Important Patient Information

Important Contact Information

It is your right as a patient in this facility to be allowed access to protective services. These services include advocacy services, certification and licensure agencies, Medicare/Medicaid fraud, abuse reporting agencies, etc. A list of agencies with telephone numbers and addresses is provided. If you have questions regarding the need to access these services, please contact Matagorda Regional Medical Center Administration or the Administrator-on-Call who will assist you during the weekends and evenings.

Reporting Suspected Abuse/Neglect

Texas Department of Aging and Disability Services, Consumer Rights and Services Hotline 1-800-458-9858

Advocacy Incorporated 1-800-252-9108
7800 Schoal Creek Blvd, Ste. 171E
Austin, TX 78757

Grievances/Complaints

Matagorda Regional Medical Center is committed to providing high quality patient care, which addresses the physical, emotional, and psychological needs of the patient. Whenever a patient or member of the patient’s family feels that those needs are not being met, he/she is encouraged to notify a member of the hospital staff so that appropriate action can be taken. To file a complaint, you may contact our Patient Advocate at 979-241-5536.

Advocacy Incorporated 1-800-252-9108
7800 Schoal Creek Blvd, Ste. 171E
Austin, TX 78757

Health Facility Licensure & Certification Division 1-888-973-0022

Texas Department of State Health Services, Patient Quality Care Unit
1100 W. 49th St., Austin, TX  78711-2668

Patient Care or Safety concerns that have not been addressed by the hospital may be reported to The Joint Commission by one of the following methods:
Phone:  1-800-994-6610 or electronically by visiting www.jointcommission.org and using the “Report a Patient Safety Event” link in the “Action Center” on the home page of the website. Fax to  630-792-5636. Mail: The Office of Quality and Patient Safety (OQPS), The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, Illinois  60181. See The Joint Commission Public Notice (the first drop-down tab below) for additional information.

Medicare/Medicaid Fraud

Medicare Fraud (ask to speak to a Medicare Representative) 1-800-633-4227
Medicaid Fraud (ask to speak to a Medicaid Specialist) 1-800-436-6184

Reporting of Concerns Related to Patient Care, Discharge, or Coverage       

KePRO 1-844-430-9504
Rock Run Center
5700 Lombardo Center, Suite 100
Seven Hills, Ohio  44131

Anti-Discrimination

Matagorda County Hospital District (MCHD) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. MCHD does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. You can access our full Anti-Discrimination Notice here.

For more information with additional assistance in English, አማርኛ, العربية, বাংলা, tsalagi gawonihisdi, 繁體中文, Chahta, Oroomiffa, Nederlands, Français, Kreyòl Ayisyen, Deutsch, ગુજરાતી, हिंदी, Hmoob, Igbo asusu, Ilokano, Italiano, 日本語, 한국어, Ɓàsɔ́ɔ̀‑wùɖù‑po‑nyɔ̀, ພາສາລາວ, Kajin Ṃajōḷ, ខ្មែរ, Diné Bizaad, नेपाली, Deitsch, فارسی, Polski, Português, ਪੰਜਾਬੀ, Română, Русский, Gagana fa’a Sāmoa, Srpsko‑hrvatski, Español, ܣܘܼܪܸܬ݂, Tagalog, ภาษาไทย, Türkçe, Українська, اُردُو, Tiếng Việt, and èdè Yorùbá, click here. 

NOTE: A Spanish version of Patient Rights and Responsibilities is available upon request.

The Joint Commission conducts periodic accreditation surveys at Matagorda County Hospital District (Matagorda Regional Medical Center).

The purpose of the survey is to evaluate the organization’s compliance with nationally established Joint Commission Standards. The survey results are used to determine whether, and the conditions under which, accreditation should be awarded to the organization.

Joint Commission standards deal with organizational quality of care issues and patient safety and the safety of the environment in which care is provided. Any individual believing that he or she has concerns regarding patient safety or quality of care concerns at Matagorda Regional Medical Center that the hospital has not addressed appropriately may contact:

The Joint Commission by one of the following methods:

Phone:  1-800-994-6610

Electronically at www.jointcommission.org using the “Report a Patient Safety Event” link in the “Action Center” on the home page of the website.

Fax:  630-792-5636

Mail:  The Office of Quality and Patient Safety (OQPS)
The Joint Commission
One Renaissance Boulevard
Oakbrook Terrace, Illinois  60181

We request that you contact MRMC administration first regarding any concerns that you have and allow MRMC to assist in resolution of the matter before you contact The Joint Commission.

When submitting a complaint to the Joint Commission about an accredited organization, you may either provide your name and contact information or submit your complaint anonymously. Providing your name and contact information enables the Joint Commission to inform you about the actions taken in response to your complaint, and also to contact you should additional information be needed. It is the Joint Commission’s policy to treat your name as confidential information and not to disclose it to any other party. However, it may be necessary to share the complaint with Matagorda Regional Medical Center in the course of a complaint investigation.

Joint Commission policy forbids an accredited organization from taking retaliatory actions against employees for having reported a patient safety or quality of care concern to the Joint Commission.

NOTE: The Joint Commission does not address individual billing issues and payment disputes. They also do not have jurisdiction in labor relations issues or the individual clinical management of a patient.

Matagorda Regional Medical Center is committed to providing high quality patient care, which addresses the physical, emotional, and psychological needs of the patient. Whenever a patient or member of the patient’s family feels that those needs are not being met, he/she is encouraged to notify a member of the hospital staff so that appropriate action can be taken. To file a complaint, you may contact our Patient Advocate at 979-241-5536.

As a patient you have certain rights and responsibilities. We feel that if you understand them, you can contribute to the effectiveness of your treatment and to the quality of patient care. The following is a list of Patient Rights which reflect our concern and commitment to you as a patient.

As a patient of our hospital and associated clinics you have the right to:

  • Reasonable access to care, treatment, and services
  • A reasonable response to your request and need for treatment or service
  • Considerate and respectful care given by competent personnel
  • Know what hospital rules and regulations apply to your conduct
  • Be informed about which physicians, nurses, and other health care professionals are responsible for your care
  • Refuse students to provide care
  • Care without discrimination based upon age, race, color, creed, religion, ethnicity, national origin, culture, language, physical or mental disability, socioeconomic status, sex, sexual preference, gender identity, expression, disability, diagnosis, or source of payment
  • Designate a surrogate decision maker to make medical decisions on your behalf and make informed decisions regarding your plan of care
  • Consent to or refuse medical care to the extent permitted by law, and to be told of the risks
  • Have your pain assessed and managed properly and to receive information about pain and pain relief measures
  • Formulate and receive information regarding Advance Directives and have physicians and hospital staff follow your directives
  • Take part in ethical questions that arise during your care (this includes your appointed representative)
  • Have your spiritual and personal values, beliefs, and preferences respected
  • Personal privacy and for your medical information to be kept confidential within the limits of the law
  • Access, request amendment to, and receive an accounting of disclosures regarding your own health information
  • Designate visitors who shall receive the same visitation privileges as your immediate family members, regardless of whether the visitors are legally related to you
  • The information necessary for you to make informed decisions, in consultation with your physician, 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 care.
  • Have a family member or representative of your choice and your own physician notified promptly of your admission to the Hospital
  • Have your family take part in your care decisions with your permission
  • Consent or refuse to take part in any human research or other educational project affecting your care, including the expected benefits, risks and any alternative treatment that might benefit you. Refusing to take part in the research or project will in no way affect your care
  • Refuse recording or filming of care and the right to request that the recording stop any time during filming or recording
  • Be free from abuse and harassment
  • Receive care in a safe setting
  • Be free from restraints that are not medically necessary
  • Be free from seclusion and restraints for behavior management except for emergencies as needed for your safety when less restrictive means may have been ineffective.
  • Request and be provided language assistance if you have a language barrier or hearing impairment at no cost to you
  • Examine and receive a detailed explanation of hospital bills
  • Information about your outcomes of care and treatment, including unanticipated outcomes of care and treatment
  • Ask for consultation or second opinion with a physician other than the attending physician
  • File a grievance

As a patient you have certain rights and responsibilities. We feel that if you understand them, you can contribute to the effectiveness of your treatment and to the quality of patient care. The following is a list of Patient Responsibilities that reflect our concern and commitment to you as a patient.

As a patient of our hospital or clinics you are responsible for: 

  • Providing accurate and complete information about present health concerns and past health history
  • Following hospital rules and regulations
  • Following and understanding your plan of treatment
  • Asking questions and expressing concerns when you don’t understand a plan of treatment and what is expected of you
  • The outcome when you refuse treatment or do not follow your plan of treatment
  • Being considerate of the rights and property of those around you
  • Providing accurate financial information and fulfilling your financial obligation
  • Reporting any allegations of abuse, neglect, harassment or exploitation

When you apply for or receive mental health services in the State of Texas, you have many rights. Your most important rights are listed in the following sections of this posting. These rights apply to all persons unless otherwise restricted by law or court order. A judge or lawyer will refer to the actual laws. If you want a copy of the laws these rights come from, you can call the Health Facility Licensure and Certification Division of the Texas Department of State Health Services at 1-888-973-0022.

It is the responsibility of this hospital under law to make sure you have been informed of your rights. But just giving you this information does not mean your rights have been protected. This hospital is required to respect and provide for your rights in order to maintain licensure and do business in this state.


Your Right to Know Your Rights

You have the right, under the rules by which this hospital is licensed, to be given a copy of these rights before you are admitted to the hospital as a patient. If you so desire, a copy should also be given to the person of your choice. If a guardian has been appointed for you or you are under 18 years of age, a copy will also be given to your guardian, parent, or conservator.

You also have the right to have these rights explained to you aloud in simple terms in a way you can understand within 24 hours of being admitted to the hospital to receive services (e.g., in your language if you are not English-speaking, in sign language if you are hearing impaired, in Braille if you are visually impaired, or other appropriate methods).


Your Right To Make a Complaint

You have the right to make a complaint and to be told how to contact people who can help you. These people and their addresses and phone numbers are listed below.

You have the right to be told about Advocacy, Inc., when you first enter the hospital and when you leave. Information about how to contact Advocacy, Inc. is also listed below.

If you believe any of your rights have been violated or you have other concerns about your care in this hospital, you may contact one or more of the following:

Health Facility Licensing and Compliance Division
1-888-973-0022
Texas Department of Health
1100 W. 49th St., Austin, TX 78756

Advocacy, Incorporated
1-800-315-3876
7800 Shoal Creek Boulevard, Suite 171 E
Austin, TX 78757

If you have been involuntarily committed and you believe that your attorney did not prepare your case properly or that your attorney failed to represent your point of view to the judge, you may wish to report the attorney’s behavior to the Ethics Committee of the State Bar of Texas by writing:

Disciplinary Council
State Bar of Texas
1414 Colorado
P.O Box 12487
Austin, TX 78711-2487

If you are a voluntary patient OR if you have been taken to the hospital against your will, refer to the section in this posting titled Voluntary Patients-Special Rights for a listing of your special rights under law in Texas. All patients should read the section in this posting titled Basic Rights for All Patients which explain the rights that apply to everyone receiving services at this hospital.


Basic Rights for All Patients

1. You have all the rights of a citizen of the State of Texas and the United States of America, including the right of habeas corpus (to ask a judge if it is legal for you to be kept in the hospital), property rights, guardianship rights, family rights, religious freedom, the right to register to vote, the right to sue and be sued, the right to sign contracts, and all the rights relating to licenses, permits, privileges, and benefits under the law.

2. You have the right to be presumed mentally competent unless a court has ruled otherwise.

3. You have the right to a clean and humane environment in which you are protected from harm, have privacy with regard to personal needs, and are treated with respect and dignity.

4. You have the right to appropriate treatment in the least restrictive appropriate setting available. This is a setting that provides you with the highest likelihood for improvement and that is not more restrictive of your physical or social liberties than is necessary for the most effective treatment and for protections against any dangers which you might pose to yourself or others.

5. You have the right to be free from mistreatment, abuse, neglect, and exploitation.

6. You have the right to be told in advance of all estimated charges being made, the cost of services provided by the hospital, sources of the program’s reimbursement, and any limitations on length of services known to the hospital. As part of this right, you should have access to a detailed bill of services, the name of an individual at the facility to contact for any billing questions, and information about billing arrangements and available options if insurance benefits are exhausted or denied.

7. You have the right to fair compensation for labor preformed for the hospital in accordance with the Fair Labor Standards Act.

8. You have the right to be informed of those hospital rules and regulations concerning your conduct and course of treatment.


Personal Rights

Unless otherwise specified, these personal rights can only be limited by your doctor on an individual basis to the extent that the limitation is necessary to your welfare or to protect another person. The reasons for and duration of the limitation must be written in your medical record, signed, and dated by your doctor, and fully explained to you. The limit on your rights must be reviewed at least every seven days and if renewed, renewed in writing.

1. You have the right to talk and write to people outside the hospital. You have the right to have visitors in private, make private phone calls, and send and receive sealed and uncensored mail. In no case may your right to contact or be contacted by an attorney, the department, the courts, or the state attorney general be limited.This right includes a prohibition on barriers to communication imposed by a hospital, such as:

  • rigid and restrictive visiting hours;
  • policies that restrict hospitalized mothers and fathers from visiting with their minor children;
  • policies that restrict parents from visiting their hospitalized children
  • limited access to telephones; and
  • failure to provide assistance to patients who wish to mail a letter.

2. You have the right to keep and use your personal possessions including the right to wear your own clothing and religious or other symbolic items. You have the right to wear suitable clothing which is neat, clean and well-fitting.

3. You have the right to have an opportunity for physical exercise and for going outdoors with or without supervision (as clinically indicated) at least daily. A physician’s order limiting this right must be reviewed and renewed at least every three days. The findings of the review must be written in your medical record.

4. You have the right to have access to appropriate areas of the hospital away from your living unit, with or without supervision (as clinically appropriate), at regular and frequent times.

5. You have the right to religious freedom. However, no one can force you to attend or engage in any religious activity.

6. You have the right to opportunities to socialize with persons of the opposite sex, with or without supervision, as your treatment team considers appropriate for you.

7. You have the right to ask to be moved to another room if another person in your room is disturbing you. The hospital staff must pay attention to your request, and must give you an answer and a reason for the answer as soon as possible.

8. You have the right to receive treatment of any physical problems which affect your treatment. You also have the right to receive treatment of any physical problem that develops while you are in the hospital. If your physician believes treatment of the physical problem is not required for your health, safety, or mental condition, you have the right to seek treatment outside the hospital at your own expense.

9. You have the right not to be unnecessarily searched unless your physician believes there is a potential danger and orders a search. If you are required to remove any item of clothing, a staff member of the same sex must be present and the search must take place in a private place.


Confidentiality

1. You have a right under HIPAA (Health Insurance Portability and Accountability Act) to have your confidentiality rights explained to you at admission. You will be provided a written copy of your confidentiality rights, including how to make a complaint,

2. You have the right to review the information contained in your medical record. If your doctor says you shouldn’t see a part of your record, you have the right to file a complaint with the hospital HIPAA privacy officer. You may also, at your expense, have another doctor of your choice review that decision. The doctor must also reconsider the decision to restrict your right on a regular basis. The right extends to your parent or conservator if you are a minor (unless you have admitted yourself to services) and to your legal guardian if you have been declared by a court to be legally incompetent.

3. You have the right to have your records kept private and to be told about the conditions under which information about you can be disclosed without your permission, as well as how you can prevent any such disclosures.

4. You have the right to be informed of the current and future use of products of special observation and audiovisual techniques, such as one-way vision mirrors, tape recorders, television, movies, or photographs.


Consent

1. You have the right to refuse to take part in research without affecting your regular care. You have the right to refuse any of the following:

  • surgical procedures;
  • electroconvulsive therapy (prohibited for minors under the age of 16); unusual medications;
  • behavior therapy
  • hazardous assessment procedures;
  • audiovisual equipment; and
  • other procedures for which your permission is required by law.

This right extends to your parent or conservator if you are a minor, or your legal guardian when applicable.

2. You have the right to withdraw your permission at any time in matters to which you have previously consented.


Care and Treatment

1. You have the right to be transported to, from, and between private psychiatric hospitals in way that protects your dignity and safety. You have the right not to be transported in a marked police or sheriff’s car or accompanied by a uniformed officer unless other means are not available.

2. You have the right to a treatment plan for your stay in the hospital that is just for you. You have the right to take part in developing that plan, as well as the treatment plan for your care after you leave the hospital. This right extends to your parent or conservator if you are a minor, or your legal guardian when applicable. You have the right to request that your parent/conservator or legal guardian take part in the development of the treatment plan. You have the right to request that any other person of your choosing, e.g., spouse, friend, relative, etc., take part in the development of the treatment plan. You have a right to expect that your request be reasonably considered and that you will be informed of the reasons for any denial of such a request. Staff must document in your medical record that the parent/guardian, conservator, or other person of your choice was contacted to participate.

3. You have the right to be told about the care, procedures, and treatment you will be given; the risks, side effects, and benefits of all medications and treatment you will receive, including those that are unusual or experimental, the other treatments that are available, and what may happen if you refuse the treatment.

4. You have the right to receive information about the major types of prescription medications which your doctor orders for you (effective May 1, 1994).

5. You have the right not to be given medication you don’t need or too much medication, including the right to refuse medication (this right extends to your parent or conservator if you are a minor, or your legal guardian when applicable). However, you may be given appropriate medication without your consent if:

  • your condition or behavior places your or others in immediate danger; or
  • you have been admitted by the court and your doctor determines that medication is required for your treatment and a judicial order authorizing administration of the medication has been obtained.

6. You have the right to receive a list of medications prescribed for you by your physician, including the name, dosage, and administration schedule, within four hours of the facility administrator or designee receiving such a request in writing.

7. You have the right not to be physically restrained (restriction of movement of parts of the body by person or device or placement in a locked room alone) unless your doctor orders it and writes it in your medical record. In an emergency, you may be restrained for up to one hour before the doctor’s order is obtained. If you are restrained, you must be told the reason, how long you will be restrained, and what you have to do to be removed from restraint. The restraint has to be stopped as soon as possible.

8. You have the right to meet with the staff responsible for your care and to be told of their professional discipline, job title, and responsibilities. In addition, you have the right to know about any proposed change in the appointment of professional staff responsible for your care.

9. You have the right to request the opinion of another doctor at your own expense. You have the right to be granted a review of the treatment plan or specific procedure by hospital medical staff. This right extends to your parent of conservator if you are a minor, or your legal guardian, if applicable.

10. You have the right to be told why you are being transferred to any program within or outside the hospital.

11. You have the right to a periodic review to determine the need for continued inpatient treatment.If you have questions concerning these rights or a complaint about your care, call the Health Facility Licensure and Certification Division for the Texas Department of Health at 1-888-973-0022.


Voluntary Patients – Special Rights

1. You have the right to request discharge from the hospital. If you want to leave, you need to say so in writing or tell a staff person. If you tell a staff person you want to leave, the staff person must write it down for you.

2. You have the right to be discharged from the hospital within four hours of requesting discharge. There are only three reasons why you would not be allowed to go:

  • First, if you change your mind and want to stay at the hospital, you can sign a paper that says you do not wish to leave, or you can tell a staff member that you don’t want to leave, and the staff member has to write it down for you.
  • Second, if you are under 16 years old, and the person who admitted you (your parents, guardian, or conservator) doesn’t want you to leave, you may not be able to leave. If you request release, staff must explain to you whether or not you can sign yourself out and why. The hospital must notify the person who does have the authority to sign you out and tell that person that you want to leave. That person must talk to your doctor, and your doctor must document the date, time, and outcome of the conversation in your medical record.
  • Third, you may be detained longer than four hours if your doctor has reason to believe that you might meet the criteria for court-ordered services or emergency detention because: – you are likely to cause serious harm to yourself; – you are likely to cause serious harm to others; or – your condition will continue to deteriorate and you are unable to make an informed decision as to whether or not to stay for treatment.

If your doctor thinks you may meet the criteria for court-ordered services or emergency detention, he or she must examine you in person within 24 hours of your filing the discharge request. You must be allowed to leave the hospital upon completion of the in-person examination unless your doctor confirms that you meet the criteria for court-ordered services and files an application for court-ordered services. The application asks a judge to issue a court order requiring you stay at the facility for services. The order will only be issued if the judge decides that either:

  • you are likely to cause serious harm to yourself;
  • you are likely to cause serious harm to others; or
  • your condition will continue to deteriorate and you are unable to make an informed decision as to whether or not to stay for treatment.

Even if an application for court-ordered services is filed, you can not be detained at the hospital beyond 4:00 p.m. of the first business day following the in-person examination unless the court-order for services is obtained.

3. You have the right not to have an application for court ordered services filed while you are receiving voluntary services at the hospital unless your physician determines that you meet the criteria for court-ordered services as outlined in §573.022 of the Texas Health and Safety Code and:

  • you request discharge (see number 2 above);
  • you are absent without authorization;
  • your doctor believes you are unable to consent to appropriate and necessary treatment; or
  • you refuse to consent to necessary and appropriate treatment recommended by your doctor and your doctor states in the certificate of medical examination that: – there is no reasonable alternative treatment; and – you will not benefit from continued inpatient care without the recommended treatment.

4. Your doctor must note in your medical record and tell you about any plans to file an application for court-ordered treatment or for detaining you for other clinical reasons. If the doctor finds that you are ready to be discharged, you should be discharged without further delay. Note: The law is written to ensure that people who do not need treatment are not committed. The Texas Health and Safety Code says that any person who intentionally causes or helps another person cause the unjust commitment of a person to a mental hospital is guilty of a crime punishable by a fine of up to $5,000 and/or imprisonment in county jail for up to one year.


Emergency Detention – Special Rights for People Brought Against to the Hospital Against Their Will

1. You have the right to be told:

  • where you are;
  • why you are being held; and
  • that you might be held for a longer time if a judge decides that you need treatment.

2. You have the right to call a lawyer. The people talking to you must help you call a lawyer if you ask.

3. You have a right to be seen by a doctor. You will not be allowed to leave if the doctor believes that:

  • you may seriously harm yourself or others;
  • the risk of this happening is likely unless you are restrained; and
  • emergency detention is the least restrictive means of restraint.

If the doctor decides you don’t meet all of these criteria, you must be allowed to leave. A decision concerning whether you must stay must be made within 48 hours, except that on weekends and legal holidays, the decision may be delayed until 4:00 in the afternoon on the first regular workday. The decision may also be delayed in the event of an extreme weather emergency or disaster. If the court is asked to order you to stay longer, you must be told that you have a right to a hearing within 72 hours (excepting weekends, holidays, or extreme weather emergencies or disasters).

4. If the doctor decides that you don’t need to stay here, the hospital will arrange for you to be taken back to where you were picked up if want to return, or to your home in Texas, or to another suitable place within reasonable distance.

5 You have the right to be told that anything you say or do may be used in proceedings for further detention.


Order of Protective Custody – Special Rights

1. You have the right to call a lawyer or to have a lawyer appointed to represent you in a hearing to determine whether you must remain in custody until a hearing on court-ordered mental health services is held.

2. Before a probable cause hearing is held, you have the right to be told in writing:

  • that you have been placed under an order of protective custody;
  • why the order was issued; and
  • the time and place of a hearing to determine whether you must remain in custody until a hearing on court-ordered mental health services can be held.
  • This notice must also be given to your attorney.

3. You have the right to a hearing within 72 hours of your detention, except that on weekends or legal holidays, the hearing may be delayed until 4:00 in the afternoon on the first regular workday. The hearing may also be delayed in the event of an extreme weather emergency or disaster.

4. You have the right to be released from custody if:

  • 72 hours has passed and a hearing has not taken place (excepting weather emergencies and extensions for weekends and legal holidays);
  • an order for court-ordered mental health services has not been issued within 14 days of the filing of an application (30 days if a delay was granted); or
  • your doctor finds that you no longer need court-ordered mental health services.

Involuntary Patients – Special Rights

Under most circumstances, you or a person who has your permission may, at any time during your commitment, ask the court to ask a physician to reexamine you to determine whether you still meet the criteria for commitment. If the physician determines you no longer meet the criteria for commitment, you must be discharged. If the physician determines you continue to meet the criteria for commitment, the physician must file a Certificate of Medical Examination with the court within 10 days of the filing of your request. If a certificate is filed, or if a certificate has not been filed within 10 days and you have not been discharged, the judge may set a time and place for a hearing on your request.

Can’t view or hear the video? Click here to visit the U.S. Department of Health and Human Service’s website to read about the contents of this video.

Download MRMC’s Notice of Privacy Practices in English.

Download MRMC’s Notice of Privacy Practices in Español. 

Trouble downloading the forms?  Contact any member of your care team of call our Patient Advocate at 979-241-5536.

Instructions: Print, complete and send or present form to the Health Information Department.

Download Authorization in English.
Descarga la Autorizacion en Español.

Patient safety is a concern of importance to all. We encourage you to utilize these resources:
View the Emmi Safety Video
Download our Personal Medication Record

Informed Consent

You have the right to decide what may be done to your body during the course of medical treatment. Your physician will discuss with you the nature of your condition, the proposed treatment and any alternate procedures that are available. Your physician also will provide you with information about the risks associated with certain medical procedures. This information will help you make an informed decision about the kind of treatment you want to receive.

Surrogate Decision-Maker

If you become unable to make your own health care decisions and do not have a legal guardian or someone designated under a Medical Power of Attorney, then certain family members and others can make medical treatment decisions on your behalf.

Advance Directives

Individuals usually make decisions regarding their health care treatment after their physician recommends a course of treatment and provides information about the treatment. These decisions may become more difficult, however, if a patient becomes unable to tell their doctors and loved ones what kind of health care treatment they want. Through documents known as advance directives, individuals can express their treatment preferences before they actually need such care, ensuring that their wishes will be carried out and that their families and others will not be faced with making these difficult decisions.

Below is some general information on the four types of advance directives recognized under Texas law. Advance directives can be changed or cancelled at any time.

Directive to Physicians

A Directive to Physicians, also known as a “living will,” allows you to tell your physician not to use artificial methods to prolong the process of dying if you are terminally ill. A Directive does not become effective until you have been diagnosed with a terminal or irreversible condition.

If you sign a Directive, talk it over with your physician and ask that it be made part of your medical record. If for some reason you become unable to sign a written Directive, you can issue a Directive verbally or by other means of nonwritten communication, in the presence of your physician.

If you have not issued a Directive and become unable to communicate after being diagnosed with a terminal or irreversible condition, your attending physician and legal guardian, or certain family members in the absence of a legal guardian, can make decisions concerning withdrawing, withholding or providing life-sustaining treatment. Your attending physician and another physician not involved in your care also can make decisions to withdraw or withhold life sustaining treatment if you do not have a guardian and certain family members are not available.

Medical Power of Attorney

Another type of advance directive is a Medical Power of Attorney, which allows you to designate someone you trust – an agent – to make health care decisions on your behalf should you become unable to make these decisions yourself.

You cannot choose as your agent your health care provider, including a physician, hospital or nursing home; an employee of your health care provider, unless he is your relative; your residential care provider, such as a nursing home or hospice; or an employee of your residential care provider, unless he is related to you.

The person you designate has authority to make health care decisions on your behalf only when your attending physician certifies that you lack the capacity to make your own health care decisions. Your agent cannot make a health care decision if you object, regardless of whether you have the capacity to make the health care decision yourself, or whether a Medical Power of Attorney is in effect.

Your agent must make health care decisions after consulting with your attending physician, and according to the agent’s knowledge of your wishes, including your religious and moral beliefs. If your wishes are unknown, your agent must make a decision based on what he believes is in your best interest.

Out-of-Hospital Do-Not-Resuscitate Order

An Out-of-Hospital DNR Order allows you to refuse certain life-sustaining treatments in any setting outside of a hospital. This advance directive must be issued in conjunction with your attending physician.

Declaration for Mental Health Treatment

Another type of advance directive deals with mental health treatment issues only. A Declaration for Mental Health Treatment allows you to tell health care providers your choices for mental health treatment, in the event that you become incapacitated.

Organ Donation

Your commitment to donation will not interfere with your medical care.  Organ, eye and tissue donations become an option only after all life-saving efforts have been made and death has been declared or is imminent.  Information is shared upon death with our Organ Procurement Agency, LifeGift.  Once suitability for donation is confirmed, LifeGift will contact family for consent.

Legal Aspects of Advance Directives

An advanced directive does not need to be notarized. Neither this healthcare entity nor your physician may require you to execute an advance directive as a condition for admittance or receiving treatment in this or any other healthcare setting. The fact that you have executed an advance directive will not affect any insurance policies that you may have.

Formal policies have been adopted to assure that your rights to make medical treatment decisions will be honored to the extent permitted by law. Matagorda County Hospital District has adopted policies relating to informed consent and implementation and treatment decisions under the Directive to Physicians, the Medical Power of Attorney, the Out-of-Hospital Do-Not-Resuscitate Order and the Declaration for Mental Health Treatment.

Complaints concerning advance directive requirements may be filed by calling the Texas Department of Health, 888-973-0022.

If you or a family member has an interest in completing an Advance Directive contact:

Matagorda Regional Medical Center
Case Management Department
979-241-3465

More Information on Advance Directives

Here are two links from the Texas Hospital Association on Advance Care Planning and Advance Directives.

Texas Price Point is sponsored by the Texas Hospital Association, provides information on Texas hospitals including basic demographic, quality, and pricing information. Read More

The Centers for Medicare and Medicaid (CMS) requires hospitals to publicly post a machine readable (e.g., XML, CSV) list of their standard charges via the Internet. Visit the standard charges page.

Condition Reports

Any personal information about your diagnosis and treatment is confidential and must come from your physician. This information will only be available to other members of our healthcare team who are directly involved in the patient’s care or for billing purposes. Information you wish your family to know should be released by you, not our staff.  On admission, you will assign a passcode for family members to use when asking about your care.  Share this code with your family members if you would like us to discuss or answer questions related to your healthcare with them.  If they do not know this passcode, then your healthcare information will not be shared with them.

Mail and Delivery

Letters and packages for patients are delivered each day by volunteers. Letters and parcels that arrive after you have been discharged are forwarded to your home. Cards are available for purchase in the Gift Shop. Outgoing mail may be given to our unit staff or a volunteer.