Thank you for your interest in Siouxland Community Health Center. We are proud to serve as your medical home and commit to a quality experience for your health care needs.
After Hours Help (All Locations)
In case of an emergency, please call 911. For non-emergencies, call 712-252-2477. You will be prompted to contact our on-call provider where an operator will assist you. If your illness or injury requires urgent medical attention, you will be directed to an emergency room.
Después de horas (Todo los Lugares)
En caso de emergencia, por favor llame al 911. Para casos que no sean emergencia, llame al 712-252-2477. Se le solicitará que se ponga en contacto con nuestro proveedor , donde una operadora lo ayudará. Si su enfermedad o lesión requiere atención médica urgente, lo enviarán a una sala de emergencias.
Sau giờ mở cửa (tất cả các địa điểm)
Trong tru?ng h?p kh?n c?p, vui lòng g?i 911. Đối với những trường hợp không khẩn cấp, gọi 712-252-2477. Quý vị sẽ được kết nối với bác sĩ trực nơi mà có một nhân viên tổng đài sẽ hỗ trợ quý vị. Nếu bệnh hoặc chấn thương của quý vị cần hỗ trợ y tế khẩn cấp, cuộc gọi của quý vị sẽ được chuyển đến phòng cấp cứu.
What to Bring On Your First Visit
For your first visit at Siouxland Community Health Center, you will be asked to complete new patient forms. These forms become part of your medical chart and include demographic information such as your address, phone number, employment and insurance carriers. Other new patient forms will include a basic questionnaire of your personal and family health history. To qualify for our sliding fee programs, uninsured or privately insured patients are also asked to bring two forms of proof of their household income. A financial counselor will assist with this process.
To request medical records: Fax 712-252-5920
Please click HERE to view the document as a PDF.
NOTICE OF PRIVACY PRACTICES
Siouxland Community Health Center
1021 Nebraska Street
Sioux City, IA 51105
Compliance Officer Phone: (712) 226-8983 Email Address: email@example.com
Siouxland Community Health of Nebraska
3410 Futures Drive
South Sioux City, NE 68776
Compliance Officer Phone: (712) 226-8983 Email Address: firstname.lastname@example.org
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential information
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide disaster relief
• Provide mental health care
• Market our services and sell your information
• Raise funds
OUR USES AND DISCLOSURES
We may use and share your information as we:
• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
• Perform quality assessment and improvement activities, including patient satisfaction surveys
YOUR RIGHTS: When it comes to your health information, you have certain rights.
This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
You can ask us to contact you in a specific way (for example, home or office phone) or to send email to a different address.
We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain information for treatment, payment or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all of the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you
before we take any action.
File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting us using the information on the top of this section.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.
YOUR CHOICES: For certain health information, you can tell us your
choices about what we share.
If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
Share information with your family, close friends, or others involved in your care
Share information in a disaster relief situation.
If you are not able to tell us your preference, we may go ahead and 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.
In these cases we never share your information unless you give us written permission:
Sale of your information
Most sharing of psychotherapy notes
In the case of fundraising:
We may contact you for fundraising efforts, but you can tell us not to contact you again.
OUR USES AND DISCLOSURES: How do we typically use or share your
We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our Organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your Services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:
Help with public health and safety issues
We can share health information about you for certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
We can share information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you for workers’ compensation claims, law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protection services.
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena when the necessary jurisdictional and statutory requirements have been met.
Information with additional protections
Certain types of protected health information are afforded additional protection under federal or state law. The State of Iowa provides greater protection for health information about mental health and HIV/AIDS, and both Iowa and federal law provide greater protection for alcohol and substance abuse. We will follow all applicable state and federal laws that require greater limits on disclosures and we will not share these records without your written permission.
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
NOTICE OF PRIVACY PRACTICES FOR SUBSTANCE USE DISORDER TREATMENT:
The following federal statute and regulations, 42 U.S.C. § 290dd-2 and 42 C.F.R. Part 2 (collectively “Part 2”), protect the confidentiality of patient records about patients receiving diagnosis, treatment, or referral for treatment for a substance use disorder from a Part 2 program. If you are receiving treatment for drug or alcohol abuse, we may not acknowledge that you are receiving treatment or disclose outside of our organization that you have or had a substance use disorder except under limited circumstances. We may disclose your patient records about substance use disorder treatment upon receipt of a valid written authorization or consent. We may disclose your patient records about substance use disorder treatment without your consent for the following reasons:
• The disclosure is allowed by a court order;
• The disclosure is made to medical personnel to the extent necessary for a medical emergency;
• The disclosure is made for scientific research, audit, or evaluation as allowed by Part 2;
• The disclosure is made in connection with the suspected commission of a crime on our premises or against our personnel;
• The disclosure is made in connection with reporting suspected child abuse or neglect; and
• The disclosure is made to an individual or entity which has entered into a qualified service organization or business associate agreement with us.
If you have consented to disclosure of your patient records about substance use disorder treatment to your “treating providers” or other general designation, you may request a list of entities to which your information has been disclosed. Your request must be in writing and be limited to disclosures made within the past two years. Please contact the Medical Records Department at 712-202-1057 if you wish to make this request.
Violation of the federal law and regulations by a Part 2 program is a crime. Suspected violations may be reported to the United States Attorney in the judicial district where the violation occurs.
Northern District of Iowa
U.S. Attorney’s Office
Ho-Chunk Building, Suite 670 600 4th Street
Sioux City, IA 51101
Suspected violations related to opioid treatment programs may be made to:
SAMHSA Center for Substance Abuse Treatment
5600 Fishers Lane
Rockville, MD 20857
For more information, see:
Changes to the terms of this Notice:
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
Effective Date: January 1, 2013
Updated: June 6, 2016; July 19, 2018; November 20, 2020
If you have any questions about this Notice, please contact the Compliance Officer at (712) 226-8983 or email@example.com.
Patient Bill of Rights and Responsibilities
Siouxland Community Health Center (SCHC) respects each patient and is dedicated to giving the best care possible. Patient Rights and Responsibilities explain what you can expect from us and, in turn, what we expect of you.
You have the right to:
- Private and confidential care
- Receive care despite sex, age, marital status, national origin, religion, creed, disability, or
- To be treated with respect, courtesy, and dignity.
- Ask questions about your healthcare and receive answers
- Obtain the information/education you need to make decisions about your healthcare.
- Change providers
- To receive information about advance directives
- Reasonable access to care
- Say no to treatment
- Be assessed for pain
- Get advice/instructions for emergent healthcare needs after the clinic is closed
- Know the names and qualifications of SCHC staff
- Apply for financial assistance (sliding fee scale)
- Interpreter services
- Correct inaccurate information
- Not participate in research projects
- Provide feedback or file a complaint about your treatment or care. Request to speak with a
manager regarding your feedback or complaint.
You are Responsible for:
- Your health.
- Following instructions given by your healthcare provider.
- Providing accurate information about medications you are taking, your health issues, problems,
- Letting staff know if you do not understand information given to you
- Behaving with respect and courtesy towards other patients and the SCHC staff
- Telling your provider about your pain
- Calling about non-emergent health problems during office hours
- Getting your medication before running out
- Calling 24 hours in advance if unable to keep an appointment
- Getting annual check-ups
- Inform SCHC if you plan to move your health or dental care to a different clinic
- Informing SCHC of your current insurance plan
- Paying your co-pay at each visit and trying to pay your bills on time.
Siouxland Community Health Center (SCHC) strives to provide the highest quality of care to our patients and families, while conducting our healthcare and business practices in a legal, ethical and professional manner.
SCHC has established a Compliance Hotline to assist patients, families, employees, and business associates with reporting known or suspected instances of fraud, waste, neglect, and abuse. If you are concerned that a decision or action may violate the law or organizational policy, please call the COMPLIANCE HOTLINE at 712-226-8992.
Contact Us and Feedback
We welcome all feedback regarding our services and programs. It allows us to continually improve our organization. Please contact us at (712) 202-1001 to provide your comments.
If you are inquiring about a health-related problem, please contact us at (712) 252-2477 to consult with a provider. If it is a life-threatening situation, please go to your nearest emergency department or call 911.
Please click HERE to Contact Us.