Patient Information

Patient Rights

Your health is of vital importance to us. It is important that you understand your role in health care so that you can assist us in providing quality care. For this reason we have established the following Patient Rights and Responsibilities.

If you have questions about these rights and responsibilities or if you feel we can improve our care for you, please talk to our staff members. We are here to help.

As a patient you have a right to:

Respectful Care

Everyone in our health care system should respect you dignity as a human being and be courteous and sensitive to your needs. Treatment is provided regardless of your race, religion, national origin or your ability to pay.

Complete Information

You have the right to complete information regarding your condition, treatment and outlook for recovery. You have the right to know the name of the physician in charge of your care.

Informed Consent

You must give permission for tests, surgery medications and other care. Before you do this your physician should tell you in language you understand the intended procedure, any risks of side effects, the consequences of no treatment and how long recovery should take.

Refuse Treatment

Patients who are legally competent may choose not to be treated. In this case, the physician should inform you of possible consequences of non-treatment.

Privacy and Confidentiality

Personal and medical details may not be disclosed to others at any time. In most cases you must give permission before anyone may gain access to your information.

Experimental Treatment

You must be informed of any therapy, medication or treatment that is considered experimental as well as the potential results and risks in the treatment. You then have the right to determine if you want to participate or not in the experimental treatment.

Second Opinion

You have the right to consult with another doctor at your own expense to help you make decisions about your health care. Some health plans pay for a second opinion. You will need to check with your insurance for possible coverage.


You have the right to know about any rules that govern conduct in the hospital or clinic. Rules include those regarding visitors, our Tobacco Free Campus policy, our no fragrances policy, movement in the buildings, supervision of children, etc. In particular, please observe our no fragrances in any form policy. Patients and health care staff alike may be adversely affected by fragranced soaps, body lotions and sprays which may trigger migraine headaches and other sensitivities in many individuals. Any changes in these rules will be conveyed to you as soon as possible.

Continued Care

You have the right to information about continuing care. This includes ongoing information about care while in the hospital/clinic as well as care and treatment needed after you leave the health care facilities.

Health Care Billing

You have a right to receive an itemized copy of the bill for healthcare services provided and receive an explanation for those charges listed if needed. You also have the right to information relating to financial assistance for health services.

Health Management

You have the right to participate in making the plan for your health care when you are able.

Ethical Issues

You or your designated representative has the right to participate in consideration of ethical issues that arise from your care.


You have the right to file complaints when you feel your rights are not being protected. You should bring problems to the attention of your health care provider. If you feel the health care provider is not responding to your concerns, you may speak to a supervisor. Most comments will be addressed within ten working days. If you do not feel your concerns have been resolved you should call (541) 997-7134.

Communication Assistance

To provide patients who do not speak English as their primary language, equal access to information and participation in health care decisions, we subscribe to Language Line interpretive services. In addition to allowing communications in many languages, there is also a Certified Medical Interpretation option that allows us to discuss medical issues and concerns with our patients. There is no charge to patients for these services. For the hearing impaired, voice amplifiers and a TTY connection are available to promote communications.

Patient Responsibilities

To be a responsible patient it is important to:

Ask Questions

Ask questions so that you understand what is being done with  your health. Listen carefully to what is being told to you and make sure you understand what is being said.

Provide Information

Give full information so the health care provider can serve your needs. This includes information about your condition, all symptoms, any medications you are taking, and previous ailments you have had, etc. Remember, the staff can only help with what they know.

Follow Your Practitioner's Advice

To get the most from your health care, carefully follow the treatment plan your practitioner gives you. If  you do not understand your practitioner's instructions, ask questions until you are satisfied you do understand and are able to follow the instructions completely.

Report Change

Report any change you see in your progress. This will help the health care providers assist you in a timely manner.

Respect Others

The health care staff and other patients deserve your respect and courtesy. Please observe rules and common courtesy.

Financial Responsibility

Assume the financial responsibility of your health care in a prompt manner.

Registration Process

On your first visit to PeaceHealth in Florence, you will need to register as a new patient. The information gathered at registration is important to you because it ensures that all the paperwork for you and your dependents includes correct information. You will be asked to verify and update information at each visit. 

You will be asked to provide

  • Your name, address and phone numbers of where you can be reached day or evening.
  • Emergency contact information
  • A copy of your most recent insurance card, if you have one
  • Personal demographic information
  • If your visit is related to work or an auto accident, you will need to supply the date, time and place of the accident
  • Your signature, which authorizes treatment, states that you will be responsible for payment of services. It also authorizes PeaceHealth to bill your insurance company directly for any services and to send the insurance company information about the services it may need to process your claim.

Note: Please pay co-pays at the time of service.

Billing Information

We know health care expense is of concern to you even if you have insurance and we want to help. We will assist you with billing issues to facilitate prompt payment on your account. Many insurance companies require prior authorization for treatment. The accurate information given to us at registration allows for verification of coverage and authorization, referral to other health care providers as well as rapid billing of the account to the appropriate payer.

Billing Cycle

Our statements reflect the status of your account. Payment of the patient responsibility portion is due upon receipt of the statement unless other payment arrangements have been made.

Medicare Patients

We accept assignment on Medicare. We ask that you not pay until you receive a statement from us showing a patient balance due. Medicare will determine the allowable amount, what they will pay and what is your responsibility. If you have secondary insurance, we will bill them for you. Since the arrangement with secondary insurance is between you and your insurance company, we seek your assistance in any follow-up on the claim or lack of payment in those instances where you disagree with the insurance coverage co-pays and deductibles from Medicare.

OMAP/Oregon Health Plan Patients

Always bring your valid Oregon Medical card with you to each visit. If you do not have a card, please get a temporary card from your caseworker before coming to your visit. Services provided without the card or services not covered by the card will be billed to you.

OHP Outreach

PeaceHealth in Florence is an outreach facility for the Oregon Health Plan. Call (800) 873-8253 for assistance.

Private Insurance Patients

Please provide us with a copy of your insurance card. We will be happy to bill your insurance companies and will honor the payment rates of those with whom we participate. Please understand that your insurance policy is a contract between you and your insurance company. Our submitting the claim for you does not take away your responsibility for payment on the claim. We will assist in claim follow-up but may need your help in resolving payment issues.

Co-Pays and Deductibles

Many insurance plans have a fixed co-pay or deductible for each visit. Please make this co-pay or deductible payment at the time of service.

Returned Checks

Returned checks (NSF, Account Closed, etc.) will be assigned to a collection agency for collection and will be assessed a $25.00 minimum service fee.


We strive to provide quality health care for our patients. When you think we have fallen short of this goal, we need to hear about your concerns. If  you have questions about your rights, problems about your care or have concerns about your bill, we need to know.

Problems with care should be brought to the attention of your health care practitioner. If you feel your practitioner is not addressing your concerns you can ask to speak to a supervisor. Concerns will be addressed as soon as possible.

Addressing Billing Questions for Complaints

If you have billing questions or complaints, please select an option:

Telephone Customer Service

  • Hospital/Home Health/Hospice (800) 873-8253
  • Clinic/Counseling Services (800) 957-4259

To schedule an appointment with a Patient Financial Counselor

  • Call (541) 902-6562

To mail in your billing inquiry or complaint

  • Hospital/Home Health/Hospice - PO Box 569, Eugene, OR 97440
  • Clinic/Counseling Services ; PO Box 24410, Eugene, OR 97402


If you feel your concerns are not being addressed please ask to speak to the Patient Financial Services Director at PeaceHealth in Florence.


PeaceHealth in Florence is an Equal Opportunity institution and does not discriminate against any person in employment, admission, treatment or participation in its' programs and benefits on the basis of race, color, national origin, creed, ability to speak English, handicap, sex, age or marital status. For further information on this policy call (541) 997-7134.

Advanced Directives (Living Wills)

Many people have strong feelings about how and what kind of medical care they want at the end of life. Few people actually share those feelings with family members or medical professionals. Death is often difficult to talk about and though you may have expressed your wishes in conversation, your family may have difficulty knowing what is really expected of them.

Advanced Directives - sometimes called Living Wills - are legal documents that allow you to retain control over what kind of care and how much care you will receive should you become terminally ill or unable to communicate your wishes. Peace Harbor Hospital is required by law to provide advance directive documents to patients upon admission to the hospital. However, hospital admission may not be the best time to make these kinds of decisions unless death is imminent. We encourage patients to talk with their family members, medical professionals or spiritual advisor before deciding what is right for them.

We carry on the healing Mission of Jesus Christ by promoting personal and community health, relieving pain and suffering and treating each person in a loving and caring way.