Under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 patients have been given more rights to their medical information.
Ownership of these records is still the property of the hospital but as a patient you have more rights to obtain your records, restrict their use in some cases, and to get a listing of to whom the hospital has released them. For a complete listing of your rights under HIPAA, please see Notice of Privacy Practices.
In general the hospital will release your records as it relates to your treatment, payment and general operations.
Please call 701-845-6545 or 701-845-6542 with questions about release of medical records or to check on the status of a request.
Please complete all highlighted fields on the attached Authorization for Release of Information form (Click here to open). If all highlighted areas are not completed, your request will be returned to you unprocessed.
If you are requesting medical records be emailed to you, you MUST complete, sign, and return the attached Electronic Record Delivery Request form with your completed Authorization for Release of Information form.
Once you have completed and signed the form(s), utilize one of these options:
- Fax it to 701-845-6539
- Mail it to:
CHI Mercy Health
570 Chautauqua BLVD
Valley City, ND 58072
- Return it to the facility’s Registration Desk
- Your request for medical records will be processed in the order it was received.
CHI Mercy Health HIM Department
Our goal as a healing ministry is to make your stay as pleasant and as comfortable as possible.
If you have questions or concerns about your hospital care, we will do our best to address them. Please talk with any staff member or request a visit with the manager of the department that provided your care. For a complete listing of your rights, please see Patient Rights & Responsibilities located on the third tab at the top of this page.
If you feel any of your rights have been violated, you may also call the Assistant Administrator of Clinical Services 701-845-6487 or submit a grievance in writing to CHI Mercy Health, 570 Chautauqua Blvd, Valley City, ND 58072. Upon receipt of any grievance, an investigation is initiated by the CHI Mercy Health Grievance Committee, who will in turn provide a response to you with the results of the process.
You also have the right to file a complaint with the Department of Health concerning patient abuse, neglect, misappropriation of patient property or complaints concerning advance directives process. That address is ND Department of Health, Division of Health Facilities, State Capital – Judicial Wing- 2nd Floor, 600 E Boulevard Ave, Bismarck, ND, 58505-0200. The Department of Health can be reached by phone at 701-328-2352.
Patient Rights & Responsibilities
Your rights as a hospital patient
At CHI Mercy Health, we consider you a partner in your hospital care. When you are well informed, participate in treatment decisions, and communicate openly with your doctor and other health professionals, you help make your care as effective as possible. CHI Mercy Health encourages respect for the personal preferences and values of each individual.
While you are a patient in CHI Mercy Health, your rights include the following:
- You have the right to participate in the development and implementation of your plan of care.
- You or your representative have the right to make informed decisions regarding your care, including being informed of your health status, involved in care planning and treatment and being able to request or refuse treatment. This right must not be construed as a mechanism to demand the provision of treatment or services deemed medically unnecessary or inappropriate.
- You have the right to effective pain management.
- You have the right to be informed of the patients rights in advance of furnishing or discontinuing patient care whenever possible.
- You have the right to formulate advance directives and to have hospital staff and practitioners who provide care in the hospital comply with these directives.
- You have the right to have a family member or representative of your choice and your physician notified promptly of your admission to the hospital.
- You have the right to personal privacy.
- You have the right to receive care in a safe setting.
- You have the right to be free from all forms of abuse or harassment.
- You have the right to be free from restraints and seclusion of any form that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation by staff.
- You have the right to the confidentiality of your clinical records.
- You have the right to access information contained in your clinical records within a reasonable time.
- You have a right to file a grievance and to be informed of the process to review and resolve the grievance.
- You have the right to choose who may visit you during your hospital stay except when clinically restricted or limited.
Your responsibilities as a hospital patient
While you are patient in CHI Mercy Health, your responsibilities include the following:
- You have the responsibility to tell your caregiver everything you know about your current health problems, past illnesses, hospital stays, drugs you are taking or used to take, and any other matters related to your health.
- You have the responsibility to report to your caregiver any concerns about the appropriateness of your care, perceived risks in your care, and any unexpected changes in your condition.
- You have the responsibility to follow the treatment instructions recommended by your doctor and other practitioners.
- You have the responsibility to inform your caregivers when you believe you cannot follow the prescribed treatment.
- You have the responsibility to accept the consequences of your actions if you refuse treatment or do not follow a practitioner’s instructions.
- You have the responsibility for asking questions if you are unsure or do not understand something.
- You have the responsibility to tell your caregiver or your doctor if you are having any pain or discomfort.
- You have the responsibility to provide a copy of your written advance directive so your wishes can be carried out. If you do not have an advance directive and would like to have one
- written, ask your nurse for information.
- You have the responsibility for following rules and to be considerate of the rights of other patients and hospital personnel. You are responsible for being respectful of the property of other persons and the hospital.
- You have the responsibility of being discreet when discussing any aspect of your health care with anyone other than your caregivers.
- You have the responsibility for meeting any financial obligation by providing accurate information for insurance claims and for working with the hospital to arrange payment when necessary. Please be prepared to pay your deductible or co-pay at the time of service.
- You have the responsibility for making any grievances known as soon as possible to the proper personnel so that action can be taken to correct any problem concerning personnel, policy or procedure.
- You have the responsibility to be aware that your long-term health depends on the decisions you make in your daily life, not just on your hospital care. You are responsible for recognizing the effect of lifestyle on your personal health.
- You or your support person has the responsibility to inform us of decisions regarding patient visitors.
Birth Certificates/Death Certificates
We often get requests for “certified” birth certificates. Even though you were born at this hospital, our copy of your birth certificate is not considered a certified copy. Once the birth certificate is registered in Bismarck, their copy is considered a certified copy. To obtain a birth certificate from the state, go online at www.ndhealth.gov/vital; or fax a request to the Division of Vital Records at 701-328-1850, or call 701-328-2360. There is a minimal fee for this service.
We do not complete death certificates. These are filled out by the funeral home and the physician involved. The hospital normally does not get a copy of the death certificate. If you need a copy of a death certificate, you must contact the Division of Vital Records as you would for a birth certificate.
Another question that is often asked is, ‘What is my blood type?’ Blood typing is not routinely done on newborn babies. Blood typing is typically not done with most blood drawing unless the physician feels there is going to be a possible need for a transfusion or has another need to know your blood type.
Under HIPAA requirements confidentiality of our patient’s health records is of the utmost importance to us. We strive for a balance of making your medical information available to your physician and/or healthcare professionals while protecting your right to privacy.