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Policies and Documents - Erlanger Western Carolina Hospital

Notice of Privacy Practices

Notice of Privacy - English 2019

Notice of Privacy Practices - Spanish 2019

Facilities and Practices covered by the Notice of Privacy Practice


Medical Records

Authorization for Release of Medical Information

Medical Record Release

Guidelines for Email


Financial Assistance Policies

Plain Language Summary

Erlanger Western Carolina Hospital and its facilities for which services are reflected in this billing statement offer financial assistance, based on the current Federal Poverty Guidelines to uninsured patients and guarantors with an outstanding balance owed for medically necessary services.

Patients or guarantors may be determined to be Presumptively Eligible for financial assistance based on eligibility for other specific state or federal programs.

Additional information regarding available financial assistance, including copies of the Financial Assistance Policy and Application can be found at www.murphymedical.org.

In addition, patients can obtain a copy of these documents, at no cost, by sending a request to Erlanger Western Carolina Hospital, Financial Counseling Department, 3990 E. US Hwy 64 Alt., Murphy, NC 28906-8707 or in person at Erlanger Western Carolina Hospital.

Our Financial Counselors can be reached at 828-835-3662; 828-835-7719, Monday – Friday from 8:30AM – 5:00PM to assist you with any additional questions.

Patients approved for financial assistance under the Erlanger Western Carolina Hospital Financial Assistance Policy will be billed no more than the amount generally billed (AGB) to Medicare and our Private Health Insurers. Applications for Financial Assistance are also available in Spanish.

Financial Assistance Policy

Financial Assistance Application

Hardship Settlement Policy

Hardship Application

Schedule H (Form 990)

Billing and Collections Policy


Non-Discrimination Policy

Non-Discrimination Policy


Accessibility Policy

Notice of Program Accessibility for Disabled Policy


Patient Rights and Responsibilities

Patient Rights and Responsibilities English

Patient Rights and Responsibilities Spanish

Reporting concerns

Your quality care and safety is important to us. If you have any unresolved complaints regarding patient care or safety issues, you may report your complaints by doing the following:

Report your complaints directly to the department director or the administrator on-call. Dial “0” on any hospital phone or call 828-837-8161 from an outside phone, and ask for the “Administrator On-call”.

You will receive a prompt response to your concern.

If your concerns cannot be resolved by Erlanger Western Carolina Hospital, you may report them to our accrediting body or the state agency listed below:

The Joint Commission One Renaissance Boulevard Oakbrook Terrace, IL 60181 Toll Free: 800-994-6610 http://www.jcaho.org/

Division of Health Services Regulation 2711 Mail Services Center, Raleigh, North Carolina 27699-2701 Toll Free: 800-624-3004


Language Services

Discrimination is against the law