 Patient Information
Notice of Privacy Practices
Notice of Privacy Practices - Espanol
Privacy Practices Acknowledgement
Privacy Practices Acknowledgement - Espanol
Patient Rights and Responsibilities
Patient Rights and Responsibilities - Espanol
State Required Ethnicity and Race Questions
State Required Ethnicity and Race Questions - Espanol
Medicare Patient Questionaire Form
Registration Form
Medication List
Advanced Directives
Healthcare Facility Concerns or Complaints:
If you have comments, questions, or concerns during your stay, you may contact the Administrator at
936-760-3443. If you prefer not to call Administration or if your concerns are not resolved at this level,
you may call:
Department of State Health Services
Manager, Health Facility Compliance Group
1-888-973-0022
PO Box 149347
Austin, TX 78714-9347
Medicare Ombudsman
1-800-MEDICARE (1-800-633-4227)
www.medicare.gov/Ombudsman/activities.asp
You may also contact:
The Joint Commission
1-800-994-6610
complaint@jcaho.org
Joint Commission is an independent, not-for-profit, national body that oversees the safety and quality of health care organizations. Consumers may share concerns about accredited healthcare facilities by calling the number above or emailing to address above.
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