at a hospital, but also the decisions you make in your daily life.)
Your privacy is important to us. This notice will cover how your medical information will be used and disclosed. It will also address how you can access your information. Please take the time to review it carefully.
We are required by law to safeguard your information. We are also committed to protecting that information in the name of privacy. This notice addresses how we use your medical information within our practice and how we may disclose your information outside our practice. Please read the notice and ask us any questions you may have.
How do you use and disclose my medical information?
Treatment: We will use your medical information as part of the care we provide you. We will share that information only with those involved in your care, but only if they need that information to treat you. Parties we may exchange information with are doctors, physician assistants, nurses, medical students, technicians, therapists, emergency service staff, medical transportation providers, and medical equipment suppliers.
For instance, your medical records will be shared with other physicians treating you. To ensure speedy treatment, we will use community-based electronic health information exchange systems to quickly access your latest health information. Our staff may also use your information in communicating the coordination of future appointments, possible treatment alternatives, the availability of health care services, or to perform follow-up calls as part of monitoring your condition.
Family, Friends and Legal Guardians Involved in Your Care: Those involved in your care, or helping pay for your care, may receive your medical information. In the cases of emergencies, we may divulge medical records to third-party relief organizations to aid in locating a family member or friend during or after a disaster. Let your doctor or hospital’s supporting staff know if you do not wish them to divulge your medical information during a visit.
Payment: We might disclose your medical information or use it to receive payment for medical services and supplies provided to you during your care. An example might be a request from your health plan or health insurance company to see part of your medical record prior to paying for your treatment.
Practice Operations: If it is necessary to improve the quality of care we provide our patients or to run our services, we may use and disclose your medical information. To conduct quality improvement activities, to audit our practice, accounting or legal services, or as part of our running our business or future planning, we may use your medical information. An example, as part of an audit of the quality of a treatment we may look at your medical records to evaluate the care you received.
Research: We may disclose your medical records as part of a research project, like studying the effectiveness of a treatment plan or rehabilitation program. These projects go a long way in providing information about the quality of care we provide. They are conducted under a process of strict confidentiality.
Required by Law: Laws on the federal, state or local level sometimes mandate that we disclose a patient’s information. For example, we are required to report child neglect or abuse and must provide certain information to law enforcement officials in the cases of domestic violence. For work-related injuries, we are required to give medical information to the State Workers’ Compensation Program.
Public Health: We may also divulge certain information for public health purposes. We are required to report the number of communicable diseases contracted, deaths and births to the State. We also report to the FDA any incidences patients experienced with medications or medical equipment, or inform patients of recalls of products they are using.
Public Safety: In limited circumstances, we might disclose certain information from medical records for public safety reasons. This includes providing medical information to law enforcement officials in response to a grand jury subpoena or search warrant. To aid in the identification or location of a person, to prosecute a crime of violence and to report deaths that resulted from criminal conduct, we may disclose medical information to assist law enforcement officials. We may also disclose your medical records to law enforcement officials and others to prevent a serious threat to health or safety.
Health Oversight Activities: We may disclose medical information to a government agency that regulates our Practice or its staff. These agencies use medical information to monitor the Practice’s compliance with federal and state laws. Such agencies include, but are not limited to, the State Department of Health, the federal agencies that are overseen by Medicare, the Board of Medical Examiners or the Board of Nursing.
Funeral Directors, Coroners and Medical Examiners: To assist them in performing their duties, we may disclose medical information about deceased patients to medical examiners, coroners and funeral directors.
Organ and Tissue Donation: Organizations that handle organ, eye or tissue donation or transplantation, may receive medical information from us.
National Security, Military, Veterans or Other Government Purposes: To comply with requirements by the military command authorities, Department of Veterans Affairs, we may release your medical information if you are a member of the armed forces. Your hospital may also have to provide medical information to federal officials for national security or intelligence purposes, or for presidential Protective Services.
Judicial Proceedings: If ordered to do so by a court of law, your hospital will disclose medical records, or if the practice receives a search warrant or subpoena. You will have a chance to object to sharing your medical information by receiving a notice in advance about the disclosure in most situations.
Additional Protection for Some Information: Under federal or state law, some information has additional protection. Medical information about communicable disease and HIV/AIDS, for example, have additional protection. Another category of information with additional protections is the evaluation and treatment for a serious mental illness. For those specially protected types of information, your hospital is required to get your permission prior to disclosing that information to others in certain circumstances.
Uses and Disclosures for which Your Authorization is required: Your hospital must obtain your written authorization prior to disclosing your medical records in the enumerated circumstances: (1) to divulge notes of psychotherapy treatment, (2) to conduct market related activities, or (3) to sell your medical information to a third party.
Other Disclosures and Uses Requiring Authorization: If your hospital wishes to disclose or use your medical information for a purpose that is not mentioned in this Notice that hospital must seek your written authorization. You may take back that authorization at any time, unless we have already relied on your authorization to disclose or us your information. To invoke your authorization, please notify the Privacy Official in writing.
What are my rights?
The Right to Request Your Medical Records: You have the right to receive and review copies of your medical information. (The law, however, requires that we keep a copy of the original.) Included in this are your billing and other records used to make decisions about your health care. To receive a copy of your medical information, write to the Privacy Official. We will charge you for the costs to copy the information if you request a physical copy of your records. We will inform you in advance what the print cost will be. You can look at your records at no cost.
The Right to Amend Medical Information You Believe Incorrect or Incomplete: If you discover your medical information is in error or incomplete, you may request us to amend the record in question. Write to the Privacy Official about amending your medical information.
The Right to Receive a List of Disclosures of Your Medical Information: You have the right to request and receive a list of many disclosures we make of your medical records. Write to the Privacy Official if you would like to obtain such a list of medical information. The first list is free, but any additional copies of the list requested during the same year may come with a fee. We will inform you in advance the cost of the list.
The Right to Request Restrictions on How the Practice Will Disclose or Use Your Medical Information for Treatment, Payment or Health Care Operations: You can request your hospital refrain from making uses or disclosures of your information for treatment, for seeking payment or to operate the hospital. The hospital is not required to agree to your request for restriction, but if they do, they will comply with the agreement. The hospital, however, must agree to your request not to disclose to your health plan medical information about items or services you have paid in full, unless such disclosure is required by law or for treatment. You must notify us at the time of registration that you do not want the practice to notify your health plan, as well as make arrangements to pay in full for your treatment.
The Right to Request for Confidentiality in Communications: You have the right to request we communicate in a confidential manner. You can, for example, request that we do not call you, but correspond by mail. Write to the Privacy Official if you wish to do this. You can also ask to speak with your doctor, or any other healthcare provider, in private outside the presence of other patients or family.
The Right to a Paper Copy: You have the right to a paper copy at any time. You can download an electronic version of the notice for printing purposes from our website or you can visit the Privacy Official to obtain a paper copy of the notice. Click to download the Notice of Privacy Practices [Add PDF of Privacy Notice].
What are your practice’s duties?
The law requires that your practice protect the privacy of your medical information, provide you a copy of this Notice of Privacy Practices, and follow the terms outlined in the Notice that is currently in effect. The Practice is obligated to notify you if there is a breach of your medical information.
Which of your healthcare personnel are covered by this notice?
This Notice of Privacy is applied to all those at our Practice who proved you with care, which includes staff, students, trainees and volunteers.
Will I be informed about changes made to this notice?
Every so often, we may change our practice concerning how we disclose or use patient medical information, or how we follow patient rights regarding their information. We reserve the right to change or make provisions in our new notice effective for all medical information. If we make any changes to our practices, we will publish a revised and updated copy of the Notice of Privacy Practices. You can get a copy of the notice at any time by contacting or visiting the Privacy Official.
Who do I speak to about a complaint or concern?
If you have any problems, concerns or complaints regarding your privacy and rights to privacy, you can contact the Practice’s confidential Compliance Hotline at 1-800-8-ETHICS.
If for whatever reason the Practice does not, or cannot, resolve your concern, you can also file a complaint with the federal government at the OCR/DHHS regional office. You will not be penalized or retaliated against for filing a complaint with the federal government.
What is the contact information for the Practice Privacy Office?
Good Samaritan Medical Center
1309 N. Flagler Dr.
West Palm Beach, FL 33401
Phone: (561) 655-5511 ext 16109
You have the right to decide on all treatment options, along with which ones you will accept and which ones you will refuse. After your doctor as covered your care options, you can put in writing your wishes in an advance directive. To ensure you wishes are carried out, our staff will follow your directive so your family doesn’t need to make any difficult medical choices on your behalf.
What is an Advance Directive?
An advance directive is a written set of instructions for medical care when you are not able to make decisions for yourself. Since you have the right to make important legal decisions related to your care, we can aid you in this important process.
Below are the three types of advance directives recognized under Florida law.
Take our Advance Directive Quiz if you want to learn more.
Types of advance directives
Directive to Physicians and Family or Surrogates (Living Will)
A “Directive to Physicians and Family or Surrogates,” also called a Living Will, allows you to make decisions in advance about the type of medical care you want to receive under Or you can use other means of non-written communication in the presence of your physician.
If you become unable to communicate and have not issued a directive after being diagnosed with a terminal condition, your attending physician, family members or legal guardian can make your decisions governing life-sustaining treatment. If, however, certain family members are not available, your doctor or another physician not involved in your care can also make decisions to withdraw or withhold life-sustaining treatment.
A directive goes into effect only once you have been diagnosed with an irreversible or terminal condition.
Download Form for Living Will [Link to Form]
En Español (Link to Form)
Medical Power of Attorney (POA)
Should you become unable to make decisions for yourself, you can give someone you trust the Medical Power of Attorney to make healthcare decisions on your behalf.
The person you select must be an adult. You can choose a family member or a friend. If you select your spouse, however, the appointment of your spouse as an agent of your Medical Power of Attorney is revoked after a divorced is finalized.
Below is a list of people who cannot be appointed as your agent:
- Your attending healthcare provider
- Unless he or she is a relative, an employee of your healthcare provider
- Unless he or she is a relative, your residential care provider or employee of your residential care provider
The person you select only has the authority to make medical decisions after your physician has certified that you lack the ability to make your own decisions. If you object, your agent cannot make a healthcare decision, regardless of whether you have the capacity to make the healthcare decision yourself or if Medical Power of Attorney is in effect.
Your agent will work with your attending physician to make healthcare decisions according to your agent’s knowledge of your wishes, including your moral and religious beliefs. Your agent can decided on authorizing, withdrawing and refusing treatment, even if refusal leads to death. If your wishes are not known, your agent will make decisions based on what he or she feels is in your best interest.
Download Form of Medical Power of Attorney:
(Insert Link to Form) English
(Insert Link to Form) En Español
Out-of-Hospital Do-Not-Resuscitate (DNR)
If you wish to refuse life-sustaining treatments outside any hospital stay, you must have an Out-of-Hospital Do-Not-Resuscitate document. The settings applicable to the Out-of-Hospital DNR are home health, nursing home, hospice, hospital emergency room and ambulance. You must issue this Advance Directive with your attending physician and signed by two witnesses on an orange sheet of paper.
Download Form for Out-of-Hospital Do-Not-Resuscitate (DNR)
(Insert Link to Form) English
(Insert Link to Form) En Español
Declaration for Mental Treatment (DMHT)
In the event, you become incapacitated, a Declaration of Mental Health allows you to provide instructions to healthcare providers your decisions for mental health treatment. It only applies to the treatment at a hospital.
The DMHT expires three years from the date it is signed, unlike a living will or medical power of attorney, both of which do not expire. The document stays in effect if you are incapacitated on that date until you are again able to make your own decisions.
Download Form for Declaration for Mental Health Treatment:
[Insert Link] English
[Insert Link] En Español
Additional information about advance directives
Certain family members or others can make medical decisions on your behalf if you are unable to make your own decisions and do not have a legal guardian or designated surrogate under a Medical Power of Attorney.
Legal Features of Advance Directives
It is not necessary to notarize an Advance Directive. Your hospital or your doctor will not mandate you have an advance directive to receive treatment or be admitted. Nor will not having an Advance Directive affect your health plan.