St. James Mercy Health System, Hornell NY
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  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)

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.
www.WebMD.com
www.nlm.nih.gov/medlineplus/

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 Health System.


 
 

St. James Mercy Health
411 Canisteo Street
Hornell, NY 14843
(607) 324-8000
information@sjmh.org
www.stjamesmercy.org
 
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St. James Mercy Health System includes St. James Mercy Hospital in Hornell, NY and serves Steuben Co. and the surrounding region

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