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PVRMC is Dedicated to Excellence

These notices describe the privacy practices of Pauls Valley Regional Medical Center and members of its workforce, as well as the physician members of the medical staff and allied health professionals who practice at PVRMC.  Teamwork and transparency with our employees, patients, and the community help make PVRMC your choice of confidence.  If you have questions or concerns, contact a member of the Pauls Valley Regional Medical Center staff for assistance at (405) 238-5501.

At PVRMC, we are dedicated to providing excellent care for our patients and creating a safe and inclusive environment for our staff.


These notices address patient’s rights,  describe how medical information about you may be used and disclosed, and how you can get access to this information. Please choose a language version below (where available) and review it carefully. If you have questions or concerns, contact a member of the Pauls Valley Regional Medical Center staff for assistance at (405) 238-5501, extension 282.


This notice describes how medical information about you may be used and disclosed and how you can get access to this information. PLEASE REVIEW THIS INFORMATION CAREFULLY. This notice applies to Pauls Valley Regional Medical the doctors and other healthcare providers practicing at the various facilities.

It is our legal duty to protect the privacy and security of your information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We are providing this notice so that we can explain our privacy practices. We must follow the duties and privacy practices described in this notice or the current notice in effect. For more information about our privacy practices, to place a complaint or report a concern or conflict, call the number listed below:

Pauls Valley Regional Medical Center

Privacy Officer 
(405) 238-5501 Extension 282

You also may also send a written complaint to the United States Department of Health and Human Services if you feel we have not properly handled your complaint. You can use the contact listed above to provide you with the appropriate address or visit http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html. Under no circumstance will you be retaliated against for filing a complaint. We reserve the right to change our policies and notice of privacy practices at any time. If we should make a significant change in our policies, we will change this notice and post the new notice. You can also request a copy of our notice at any time.

We may use health information about you for your treatment purposes, to obtain payment, or for healthcare operations and other administrative purposes. We may use your information in treatment situations if we need to send or share your medical record information with professionals who are treating you. For example, a doctor treating you for an injury asks another doctor about your overall health condition. We can use and share your health information to bill and receive payment from health plans or other entities. We will give your information to your health insurance plans such as Medicare, Medicaid or other health insurance plans so it will pay for your services. Your information will be used when processing your medical records for completeness and to compare patient data as part of our efforts to continually improve our treatment methods. We may disclose your information to business associates with whom we contract to provide service on your behalf that require the use of your health information. We can use and share your health information to run our practice, improve your care and contact you when necessary. We may contact you or disclose certain parts of your health information to our associates or related foundations for fundraising purposes. You have the right to opt out of receiving such fundraising communications. We may share certain information with a person(s) you identify as a family member, relative, friend or another person that is directly involved in your care or payment for your care, or to your “Lay Caregiver” or appointed Personal Representative if you tell us who these individuals are. If it becomes necessary, we will notify these individuals about your location, general condition or death. We maintain a hospital directory listing the patients currently receiving care in our facility. In addition, we may need to disclose medical information about you to an entity assisting in disaster relief efforts so that your family can be notified about your condition, status, and location. If you have a clear preference for how we share your information, talk to us. Tell us what you want us to do, and we will follow your instructions. If you are not able to tell us your preference, for example, if you are unconscious, we may also share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

We will never share your information unless you give us written permission in these cases: for marketing purposes or the sale of your information.

Under certain circumstances, we may be required to disclose your health information without your specific authorization. Examples of these disclosures are: requirements by state and federal laws to report cases of abuse, neglect, or other reasons requiring law enforcement; for public health activities; to health oversight agencies; for judicial and administrative proceedings; for death and funeral arrangements; for organ donation; for special government functions including military and veteran requests and to prevent serious threats to health or public safety such as preventing disease, helping with product recalls, and reporting adverse reactions to medications. We may also contact you after your current visit for future appointment reminders or to provide you with information regarding treatment alternatives or other health-related services that may be of benefit to you. We will obtain your written authorization for any other disclosures beyond the reasons listed above. Remember, if you do authorize us to release your information, you always have the right to revoke that authorization later. We will be happy to honor that request unless we may have already acted.

As a patient, you have rights regarding how your information can be used and disclosed. These rights include access to your health information. In most cases, you have the right to look at or receive a copy of your health information. This may take up to 30 days to prepare, and there may be a preparation fee associated with making any copies. You can ask for an accounting of disclosures. This is a list of instances in which we have disclosed your information for reasons other than treatment, payment, and operations that you have not specifically authorized but that we are required to do by law (see section on how your information may be used and disclosed). We can provide you one list per year without charge; all additional requests in the same year will be subject to a nominal charge. If you believe that the information we have about you is incorrect or if important information is missing, you have the right to request that we amend or correct your paper or electronic medical records. There may be some reasons that we cannot honor your request for which you submit a statement of disagreement. You can also request that your health information is communicated to you at an alternate location or address that is different from the one we received when you were registered. If you pay for your service in full up front, you can ask that we not disclose information about your treatment to your health plan. Finally, you can request in writing that we not use or disclose your information for any reasons described in this notice except to persons involved in your care, or when required by law or in emergency situations. We are not legally required to accept such a request, but we will try to honor any reasonable requests.


Know Your Rights and Responsibilities

You have the right to:

Be treated in a dignified and respectful manner and to receive reasonable responses to reasonable requests for service.
To effective communication that provides information in a manner you understand, in your preferred language with provisions of interpreting or translation services, at no cost, and in a manner that meets your needs in the event of vision, speech, hearing or cognitive impairments. Information should be provided in easy to understand terms that will allow you to formulate informed consent.
Respect for your cultural and personal values, beliefs and preferences.
Personal privacy, privacy of your health information and to receive a notice of the facility’s privacy practices.
Pain management.
Accommodation for your religious and other spiritual services.
To access, request amendment to and obtain information on disclosures of your health information in accordance with law and regulation within a reasonable time frame.
To have a family member, friend or other support individual to be present with you during the course of your stay, unless that person’s presence infringes on others’ rights, safety or is medically contraindicated.
Care or services provided without discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression.
Participate in decisions about your care, including developing your treatment plan, discharge planning and having your family and personal physician promptly notified of your admission.
Select providers of goods and services to be received after discharge.
Refuse care, treatment or services in accordance with law and regulation and to leave the facility against advice of the physician.
Have a surrogate decision-maker participate in care, treatment and services decisions when you are unable to make your own decisions.
Receive information about the outcomes of your care, treatment and services, including unanticipated outcomes.
Give or withhold informed consent when making decisions about your care, treatment and services.
Receive information about benefits, risks, side effects to proposed care, treatment and services; the likelihood of achieving your goals and any potential problems that might occur during recuperation from proposed care, treatment and service and any reasonable alternatives to the care, treatment and services proposed.
Give or withhold informed consent to recordings, filming or obtaining images of you for any purpose other than your care.
Participate in or refuse to participate in research, investigation or clinical trials without jeopardizing your access to care and services unrelated to the research.
Know the names of the practitioner who has primary responsibility for your care, treatment or services and the names of other practitioners providing your care.
Formulate advance directives concerning care to be received at end-of-life and to have those advance directives honored to the extent of the facility’s ability to do so in accordance with law and regulation. You also have the right to review or revise any advance directives.
Be free from neglect; exploitation; and verbal, mental, physical and sexual abuse.
An environment that is safe, preserves dignity and contributes to a positive self-image.
Be free from any forms of restraint or seclusion used as a means of convenience, discipline, coercion or retaliation; and to have the least restrictive method of restraint or seclusion used only when necessary to ensure patient safety.
Access protective and advocacy services and to receive a list of such groups upon your request.
Receive the visitors whom you designate, including but not limited to a spouse, a domestic partner (including same-sex domestic partner), another family member, or a friend. You may deny or withdraw your consent to receive any visitor at any time. To the extent this facility places limitations or restrictions on visitation; you have the right to set any preference of order or priority for your visitors to satisfy those limitations or restrictions.
Examine and receive an explanation of the bill for services, regardless of the source of payment.
You have the responsibility to:

Provide accurate and complete information concerning your present medical condition, past illnesses or hospitalization and any other matters concerning your health.
Tell your caregivers if you do not completely understand your plan of care.
Follow the caregivers’ instructions.
Follow all medical center policies and procedures while being considerate of the rights of other patients, medical center employees and medical center properties.
You also have the right to:

Lodge a concern with the state, whether you have used the hospital’s grievance process or not. If you have concerns regarding the quality of your care, coverage decisions or want to appeal a premature discharge, contact the State Quality Improvement Organization (QIO).

Quality lmprovement Organization
Phone: (216) 447-9604
Toll Free (844) 430-9504
Fax: (844) 878-7921
5700 Lombardo Center Dr.
Suite 100
Seven Hills, OH 44131

If you have a Medicare complaint you may contact:

Oklahoma State Department of Health Services
Phone: (800) 522-0203
Mail: Oklahoma State Department of Health Services
1000 NE 10th
Oklahoma City, OK 73117

Regarding problem resolution, you have the right to:

Express your concerns about patient care and safety to facility personnel and/or management without being subject to coercion, discrimination, reprisal or unreasonable interruption of care; and to be informed of the resolution process for your concerns. If your concerns and questions cannot be resolved at this level, contact the accrediting agency indicated below:

The Joint Commission
Phone: (800) 994-6610 Fax: (630) 792-5636
Email: complaint@jointcommission.org
Mail: Office of Quality Monitoring/the Joint Commission
One Renaissance Boulevard
Oakbrook Terrace, IL 60181


Aviso de derechos y responsabilidades del paciente

Usted tiene el derecho a:
• Ser tratado de una manera digna y respetuosa y a recibir
respuestas razonables a las solicitudes razonables de
• Una comunicación efectiva que le proporcione
información, de forma que usted la comprenda, en su
idioma preferido, con prestación de servicios gratuitos
de traducción o interpretación y de manera que satisfaga
sus necesidades si usted tiene alguna discapacidad de la
vista, habla, auditiva o cognitiva. La información debería
proporcionarse en términos fáciles de comprender que le
permitan formular un consentimiento informado.
• El respeto de sus valores, creencias y preferencias
personales y culturales.
• La privacidad personal, privacidad de su información
médica y a recibir un aviso de las prácticas de privacidad
del hospital.
• El manejo del dolor.
• La adaptación para sus servicios religiosos y otros
servicios espirituales.
• Acceder a la información sobre divulgaciones de su
información de salud, obtener dicha información y
solicitar enmiendas a tal información, de conformidad con
la ley y la reglamentación, dentro de un plazo razonable.
• Tener un familiar, amigo u otra persona de apoyo para
que esté presente con usted durante su estadía, a menos
que la presencia de esa persona infrinja los derechos y la
seguridad de otros o esté médicamente contraindicado.
• Que se le proporcionen atención o servicios sin
discriminación con base en la edad, raza, origen étnico,
religión, cultura, idioma, discapacidad física o mental,
nivel socioeconómico, sexo, orientación sexual e
identidad o expresión de género.
• Participar en las decisiones sobre su atención, incluso a
crear su plan de tratamiento, a planificar su alta y a tener
a su familia y médico personal notificados rápidamente de
su ingreso.
• Seleccionar proveedores de productos y servicios para
recibirlos después del alta.
• Rechazar la atención, el tratamiento o los servicios de
conformidad con la ley y la reglamentación, y a dejar
el centro de atención médica en contra del consejo del
• Tener una persona suplente encargada de tomar
decisiones para que participe en las decisiones de
atención, tratamiento o servicios cuando usted no pueda
tomar sus propias decisiones.
• Recibir información sobre los resultados de su atención,
tratamiento y servicios, incluso los resultados inesperados.
• Dar o retirar su consentimiento informado en el momento de
tomar decisiones sobre su atención, tratamiento o servicios.
• Recibir información sobre los beneficios, los riesgos, y los
efectos secundarios de la atención, el tratamiento y los
servicios propuestos; la probabilidad de lograr sus objetivos
y cualquier problema posible que pudiera ocurrir durante
la recuperación posterior a la atención, el tratamiento y el
servicio propuestos y cualquier alternativa razonable a la
atención, al tratamiento y a los servicios propuestos.
• Dar o retirar su consentimiento informado para grabaciones,
filmaciones u obtención de imágenes suyas para cualquier
propósito distinto a su atención.
• Participar o rechazar participar en estudios, investigaciones
y pruebas clínicas sin poner en riesgo su acceso a la
atención y a los servicios no relacionados con el estudio.
• Conocer el nombre del médico que tiene la responsabilidad
primaria de su atención, tratamiento o servicios y los
nombres de los otros médicos que le proporcionan su
• Formular instrucciones anticipadas sobre la atención
que recibirá al final de la vida y a que se respeten esas
instrucciones anticipadas en la medida de las posibilidades
del hospital para hacerlo de conformidad con la ley y la
reglamentación. También tiene el derecho de revisar o
modificar cualquier instrucción anticipada.
• No sufrir negligencia, explotación ni abuso verbal, mental,
físico y sexual.
• Un entorno que sea seguro, que preserve su dignidad y
contribuya a una imagen propia positiva.
• Que no se le someta a ninguna forma de restricción
ni aislamiento que se utilice como medio de ventaja,
disciplina, coacción o represalias y a utilizar el método más
leve de restricción o aislamiento solamente cuando sea
necesario o para garantizar la seguridad del paciente.
• Acceder a servicios de protección y defensa y a recibir una
lista de dichos grupos si la solicita.
• Recibir a los visitantes a quienes usted nombre, incluso
(entre otros) su cónyuge, una pareja (incluso una pareja del
mismo sexo), otro familiar o un amigo. Usted puede


This facility and its affiliates comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. This facility and its affiliates do not discriminate against any person on the basis of color, race, gender, age, religion, national origin, ethnicity, culture, language, disability, genetic information, gender identity or expression, socioeconomic status, sexual orientation, veteran’s status or any other basis protected by applicable federal, state or local law, in admission, treatment, visitation, or participation in our programs, services, and activities or employment.

Our facility and its affiliates:

Provide free aids and services to people with disabilities to communicate effectively with us, such as:

Qualified sign language interpreters

Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provide free language services to people whose primary language is not English, such as:

Qualified interpreters

Information written in other languages

If you need these services, contact the Compliance Officer (CO) listed below.

If you believe that our facility or its affiliates have failed to provide these services or discriminated in another way on the basis of color, race, gender, age, religion, national origin, ethnicity, culture, language, disability, genetic information, gender identity or expression, socioeconomic status, sexual orientation, veteran’s status or any other basis protected by applicable federal, state or local law, you can file a grievance with:

Compliance Officer, One Wikersham Drive, Pauls Valley, OK 73554

Telephone: (580)782-3353, Fax (580)782-5944


You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the CO is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

ATENCIÓN:  si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.  Llame al 1-(580)782-3353.

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 1-435-637-4800

CHÚ Ý:  Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ tr ngôn ng miễn phí dành cho bạn.  Gọi số 1-435-637-4800.

주의한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 있습니다.  1-435-637-4800 번으로 전화해 주십시오.

Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’aánída’áwo’dę́ę́’, t’áá jiik’eh, éí ná hólǫ́, kojį’ hódíílnih 1-(580)782-3353.

ध्यान दिनुहोस्: तपार्इंले नेपाली बोल्नुहुन्छ भने तपार्इंको निम्ति भाषा सहायता सेवाहरू निःशुल्क रूपमा उपलब्ध फोन गर्नुहोस् 1-(580)782-3353

FAKATOKANGA’I: Kapau ‘oku ke Lea-Fakatonga, ko e kau tokoni fakatonu lea ‘oku nau fai atu ha tokoni ta’etotongi, pea teke lava ‘o ma’u ia. Telefoni mai 1-(580)782-3353.

OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-(580)782-3353.

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-(580)782-3353.

ACHTUNG:  Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.  Rufnummer: 1-(580)782-3353.

ВНИМАНИЕЕсли вы говорите на русском языке, то вам доступны бесплатные услуги переводаЗвоните 1-(580)782-3353.

ប្រយ័ត្ន៖  បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, សេវាជំនួយផ្នែកភាសា ដោយមិនគិតឈ្នួល គឺអាចមានសំរាប់បំរើអ្នក។  ចូរ ទូរស័ព្ទ 1-(580)782-3353

ATTENTION :  Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement.  Appelez le 1-(580)782-3353.



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Pauls Valley Regional Medical Center provides these links to other websites solely as a convenient service for users of thePauls Valley Regional Medical Center web site.Pauls Valley Regional Medical Center does not exercise control over the content of these sites or any succeeding links, other than those established and maintained on behalf ofPauls Valley Regional Medical Center. The listing of these sites reflects neither an endorsement nor recommendation byPauls Valley Regional Medical Centerof any information or opinions that may be found within them.Pauls Valley Regional Medical Center urges users to exercise diligence before following any guidance or recommendations obtained online.