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Glacier Community Health Center Privacy Practices (HIPAA)

After reading the Privacy Statement, please download the Acknowledgement form, sign it, and bring it with you to your first clinic visit.

Notice of Privacy Practices: Adobe Acrobat || MS Word

Notice of Privacy Practices-Acknowledgement: Adobe Acrobat || MS Word

Patient Safety for Patients: Adobe Acrobat || MS Word


Patient Partner Advisory Council

GCHC’s Patient Partner Advisory Council is made up of eleven interested patient partners who have volunteered to advise GCHC’s leadership, providers and staff through a team approach to patient-centered healthcare from a patient’s and family member’s perspective.  They meet quarterly (January/April/July/October). 

The Advisory Council works in partnership with Glacier CHC staff and providers to:

    *Strengthen communication and collaboration among patients, families, caregivers, providers and staff.

    *Provide input and feedback to leadership, providers and staff in planning and evaluating programs, policies, services, and facilities.

    *Advocate for, promote, and support the philosophy of patient-centered care.

    *Foster accountability for a healthcare environment that is safe, accessible and supportive.

    *Promote activities or initiatives which serve to increase patient, family, and staff engagement and satisfaction at Glacier CHC.

    *Facilitate and promote a positive relationship between Glacier CHC and the community.

If you have suggestions for the Advisory Council to consider, please send them in an email to  with ‘Advisory Council’ in the subject line.


Patient Safety 

We urge you and your family to become part of our patient safety team.

For our patient safety program to be truly effective, we need you to be fully informed and actively involved in your care.

What does your involvement in patient safety mean to you and your family?

  • It means we need you to provide detailed information about your condition.

  • It means that you should clearly understand your diagnosis and treatment plan and know what to expect. 

  • It means keeping us informed of any changes in your condition, good or bad, such as an allergic reaction to a drug. 

  • It means we want you to speak up when you have a question about any aspect of your care.

We want you to become a partner in the development of a safe care plan. Your active involvement will help us consistently do the right thing at the right time for the right person – you.

Don’t be afraid to ask questions if you have doubts or concerns:

Speak up! This will allow your healthcare providers an opportunity to better assist you. We want you to understand your treatment plan and why we have chosen it for you.

Involve your loved ones:

Keep your loved ones informed about your care plan. Better yet, ask a family member to assist you in understanding and carrying out your care plan.

Understand your role in your care:

Take a look at the GCHC Patient Rights and Responsibilities hanging on the wall in the waiting room and printed on the reverse side.

Make sure you and your caregivers are clear about what medications you take:

Be sure to tell your caregivers what medications you are taking, including non-prescription medications, vitamins and herbal remedies. When you receive a prescription, make sure it is the right medication and the right dose. Use the clinic’s medication record sheet to help with keeping track of all your medications.

Infection: Don’t pass it on!

Did you know that each year, many lives and millions of dollars are lost due to the spread of infections in hospitals? Don’t be afraid to remind friends, family and healthcare providers to wash and sanitize their hands before coming into direct contact with you.

Know what to do after leaving the clinic:

Make sure you understand what you need to do to keep your care plan active. Take time to speak to your caregivers about what medications you’ll need and when you’ll need to take them. Make sure you have contact information for one or more of your caregivers if you have further questions once you get home.

If you have any concerns about your health care treatment at Glacier Community Health Center, or wish to report any safety concerns for yourself or a member of your family, please contact the Chief Executive Officer at 406-873-5670. Your safety is our biggest concern.

Patient Rights and Responsibilities

Patients have a fundamental right to medical care that safeguards their personal dignity and respects their cultural, psychosocial and spiritual values. Glacier Community Health Center (GCHC) strives to provide understanding and respect of these values in meeting patients’ needs so long as these values are within the health center’s capacity, its stated mission and philosophy and relevant laws and regulations.


As one of our patients, you have choices, rights and responsibilities.



New Patient Paperwork

New patients should download the forms, fill them out and bring them in to their appointment.

Patient Social and Medical History: Adobe Acrobat || MS Word

Patient Information: Adobe Acrobat || MS Word

Appointment Agreement: Adobe Acrobat || MS Word

Authorize to Give Information: Adobe Acrobat || MS Word

Patient Rights and Responsibilities




  • To be treated with dignity and respect.

  • To know the names and professional status of people serving you.

  • To personal and informational privacy.

  • To personal safety and to receive care in a safe setting.

  • To receive accurate information about your health-related concerns in terms that you can understand.

  • To receive appropriate assessment and management of pain.

  • To know the effectiveness, possible side effects and problems of all forms of treatment.

  • To participate in choosing a form of treatment and participated in the development of your plan of care.

  • To receive education and counseling.

  • To consent to, or refuse treatment, to the extent permitted by law after having received clear, concise information from your provider.

  • To select and/or change your health care provider.

  • To review your medical records with a clinician.

  • To information about services and any related costs.

  • Right to ask about costs of services before accepting the services.

  • Right to evaluate care received at GCHC.


  • To seek medical attention promptly.

  • To be honest about your medical history by providing, to the best of your knowledge, an accurate and complete description of your present condition and past medical history, including past illnesses, medications, and hospitalizations.

  • To ask about anything you do not understand relating to your treatment.

  • To follow health advice and medical instructions.

  • To report any significant changes in symptoms or failure to improve.

  • To treat all members of the GCHC health care team with respect, consideration, and dignity.

  • To respect GCHC policies.

  • To keep scheduled appointments or to cancel in advance.

  • To seek non-emergency care during regular business hours.

  • To provide useful feedback about GCHC services and policies.

  • To make arrangements for promptly meeting your financial commitment to GCHC, which has supplied resources to meet your health care needs.


When you have questions… ASK

When you have problems… SPEAK UP

When you are satisfied… COMPLIMENT

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Right and Resp of Pts
Pt Adv Council
New Pt Pprwrk
Patient Handbook
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