Physician Orders for Life-Sustaining Treatment Form – POLST (English | Español)
The Spanish translation of the California POLST form is to be used when discussing a patient’s wishes as indicated on the POLST form. The signed POLST form must be in English so that emergency personnel can read and follow your orders.
Authorization to Verbally Discuss Protected Health Information with Family and/or Friends (English | Español)
Please click on the link above to download and print the Authorization to Verbally Discuss Protected Health Information with Family and/or Friends. Submit the form to the HIM Fax line: (707) 431-6466 or in person. If you have questions, please contact HIM Mainline: (707) 431-6470.
Medical Record Request Form (English| Español)
To request a copy of your medical records, please click on the link above to download and print the Authorization for the Use and Disclosure of Protected Health Information form. Then fill out and submit the form to the HIM Fax line: (707) 431-6466 or in person. If you have any questions, please contact HIM Mainline: 707-431-6470 for questions.
Interpreter Policy: Communications for Special Language Needs (English | Español)
Healdsburg District Hospital provides trained medical interpreter services to assure non-English speaking, deaf, and hearing-impaired patients of their right to understand medical treatment and procedures, as well as to communicate their healthcare needs. Please click on the link above for further information. To request an interpreter, please call the Patient Access Manager at (707) 431-6500.
Patient Rights (English | Español)
Healdsburg District Hospital respects your right to privacy and honors your right to quality, considerate and compassionate care.
Reporting Safety / Quality Concerns (English | Español)
How to contact Healdsburg District Hospital’s Grievance Officer, California Department of Public Health and/or The Joint Commission to report concerns about safety and quality of care.
Notice of Privacy Practices (English | Español)
Case Manager / Social Worker
Your case manager or social worker is available to assist you with your discharge options and any financial concerns about your care. If you need their assistance, please ask your nurse. They are available Monday through Friday.
The dietitian will be more than happy to discuss any concerns you have with your diet or provide you with educational material. Ask your nurse if you would like to speak with our Registered Dietitian.
Your doctor may order occupational therapy to work on strength and coordination as well as increasing your independence with the activities of daily living, such as grooming, dressing, bathing and toilet transfers. For more information about our inpatient services, please call (707) 431-6376.
Physical and Rehabilitation Therapy
Your doctor may order physical and rehabilitation therapy to work on strength, balance, coordination, and endurance, as well as transfer and walking/wheelchair skills. For more information about our inpatient services, please call (707) 431-6376.
Financial Assistance Policy and Application
It is part of the Mission of Healdsburg District Hospital to provide financial assistance to the patients of the communities we serve. This policy authorizes the Chief Financial Officer (CFO) to implement and oversee the process to provide charitable services at a discounted rate.
Financial Assistance Application – English
Financial Assistance Policy – English
Financial Assistance Application – Español
Financial Assistance Policy – Español