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312 9th Street SW, Waverly, Iowa 50677

(319) 352-4120

Forms & Notices

Forms

Your Rights and Responsibilities as a Patient

Patient Privacy (HIPAA)

Non-Discrimination Statements

As a recipient of Federal financial assistance, the health center does not exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by the health center providers directly or through a contractor or any other entity with which the health center providers arrange to carry out its programs and activities.

This institution is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at Complaint Form, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.

 

Iowa Physician Orders for Scope of Treatment

IPOST Information

Tobacco Free Campus

We are a TOBACCO-FREE campus. The use of tobacco products is not allowed on our grounds and in our buildings.

Weapons Free Campus

We are a WEAPONS-FREE campus. Weapons are not allowed on our grounds and in our buildings.

Lost & Found

Our Lost & Found is located at the green entrance registration desk. Items are kept for 60 days.