What You Need to Know About Admissions Information

  • Your Rights and Responsibilities as a Patient
  • Financial Assistance Program
  • Notice of Privacy Practices
  • What you need to know about Advanced Directives
  • Services Offered by McGehee Hospital
  • What you need to know if you are being admitted
  • Conditions of Admission
  • Your Rights and Protections Against Surprise Medical Bills

Your rights & responsibilities as a patient

Patient Rights:

  • You are entitled to these rights regardless of sex, race, cultural, economic, educational or religious background or the source of payment for your healthcare. All your rights as a healthcare consumer also apply to the person who may have legal responsibility to make decisions regarding your healthcare.
  • The following statement of Patient Rights has been adopted by McGehee Hospital and the medical staff. As a patient at McGehee Hospital, you have the right to:
    • Receive impartial access and exercise these rights to treatment without regard to sex, culture, economic, educational, religious background or the source of payment for care.

Considerate and Respectful Care:

  • Have knowledge of the name of the physician who has primary responsibility for coordinating your care and the names and professional relationships of other physicians and healthcare providers who will see you as a patient.
  • Receive information from the physician about your illness, your course of treatment and your prospects for recovery in terms that you can understand.
  • Receive as much information about any proposed treatment or procedure as you may need in order to give informed consent or to refuse the course of treatment. Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved in the treatment, alternate course of treatment or non-treatment and the risks involved in each and to know the name of the person who will carry out the procedure or treatment.
  • Participate actively in decisions regarding your medical care. To the extent permitted by law, this includes the right to refuse treatment.
  • Appropriate management of your pain.
  • Full consideration of privacy concerning your medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discretely.  You have the right to be advised as to the reason for the presence of any individual.
  • Confidential treatment of all communications and records pertaining to your care and your stay in the hospital. Your written permission will be obtained before your medical records can be made available to anyone not directly concerned with your care.
  • Access to information contained in your medical record within a reasonable time frame.
  • Reasonable responses to any reasonable request you may make for service.
  • Leave the hospital even against the advice of your physician.
  • Reasonable continuity of care and to know in advance the time and location of appointment as well as the physician providing your care.
  • Be advised if hospital or your personal physician proposes to engage in or perform human experimentation affecting your care or treatment. You have the right to refuse to participate in such research projects.
  • Be informed by your physician or a delegate of your physician of the continuing healthcare requirements following your discharge from the hospital.
  • Examine and receive an explanation of your bill regardless of source of payment.
  • Know which hospital rules and policies apply to your conduct while you are a patient.
  • Have all of your patient’s rights apply to the person who may have legal responsibility to make decisions regarding medical care for you.

Patient Responsibilities:

  • The care a patient receives depends partially on the patient himself. Therefore, in addition to these rights, a patient has certain responsibilities as well.  These responsibilities should be presented to the patient in the spirit of mutual trust and respect:
  • The patient has the responsibility to the best of his/her ability to provide accurate and complete information concerning his/her present complaints, past illnesses, hospitalizations, medications and other matters relating to his/her health.
  • The patient is responsible for reporting perceived risks in their care and unexpected changes in their condition to their responsible practitioner.
  • The patient and family are responsible for asking questions when they do not understand what they have been told about the patient’s care or what they are expected to do.
  • The patient is responsible for following the treatment plan established by his/her physician, including the instructions of nurses and other health professionals as they carry out the physician’s orders.
  • The patient is responsible for keeping appointments and for notifying the hospital or physician when he/she is unable to do so.
  • The patient is responsible for his/her actions should he/she refuse treatment or not follow his/her physician’s orders.
  • The patient is responsible for assuring that the financial obligations of his/her hospital care are fulfilled as promptly as possible.
  • The patient is responsible for following hospital policies and procedures.
  • The patient is responsible for being considerate of the rights of other patients and hospital staff.
  • The patient is responsible for being respectful of his/her personal property and that of other persons in the hospital.

Healthcare Dilemmas:

  • McGehee Hospital and the medical staff support your right to actively participate in decisions regarding your healthcare program, including decisions regarding the right to refuse life-sustaining treatment. In compliance with federal law, you will be given information regarding these rights upon your admission to the hospital.
  • Feelings of anxiety and uncertainty often affect both you and your family when you are hospitalized. Sometimes you or your family members may have a dilemma related to your plan of care.  If you have a dilemma or conflict with your planned course of treatment, you may request a meeting with Case Management.
  • Case Management provides a consulting service to patients, physicians and hospital staff when ethical considerations or personal dilemmas arise, as to the extent of treatment of irreversible or terminal conditions. Usually Case Management is consulted when there is a conflict between any of the involved parties relating to levels of treatment that are planned for you.  If you feel you or your family members would like to meet with Case Management, or if you would like the Case Management to review your care in terms of planned treatment for your irreversible or terminal condition, inform your nurse.  Your nurse will contact the appropriate parties, and a meeting with Case Management will be arranged.

Concerns During Your Hospitalization:

  • At McGehee Hospital your satisfaction with all care provided is important to us. Should you or your family members experience concerns about the care you are receiving, you may contact the Compliance Officer and discuss issues that did not meet your expectations.  You may contact the Compliance Officer during your hospitalization after you are discharged.  We encourage you to voice your opinion regarding the care you have received, and we welcome your comments.
  • If the staff of McGehee Hospital do not resolve your concerns regarding patient care and safety, you may contact a member of the hospital management.
  • If your concerns are still not addressed, you are encouraged to contact Arkansas State Department of Health (DOH) to report your concern regarding patient care and safety.

Financial Assistance Program

McGehee Hospital offers financial assistance to help members of the community receive needed healthcare.

Certain financial criteria must be met in order to qualify.

Application can be requested from the front office admission area of the hospital as well as over the telephone.

Needed Information:

  • Application
  • Copy of Tax Return
  • Copy of W2
  • Copy of 1099
  • Copy of Medicaid application denial

Other information as requested

Notice Of Privacy Practices



If you have any questions about this Notice, please contact the McGehee Hospital Incorporated Privacy Officer at 870-222-5600

Effective Date:  September 23, 2013


The notice describes our System’s practices and that of:

  • Any member of a volunteer group we allow to help you while you are in the hospital.
  • All employees, member of the Hospital Medical Staff and other System Personnel.
  • Any healthcare professional authorized to enter information into your chart.


We understand that medical information about you and your health is personal.  We are committed to protecting medical information about you.  We create a record of the care and services you receive from our System.  We need this record to provide you with quality care and to comply with certain legal requirements.  This Notice applies to all of the records of your care generated by our System, whether made by System personnel or your physician.  Your physician may have different policies or notices regarding the physician’s use and disclosure of your medical information created in the physician’s office or clinic.

This Notice will tell you about the ways we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.


Make sure that medical information that identifies you is kept private.  Give you this Notice of our legal duties and privacy practices with respect to medical information about you.  Follow the terms of the Notice that is currently in effect.


The following categories describe different ways that we use and disclose medical information.  For each category of uses or disclosures, we will explain what we mean and try to give some examples.  Not every use or disclosures in a category will be listed.  However, all of the ways we are permitted to use and disclose information will fall within one of the categories.


We may use medical information about you to provide you with medical treatment or services.  We may disclose medical information about you to physicians, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you.  For example, a physician treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process.  In addition, the physician may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals.   Different departments within the System also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays.  We also may disclose medical information about you to people outside our System who may be involved in your medical care later, such as family members, clergy or others we use to provide services that are part of your care.


Healthcare professionals, using their best judgement, may disclose to a family member, a close friend or any other person you identify, health information needed for that person to be involved in your care or payment related to your care.


We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research project and established protocols to ensure the privacy of your health information.  For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition.  We may also disclose medical information about you to people preparing to conduct a research project, for example to help them look for patients with specific medical needs, so long as the medical information they review does not leave the hospital.


We will disclose medical information about you when required to do so by Federal, State or Local law.


We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Any disclosure, however, would only be to someone able to prevent the threat.



If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.


Our Foundation may use information to notify you about fundraising campaigns or other charitable events to raise money for MHI.  You have the right to opt-out of receiving fundraising communications and may do so by calling 870-222-5600 or emailing csmith@mcgeheehospital.org.


If you are a member of the armed forces, we may release medical information about you as required by military command authorities.  We may also release medical information about foreign military personnel to the appropriate foreign military authority.


We may release medical information about you for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries.


As required by law, we may disclose medical information about you to authorities charged with preventing or controlling disease or disability.


We may disclose medical information to a health oversight agency for activities authorized by law.  These oversight activities included, for example, audits, investigations, inspections and licensure.  These activities are necessary for the government to monitor the healthcare system, government programs and compliance with civil rights laws.


If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order.  We may also disclose medical information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.


We may release medical information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process, to identify or locate a suspect, fugitive, material witness or missing person, about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s Agreement, about a death we believe may be the result of criminal or conduct within our System and in emergency circumstances to report a crime; the location of a crime or victims or the identity, description or location of the person whom committed the crime.


We may release medical information to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or determine the cause of death.  We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.


We may release medical information about you to authorized Federal officials for intelligence, counterintelligence and other national security activities authorized by law.


We may disclose medical information about you to authorized Federal officials so they may provide protection to the President, other authorized persons of foreign heads of state or conduct special investigations.


If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.  This release would be necessary (1) for the institution to provide you with healthcare, (2) to protect your health and safety or the health and safety of others, or (3) for the safety and security of the correctional institution.


Other uses and disclosures of medical information not covered by the Notice, specifically those for marketing, the sale of PHI, and psychotherapy notes, will be made only with your written permission.  If you provide permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time and we will no longer use or disclose medical information about you for the reasons covered by your written authorization.  You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.


You have the following rights regarding medical information we maintain about you:


You have the right to inspect and obtain either a paper or electronic copy of medical information that is used to make decisions about your care.  Usually this includes medical and billing records, but does not include psychotherapy notes.

To inspect and obtain a copy of medical information that may be used to make decisions about you, you must submit your request in writing to the McGehee Hospital Incorporated, Attn:  Privacy Officer, 900 S. Third St., McGehee, AR 71654.  If you request a copy of the information, we may charge a fee for the costs of copying, mailing and other supplies associated with your record.

We may deny your request to inspect and obtain a copy in certain very limited circumstances.  If you are denied access to medical information, you may request that the denial be reviewed.  Another licensed healthcare professional chosen by the hospital will review your request and the denial.  The person conducting the review will not be the person who denied your request.  We will comply with the outcome of the review.


If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment for as long as the information is kept by or for the hospital.  To request an amendment, your request must be made in writing and submitted to the PRIVACY OFFICER, McGehee Hospital Incorporated, 900 S. Third St., McGehee, AR 71654.  In addition, you must provide a reason that supports your request.  In addition, we may deny your request if you ask us to amend information that:

  • Was not created by us, unless the person or entity that created the information is no longer available.
  • Is not part of the medical information kept by or for our System.
  • Is not part of the information which you would be permitted to inspect and obtain a copy.
  • Is accurate and complete.


You have the right to receive notice if there is a breach of your protected health information.


You have the right to request an “accounting of disclosures”.  This is a list of some of the disclosures we made of medical information about you.  To request this list of accounting of disclosures, you must submit your request in writing to:  McGehee Hospital Incorporated, Attn:  Privacy Officer, 900 S. Third St., McGehee, AR 71654.  Your request must state a time period which may not be longer than six (6) years and may not include dates before April 14, 2003.  Your request should indicate in what form you want the list.  For example, on paper, electronically.  The first list you request within a twelve (12) month period will be free.  For additional lists, we may charge you for the costs of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.


You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations.  You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like family members or friends.  For example, you could ask that we not use or disclose information about a surgery you had.


However, we must agree to a request to restrict the disclosure of your protected health information to a health plan if you request the restriction in writing and in advance to any of the services being provided and if you have paid MHI in full for the services, out-of-pocket, in advance.


You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  For example, you can ask that we only contact you at work or by mail.  To request confidential communications, you must make your request in writing to the Privacy Officer.  We will not ask you the reason for your request.  We all accommodate all reasonable requests.  Your request must specify how or where you wish to be contacted.


You have the right to a paper copy of this Notice.  You can ask us to give you a copy of this Notice at any time.  Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.  You may obtain a copy of this Notice at our website, www.mcgeheehospital.org.


If you believe your privacy rights have been violated, you may file a complaint with MHI or with the Secretary of the Department of Health and Human Services.  To file a complaint with the System, contact the PRIVACY OFFICER, McGehee Hospital Incorporated, 900 S. Third St., McGehee, AR 71654.  All complaints must be submitted in writing.


We may use and disclose medical information about you so that treatment and services you receive from our System may be billed to and payment may be collected from you, an insurance company or a third party.  For example, we may need to give your health plan information about the care you received from our System so your health plan will pay us or reimburse you for the surgery.  We also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.


We may use and disclose medical information about you for healthcare operations.  These uses and disclosures are necessary to run the System and make sure that all of our patients receive quality care.  For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you.  We may also combine medical information about many patients to decide what additional services the System should offer, what services are not needed, and whether certain new treatments are effective.  We may also disclose information to physician, nurses, technicians, medical students, and other hospital personnel for review and learning purposes.  We may also combine the medical information we have with medical information from other healthcare providers to compare how we are doing and see where we can make improvements in the care and services we offer.  We may remove information that identifies you from this set of medical information so others may use it to study healthcare delivery without learning who the specific patients are.


Unless you notify us that you object, we will include certain limited information about you in the hospital directory while you are a patient in the hospital.  This information includes your name, location in the hospital, and your religious affiliation.  The directory information may be given to a member of the clergy, such as a priest or rabbi who is of the same religious affiliation that you indicate, even if they do not ask for you by name.  This information may be given to members of the public if they ask for you by name.  This is so your family, friends and clergy can visit you in the hospital and generally know how you are doing.

What You Need To Know About Advanced Directives

  • Living Wills
  • Healthcare Proxy
  • Durable Power of Attorney for Healthcare

Adult patients of sound mind have the right to accept or refuse any medical or surgical treatment through an ADVANCE DIRECTIVE, also known as a LIVING WILL. You also have the right to appoint a relative or friend to make medical decisions for you if you become unconscious or mentally incapable of making decisions.

What is a LIVING WILL?  A LIVING WILL is a legal document which states your wishes about medical treatment if you become terminally ill or permanently unconscious.  The LIVING WILL tells your doctors, nurses and family members of those wishes. It states which medical procedures to be done or not done if you have a condition from which you cannot recover. It allows you to refuse certain medical procedures that may only prolong your dying, or maintain your body in an unconscious state. The LIVING WILL goes into effect only if you become terminally ill or permanently unconscious.

What is a HEALTHCARE PROXY (Durable Power of Attorney)?  With a HEALTHCARE PROXY, you can choose another person to decide healthcare issues any time you are unconscious or mentally unable to decide. The person you choose is your “Healthcare Representative”.  Your HEALTHCARE PROXY can be part of your LIVING WILL.

Should I have a LIVING WILL and a HEALTHCARE PROXY?  You do not have to be seriously ill or even expecting to be ill to benefit from having this document. If you sign a document when you are able, you will be protecting family members from emotional stress in an unexpected crisis. You will be deciding in advance who will make healthcare decisions for you. You will control the extent to which doctors will use medical means to prolong your life. You will relieve others from the responsibility of having to decide.

Does this mean giving up or stopping care?  No, it does not. If you are terminally ill or permanently unconscious, your doctors and nurses will continue to provide care, attending to your needs and making every effort to keep you comfortable. They will continue humane treatment.

What Types of Treatment are Affected by a LIVING WILL?  In your LIVING WILL, you can tell your doctor that you do not want certain treatments. For example, you may wish to not be hospitalized if you are terminally ill or permanently unconscious.  In addition, you may decide against any treatments, which your doctor believes will not cure you, but will only postpone the moment of death by keeping your body functions going artificially.  Some examples include:

  • ARTIFICIAL FEEDING: If you are no longer able to swallow, your doctor may have you fed through tubes inserted through your nose, an incision in your abdomen, or intravenously (through a vein).
  • ARTIFICIAL VENTILATION: Ventilators and respirators are machines that aid your breathing.  Some patients become dependent on ventilators and would die without their support. In your LIVING WILL, you can make it clear whether you want a ventilator if your condition is not likely to improve.
  • CARDIOPULMONARY RESUSCITATION (CPR): When the heart stops (cardiac arrest), doctors and nurses use special measures called cardiac resuscitation to try to restart the heart.  They may utilize heart massage, give IV medications, or use electrical shocks.


You may make a LIVING WILL and HEALTHCARE PROXY by completing a form that may be obtained from McGehee Hospital. Have two adults witness your signature. A LIVING WILL does not require an attorney.

What Do I Do With My LIVING WILL and HEALTHCARE PROXY form?  Give a copy of your LIVING WILL and PROXY to your doctor and family

members in advance.  McGehee Hospital Medical Records Department will also keep your LIVING WILL on file if you provide them with a copy.  Always take a copy with you to the hospital for your chart.  It is important for any healthcare provider to know your wishes.

What If I Change My Mind?  You can change or revoke your Living Will at any time. Tell your family, doctor and anyone else that has a copy of your change.  Ask them to tear up or throw away all copies of the LIVING WILL that is no longer in effect.

Can One Person Make a LIVING WILL for Another ?  You can make a LIVING WILL for a close family member who is under 18 if you are the  parent or legal guardian.

Can My HEALTHCARE PROXY Make Decisions Even if I Am Not Terminally Ill?  Yes.  Your HEALTHCARE PROXY  can make decisions for you any time you are unconscious or mentally unable to make your own healthcare decisions. You would not have to be terminally ill.  Your proxy has to try to make decisions similar to what you would have made.  Therefore, you should talk with your representative so that person will know what all of your wishes are.

A LIVING WILL may direct the healthcare team to use any or none of these measures; the choice is yours.

Services offered by McGehee Hospital

  • Emergency
    • The Emergency Department at McGehee Hospital is the newest addition to our facility. Built in 2017 with the assistance of a sales tax supported by the community, the Level IV ED consists of 8 beds, including a Trauma Room, 3 Treatment Rooms and an Outpatient/Ambulatory Care area.
  • Clinical Laboratory
    • The Clinical Laboratory is open 24 hours a day of every day of the year. Our laboratory employs skilled health professionals, Medical Laboratory Scientist and Medical Laboratory Technicians who routinely performs an array of clinical diagnostic testing, maintains instrumentation, interprets and manages data to provide the physicians with state-of-the-art laboratory results. Our in-house testing includes blood bank, microbiology, chemistry, hematology, coagulation, virology, and urinalysis. We have the best reference labs available for all tests we refer.
  • Radiology
    • McGehee Hospital’s Diagnostic Imaging Department offers high-quality diagnostic testing for patients of all ages with an array of illnesses. Our tests enable our physicians to comprehensively evaluate the patient’s illness, diagnose the problem, create a personalized plan of care, and monitor the treatments. We offer Computed Tomography (CT), Ultrasound, and X-Ray and continually strive to provide the latest technology so that our patients can get a fast, accurate diagnosis and a treatment plan specifically tailored to their needs. We also offer convenient appointments, safety, and personalized patient care.
  • Respiratory Therapy
    • McGehee Hospital Respiratory Therapy Department is dedicated to excellence. Our experienced therapists offer a professional approach to respiratory care management.
      • Smart ABI
      • Oxygen Therapy
      • Hand-held Nebulization Therapy (updrafts)
      • Chest Physical Therapy (CPT)
      • Incentive Spirometry
      • Cardiopulmonary Resuscitation
      • Ventilator Management
      • ECG (EKG)
      • BIPAP
      • CPAP
      • Arterial Blood Gas Analysis and interpretation with the use of our Rapid Point 500 Arterial Blood Gas analyzer*

*In addition to measured and calculated parameters on this maintenance-free instrument, the RAPIDPoint 500 system can be used to help enhance clinical decision-making with accuracy and reliability you come to trust.

  • Specialty Clinic
    • McGehee Hospital hosts specialty clinics so patients may obtain care that would not otherwise be available at home.
  • Hands On Rehab Services
    • Hands On Rehab Services is an outpatient rehabilitation healthcare facility located here in McGehee.
  • McGehee Family Clinic
    • A full-service clinic with state-of-the-art equipment in a single location that would provide easy access for patients and attract and retain quality physicians, nurses, technicians and support staff to McGehee. The 10,800-sq.-ft. clinic was designed to accommodate up to six physicians. It opened in September 2017.
  • Nursing
    • We value our patients and seek to be the provider of choice for our community. We are here 24/7. Our nurses are experienced and certified in the following:
      • Advanced Cardiac Life Support
      • NIH Stroke Scale
      • Pediatric Advanced Life Support
      • Trauma Nursing
      • Advanced Stroke Life Support
      • Advanced Burn Life Support
    • Swing Bed
      • McGehee Hospital offers the Swing Bed program, which provides 24-hour skilled nursing care for patients who require continued supervised nursing care but no longer need intensive care provided in an Acute Care hospital unit.
    • IDHI Stroke Program
      • The University of Arkansas for Medical Sciences (UAMS) Institute for Digital Health & Innovation (IDHI) (formerly AR SAVES), in cooperation with the Department of Human Services, has implemented a telehealth program designed to save Arkansans from imminent stroke-related neurological damage and possible death through statewide collaboration between remote neurologists and the state’s most affected rural hospitals.
    • Pharmacy
      • Our pharmacists are trained to prepare intravenous medications, dispense medications, advise staff on the dosage of medicines, and work with other healthcare team members on the most appropriate drug therapy. Our pharmacist will write guidelines for drug use within the hospital and implement hospital regulations.
      • The staff is trained to help with kinetics and the clinical monitoring of patients’ drug regimens. They work on purchasing medications for our patients, maintaining our inventory.
    • Chronic Care Management
      • Chronic disease and conditions are among the most expensive, common, and preventable health issues in the United States.
      • If you live with two or more chronic conditions like arthritis, diabetes, depression, or high blood pressure, our chronic care management services may be for you.

What you need to know if you are being admitted

It is the mission of McGehee Hospital to provide personalized healthcare using conventional and innovative services.


  • Your Room:
  • Your room includes a bedside stand, for your belongings such as toiletries, an overbed table which opens and is equipped with a mirror. A nurse call button which rings at the nurses’ station and can be answered by intercom.  Your bed has an electrical control enabling you to raise or lower the foot or head for comfort.  There is an emergency button in your bathroom should you require assistance.
  • Meals:
  • Diet instruction and nutritional counseling will be provided with your physician’s approval. If you would like to speak to a Registered Dietitian, please ask your nurse.


  • Smoking Policy:
  • McGehee Hospital is a smoke free facility. As a healthcare institution, McGehee Hospital recognizes the hazards of smoking and enforces a “no smoking policy” throughout the institution.  Patients, visitors, physicians, staff and volunteers are not permitted to smoke on the premises under any circumstances.  Please speak to your physician in regard to alternative measures.
  • Medication:
  • Please give your nurse a list of any medications and herbal supplements you are taking, including dosage and times. Your nurse will review these with your physician who will make a decision on which medications you should continue to take during your hospitalization.  Your nurse will bring your medication to you as ordered by your physician.  All medications you may have brought with you, including aspirin, should be returned home as they can interfere or interact with tests or medicines ordered for your treatment.
  • For your safety and protection, only medicines approved by your physician and supplied by our

Pharmacy will be given to you during your stay.  Your nurse will ask you questions concerning your past responses to medications and any allergies you may have.  You may be asked to wear an allergy bracelet, which alerts all caregivers to your allergies.

  • Consent Forms:
  • You may be asked to sign consent forms for certain types of treatment, tests and/or procedures. These tests or procedures will have been explained by your physician.  If you do not understand the procedure or test you are asked to consent to, tell your nurse and your physician will be notified.  It is important for you to understand the risks, benefits and alternatives available to you whenever you are undergoing anything other than a minor test; (such as having a chest x‑ray) or treatment; (such as having the nurse administer intravenous fluids).
  • Your Personal Belongings:
  • As we cannot accept responsibility for valuables left in your room, we strongly encourage you to give extra money, medications, credit cards, wallets, jewelry, etc., to a family member or close friend to take home. Or, ask your nurse to put your valuables in the secure place.
  • Eyeglasses, Dentures, Hearing Aids:
  • Eyeglasses, dentures and hearing aids are an important part of your life if you require them in your daily living activities. These items require special care.  Take care not to leave any of these items on your meal tray or lying on your bed, as they may be inadvertently disposed of or lost.

Conditions of Admission to McGehee hospital

CONSENT: I hereby authorize McGehee Hospital (“Hospital”) and my physician, any attending physician, or the emergency department physician to render anynecessary hospital care, including surgical operations, diagnostic procedures, medication management, drugs, supplies and emergency treatment, that the physician,his assistants and designees and employees of the Hospital deem necessary or advisable in their judgment. I authorize the Hospital to dispose of any tissues removedin the performance of any procedure authorized above. I understand that the practice of medicine and surgery is not an exact science. I understand that there are risks incidental to any medical treatment or procedure and that no guarantees have been made to me as to the results of any examination, treatment, and/or procedure provided tome by the Hospital or any physician.

PERSONAL VALUABLES: I understand and agree that the Hospital can inventory and lock up money and valuables for safekeeping and that the Hospital shall not be liable for the loss or damage to any personal property, unless deposited with the Hospital for safekeeping. Personal property includes, but is not limited to, money, jewelry, glasses, bridges, dentures, hearing aids, watches, documents and furs.

FINANCIAL AGREEMENT: The undersigned agrees, whether he/she signs as the patient’s representative or as the patient, that in consideration of the services to berendered to the patient, he/she hereby individually obligates himself/herself to pay the account of the Hospital in accordance with the regular rates, terms and chargesof the Hospital. The undersigned understands and agrees that the amount is due in full within one hundred twenty (120) days after receipt of the first bill to thepatient. Arrangements may be made with the Hospital Patient Accounts department for installment agreements. Private room and guest tray charges are due at time of service.

RELEASE OF INFORMATION:  I authorize the Hospital to release all medical information as may be necessary for submission to any third party payer of any claims for payment of services and supplies provided to me.

ITEMIZED STATEMENT: I understand that I may receive an itemized statement of Hospital’s bill following formal request to the Hospital’s Insurance/Billing Department.

MEDICAL SERVICES BILLING: I understand that I may be billed separately for medical services provided by physicians, including, but not limited to, medicaldoctors, radiologists, pathologists, anesthesiologists, surgeons, and emergency department physicians. These charges are separate from and in addition to my Hospital bill.

MEDICARE/MEDICAID CERTIFICATION: I certify that the information given by me in applying for payment under Title XVIII and XIX of the Social Security Act is correct. I authorize any holder of medical or other information about me to release to the Social Security Administration or its intermediaries or carriers any information needed for this or a related medical claim. I request that payment of authorized benefits be made on my behalf.

DIRECTORY INFORMATION: I have the right to have or not have certain information included about me in the Hospital’s directory. If I am included in the directory, myname, room number in the Hospital, and a one-word statement of my condition may be released by the Hospital to anyone who asks for me by name while I am a patient in the Hospital.

ASSIGNMENT OF INSURANCE BENEFITS: I hereby assign to the Hospital, physicians participating in my case, and other licensed providers any and all rights andbenefits to which I may be entitled arising out of any healthcare insurance, liability insurance, Medicare, Medicaid or other third party payers. I hold the Hospitalharmless from any reduction in health care benefits by my insurance company resulting from noncompliance with any clause or condition contained in mypolicy which may require notification, precertification, prior to retrospective authorization, or utilization review of the medical services I receive. I understand thatif I leave the Hospital Against Medical Advice, that payment will not be made to the Hospital by Medicare, Medicaid or other insurance companies. I amfinancially responsible for all charges, including deductibles and co-insurance, not covered by my policy.

NURSING CARE: I understand that the Hospital provides only general duty nursing care. I understand that I should consult with my physician to determine whether continuous or special duty nursing care is required, and if so, arrangements for such special nursing care must be made by the patient or the patient’s legal representative.

PRIVATE ROOM: I understand and agree that Medicare does not cover any private room charge difference unless medically necessary and documented by my physician. If I am assigned to a private room, I understand that I am responsible for payment of the private room difference at the time of service.

TELEPHONE CONSUMER PROTECTION ACT (TCPA): “You agree, in order for us to service your account or to collect any amounts that you may owe us, we may call youat any phone number associated with your account, including wireless numbers, which could result in charges to you. We may also communicate with your by sending textmessages or e-mails to your wireless number or e-mail address. Methods of contact may include using a pre-recorded/artificial voice and/or the use of an automated dialingdevice. These authorizations shall remain in effect until individually withdrawn by you in writing to our facility and/or any others to which authorization has been extended. Ihave read this disclosure and agree that ‘your office or agent’ may contact me as described above.”

NOTICE OF PRIVACY PRACTICES: I acknowledge that I have received a copy of the Hospital’s Notice of Privacy Practices.

_________(Patient or Representative Initials)


The above conditions apply to all units within the hospital system, and this form is valid for the length of the admission, including any discharge and readmission to another unit or facility of the hospital during my hospitalization.  Assignment of my insurance benefits is valid and binding until final settlement of the account is received.  The undersigned certifies that he/she has read this form, has received a copy, is the patient or authorized representative of the patient, and the conditions of admission are fully understood and accepted.

________________________________________________________                            ________________________________________________________

Signature of Patient Signature of Patient’s Representative (if applicable)

(Also indicate type of relationship, if applicable (i.e. parent / guardian) *


Witness (Admissions Clerk / ER Clerk / Other)


Date and Time

*Anyone signing as a “representative” of the patient hereby represents to the Hospital that such person is legally authorized to execute this document by virtue of his/her relationship with the patient as indicated above.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You’re protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have these protections:

  • You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
  • Generally, your health plan must:
    • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
    • Cover emergency services by out-of-network providers.
    • Base what you owe the provider or facility(cost-sharing)on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you’ve been wrongly billed, contact the Consumer Services Division at 501-371-2640 or toll-free 1-800-852-5494. You may also contact via email insurance.consumers@arkansas.gov. If you would like to file a complaint, you may file through the Arkansas Insurance Department website https://insurance.arkansas.gov/pages/ consumer-services/consumer-services/. Thefederalphonenumberforinformationand complaints is: 1-800-985-3059.

Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.

Visit https://insurance.arkansas.gov/pages/consumer-services/consumer-services/ for more information about your rights under Arkansas state laws.