Heart of America Medical Center your health. our passion.
hospital
johnson
care center
supportive
surgical
wellness
about
pay
ecard
gift
donate
volunteer
Contact
Printer Friendly Page
Hospital
You are here: Home  | Hospital  | For Patients  | Forms 
Current Medication List: It is imperative that your medical provider and nursing staff have knowledge of your allergies, immunizations and current medications, including over-the-counter, vitamins and herbal medications. Please bring all the medications you take at home to the hospital with you, or bring a current list of medications. You can download a form below that includes all this information. Please keep this form with you at all times and update it as changes occur.

Current Medication Form (document)
File Size: 9.13 kb



Advance Care Directive: An advance health care directive communicates your health care decisions should you be unable to make or communicate them for yourself. For more information, please see the Advance Care Directive section of this website or download a form below.

Advance Health Care Directive (document)
File Size: 346.59 kb



Community Care Program: Heart of America Medical Center's Community Care Program is available to individuals who cannot afford to pay their medical bills and who meet financial guidelines. For more information, please see the Community Care Program section of this website or download an application form below.

Residents' Rights: Our goal is to treat our residents with the utmost care and respect. However, should you have questions or concerns about your care, privacy, fees and services we encourage you to consult our Resident's Rights manual. A PDF of the document can be downloaded below.

Resident's Rights Manual (document)
File Size: 970.21 kb



Grievance Procedure: At Heart of America Medical Center, we strive for excellent care. If, for some reason, you feel this has not been the case, please bring this concern to any staff member and/or supervisor of the department for which the issue pertains. If you are still not satisfied with the outcome, you may refer to our Grievance Procedure. A PDF of the procedure can be downloaded below.

Grievance Procedure (document)
File Size: 10.24 kb



Ethical Issue Form: If you or a member of your family is facing a difficult medical decision, the Ethics Committee at Heart of America Medical Center may be able to help you. Please also consult your medical provider, nursing staff, hospital chaplain and social services as much as necessary for support, education and consultation. If you still feel you need the assistance of the Ethics Committee, the Ethical Issue Form may be downloaded below. Please follow the instructions on the form for submission.

Ethical Issue Form (document)
File Size: 64.72 kb



Find Out More
providers
career
classes
pharmacy
news
ambulance
haaland
employees
The HAMC radiology staff does a wonderful job. They make you feel comfortable and confident.
Bernie Howard, Rugby
Heart of America Medical Center      800 South Main Avenue      Rugby, ND 58368      Tel: 701.776.5261      Fax: 701.776.5448      TDD: 701.776.5043