Patient Portal
What to bring with you
Whether you have an appointment at Morton Rural Health Clinic or coming to the emergency room, having the proper information and documents is important in helping us help you.
- Valid form of identification
- Driver's License
- State Identification Card
- Passport
- Up-to-Date list of Medications or all of your current medications
- Current Insurance Card
Morton Rural Health Clinic Forms & Resources
Be better prepared for your next visit!
You can print and complete the forms below and bring them with you to your next appointment.
Notice of Privacy Practices
Patient Rights
Notice of Patient Rights
At Cochran Memorial Hospital, we believe that the protection and support of the basic human rights of freedom of expression, decision and action are important to the healing and well-being of our patients. Therefore, we strive to treat patients with respect and with full recognition of human dignity. Decisions regarding health care treatment will not be based on race, creed, sex, national origin, age, disability, or sources of payment. As a patient of Cochran Memorial Hospital:
1. You have the right to a reasonable response to your request and need for treatment or service, within Cochran Memorial Hospital’s capacity, its stated mission, and applicable laws and regulations.
2. You have the right to be informed about which providers, nurses and other health care professionals are responsible for your care.
3. You have the right to the information necessary for you to make informed decisions, in consultation with your provider, about your medical care including information about your diagnosis, the proposed care and your prognosis in terms and a manner that you can understand before the start of your care. You also have the right to take part in developing and carrying out your plan of care.
4. You have the right to consent to or refuse medical care, to the extent permitted by law, and to be told of the risks of not having the treatment and other treatments which may be available.
5. You have the right to reasonable access to care. Although Cochran Memorial Hospital respects your right to refuse treatments offered to you, Cochran Memorial Hospital does not recognize an unlimited right to receive treatments that are medically ineffective or non-beneficial.
6. You have the right to care that is considerate and respectful of your personal values and beliefs. Cochran Memorial Hospital strives to be considerate of the ethnic, cultural, psychosocial, and spiritual needs of each patient and family. Cochran Memorial Hospital acknowledges that care of the dying patient includes care with dignity and respect, management of pain and consideration for the patient's and family's expression of grief.
7. You have the right to have a family member or representative of your choice and your own provider notified promptly of your admission to Cochran Memorial Hospital. You have the right to have your family take part in your care decisions with your permission.
8. You have the right, to the extent permitted by law, to have your legal guardian, next of kin, or a surrogate decision maker appointed to make medical decisions on your behalf in the event you become unable to understand a proposed treatment or procedure, are unable to express your wishes regarding your care, or you are a minor. The person appointed has the right, to the extent permitted by law, to exercise your rights as a patient on your behalf.
9. You and your appointed representative have the right to take part in ethical questions that arise during your care.
10. You have the right to communicate with family, friends and others while you are a patient in Cochran Memorial Hospital unless restrictions are needed for therapeutic effectiveness. You also have the right to receive visitors of your choosing including a spouse, a domestic partner (including a same-sex domestic partner), family members, and friends. This right is subject to any clinically necessary or reasonable restrictions imposed by Cochran Memorial Hospital or your provider. You also have the right at any time to refuse to have visitors.
11. You and your legal representative have the right to access the information contained in your medical record in a timely manner subject to state and federal law.
12. You may request an explanation of your hospital bill, even if you will not be paying for your care.
13. You have the right to issue advance directives and to have providers at Cochran Memorial Hospital and facility staff follow your directives in accordance with state and federal law.
14. You have the right to personal privacy and for your medical information to be kept confidential within the limits of the law.
15. You have the right to receive care in a safe setting.
16. You have the right to be free from abuse or harassment.
17. You have the right to be free from restraints that are not medically necessary; restraints include physical restraints and medicines.
18. You have the right to be free from seclusion and restraints for behavior management except in emergencies as needed for your safety when less restrictive means may have been ineffective.
19. You have the right to consent or refuse to take part in any human research or other educational project affecting your care. You also have the right to be given information about the expected benefits and risks of any research you choose to take part in and any alternative treatment that might benefit you. Refusing to take part in the research or project will in no way affect your care.
20. You have the right to have your pain assessed and managed properly and to receive information about pain and pain relief measures.
21. You have the right to obtain information concerning the relationship of Cochran Memorial Hospital to other health care Facilities as they relate to your care.
22. You have the right to submit a complaint to Cochran Memorial Hospital regarding your care or regarding any belief you have that you are being discharged too soon. Your care will not be affected by submitting a complaint. The steps for doing so are at the end of this statement.
23. You have a right to request and/or be provided language assistance i.e., interpreter services, if you have a language barrier or hearing impairment. This will be provided at no cost to you to help you actively participate in your care.
Patient Responsibilities
As a patient, you have specific responsibilities, and we want you to understand your responsibilities.
1. Keep Us Accurately Informed.
You have the responsibility to provide, to the best of your knowledge, accurate and complete information to your healthcare providers about your present complaints, past illnesses, hospitalizations, medications, and all other matters pertaining to your health, including reporting unexpected changes in your condition to your provider.
2. Follow Your Treatment Plan.
You are responsible for following the plan of care recommended by your provider. This may include following the instructions of health care personnel as they carry out the coordinated plan of care, implement the provider’s orders, and enforce the applicable practice rules and regulations. It is important you communicate to your healthcare providers whether or not you understand your plan of care and what is expected of you.
3. Keep Your Appointments.
You are responsible for keeping your appointments and, when unable to do so for any reason, for notifying appropriate person at the facility.
4. Take Responsibility For Non-compliance.
Know the consequences of your own actions if you refuse treatment or do not follow your provider's instructions. If you cannot follow through with the prescribed plan of care, you are responsible for informing the provider.
5. Be Responsible For Your Financial Obligations.
You are responsible for ensuring that the financial obligations of health care services are fulfilled as promptly as possible and for providing up-to-date insurance information.
6. Be Considerate Of Others.
You are responsible for being considerate of the rights of other patients and facility personnel and for following facility policies and regulations regarding care and conduct.
7. Be Responsible for Lifestyle Choices.
Your health depends not just on the care provided at this facility but on the long-term decisions you make in daily life. You are responsible for recognizing the effects of these decisions on your health.
Take Charge of Your Healthcare
You are the most important member of your healthcare team!
If you have concerns, questions, or don't understand something, speak up!
You have the right to ask and get an answer from your provider or nurse that makes sense to you.
You have the responsibility to share with hospital staff:
What language you prefer to speak.
If you wear glasses and/or contact lenses.
If you need hearing aids or other devices.
Any cultural, ethnic, or religious-based needs.
Who, if anyone, will be your support person to talk with hospital staff about your healthcare.
Ways to take Charge of Your Healthcare
Speak Up!
Ask questions and voice concerns. You have the right to know!
Pay Attention
Double check you are getting the right treatments and medications from the right hospital staff.
Educate Yourself
Learn about your medical conditions, tests, and treatment options.
Find a Support Person
A trusted friend or family member is a huge help. Find one key person to be your healthcare advocate. If your ability to communicate changes, this person can stand in and up for you and your care. Support persons ask questions, double-check your medications and treatments, and watch for signs your condition is getting worse and ask for help.
Know Your Medicines
Understand what your medications are and what they treat, why you need them and how to take them for the best results.
Participate in Your Care
You are the most important member of your healthcare team. Make sure you understand and know what's happening every step of the way.