St. James Mercy  Hornell NY
St. James Mercy Health System, Hornell NY Home Find a Doctor Services and Clinics Patients and Visitors Careers Beat the Blues Community and Education Contact Us



Patient Access Center

Patient Instructions

Patient Education

Patient Forms

Visiting Hours & Restrictions

Location Maps

Food Services & Cafeteria

Gift Shops

Financial Counseling & Billing

NYS Surprise Bill

Health Insurance Exchange

Support Groups & Meetings

Spiritual Care

Health Information & Forms

The Patient Channel

Corporate Compliance


  Health Information & Forms
St. James Mercy Hospital

Patients’ Bill of Rights
As a patient in a hospital in New York State, you have the right, consistent with law, to ...
Patients’ Bill of Rights (PDF)

HIPAA Privacy Notice
Protecting our patients’ medical information is a priority at St. James Mercy. The notice below describes how medical information about you may be used and disclosed and how you can get access to this information.
Notice of Privacy Practices in English (PDF)
Notice of Privacy Practices in Spanish (PDF)

Medical Record Request
Patients can request a copy of their health records by downloading and printing a copy of the Patient’s Request for Release to Protected Health Information form.
Authorization for Release of Health Information, HIPAA (PDF)

If you were a patient of Dr. Sen or Dr. Yang, please call (585) 235-3380 to request patient records. St. James Mercy Hospital does not have access to Drs. Sen’s or Yang’s patient records.

Mail or Fax the original, signed form to:

St. James Mercy Hospital
Attention: Health Information Management Services
411 Canisteo St., Hornell, NY 14843
Or Fax to (607) 324-8708

Please note – Health information cannot be mailed to patients’ homes. Picture ID is required at time of pick up, and there may be a charge for this request. Releases for office medical records will be forwarded to the SJMH offices manager for processing.

Health Care Proxy
New York State Health Care Proxy Form (PDF)

Universal Medication Form
It is important for you to have a record of the medications you are taking in an emergency. Please download and print the Universal Medication Form and fill it out for you or your loved one and carry it with you.
Universal Medication Form and Instruction Sheet (PDF)

Health Links
These online health resource websites are designed to help meet your health information needs and aim to provide general information about the topics they present. To search for health information, click on any of the following links.

Note: This information is general in nature and should not be relied upon as medical advice. The above organizations are not affiliated in any way with St. James Mercy Hospital.


St. James Hospital
411 Canisteo Street
Hornell, NY 14843
(607) 324-8000

About St. James Hospital
News & Events

Express Care Clinic
Find a Doctor
Services & Clinics
Center for Colorectal Health
Jobs & Employment

Patients & Visitors
Patient Instructions
Community & Education
Financial Counseling & Billing
Health Information

St. James Hospital Foundation
Make A Gift—Donate Online
Quality & Safety
Corporate Compliance
Privacy Policy
  Social media Facebook Twitter Google Plus YouTube LinkedIn RSS feed
    Copyright 2005 – 2018 St. James Hospital.
All rights reserved.