Ogolaanshaha Adeegydada Daryeelka Caafimaad

Ogolaanshaha Adeegydada Daryeelka Caafimaad

Magaca Buuxa ee Bukaan jiifka (DAABAC) Taariikhda Dhalashada Bukaan jiifka

Halkan waxaan ku ogolaanayaa Adeegyada Caafimaadka ee Bulshadda Caalamiga ah (ICHS) iyo Adeeg bixiyayaasheeda si ay u bixiyaan adeegyada daryeelka caafimaad, ay ka mid tahay qiimaynta, baadhitaanka, iyo nidaamyada daawaynta, ee aniga la iigu xxxx in xx xxxxx huraan ii yihiin ama uu ku taliyo Adeeg bixiyahaygu si loo qiimeeyo oo loo daweeyo xaalada caafimaad. Waxaan fahmay in aan leeyahay xaqa aan si firfricoon uga qayb qaato go’aanada ku saabsan daryeelkayga oo waxaan waydiin karaa su’aalo ku saabsan dabeecada iyo sifada daawayntayda lagu talo bixiyay ama kale. Taa xx xxxxx, waxaan leeyahay xaqa aan ku fahmo natiijooyinka la filayo ee daryeelkayga iyo beddelaadaha xxxx xx la ii heli karo aniga iyo halisahayga caafimaad ee la aqonsaday ama ka sii xxxxx xxxx oo isaamayn kara aniga. Waxaa la iga filayaa in aan su’aalo waydiiyo marka Adeeg bixiya la xidhiidho dheefaha la filayo, halisaha, ama ka dii darka aniga ah, iyo ku guul daraysigayga in aan waydiiyo kala caddaynta su’aalaha waxaa loo qaadan doonaa in loola jeedo in aan si buuxda u fahmay dabeecada iyo sifada daryeelkaygada ama aan si aan khasab ahayn u doortay in aan in dheeraad ah la igu wargelin. Sidoo kale waxana fahmay in kala noqon karo ogolaanshaha adeeg kasta oo daryeelka caafimaad ah wakhti kasta.

Halkan waxaan ku ogolaanayaa ICHS in ay shaaciso macluumadka uu u baahdo kooxdayda saddexaad ee caymiska si loo bixiyo lacagta adeegyada ICHS. Macluumaadka bixinta socda codsan doonaa marka adeegyada aan lagu sameeyaa ilkaha Mobile ka Clinic. ICHS waxa bixisaa lacahgdhimis hoos u dhacaysa ( oo lagu saleeyo dakhliga iyo cabbirka qoyska) bukaan jiifka u qalma ee aan caymiska ku jirin kharashaadkiisa ka baxsan jeebka xx xxx lacag bixinta caymiska kooxda saddexaad. Waxaan filayaa in aan ka bixiyo saami xaq ah kharashaadka wakhti qorshaysan ama aan la sameeyo qaban qaabada lacag bixinta ICHS haddii aanan awod u lahayn in aan si buuxda u bixiyo hadhaagayga. Adeegyada qaar kood, lacag bixinta buuxda ayaa loo baahan doonaa wakhtiga booqashada. Waxaan fahmay in aan la ii diidi doonin daryeelka caafimaad iyaddoo ay ugu wacanyahay karti darrada aanu ku bixiyo biilkayga ilaa inta aan bixiyo macluumaadka maaliyadeed xx xxx baahanyahay. Si kastaba ha ahaatee, diidmada in la bixiyo saami xaq ah oo kharashaaadka ah ama la’aanta la shaqaynta in la qaban qaabiyo qorshaha lacag bixinta waxay keeni kartaa joojinta adeegyada.

Waxaan fahmay haddii aan ahay qof wayn oo ogolaanaya daryeelka bukaan jiifka yar ama bukaan jiifka wayn ee kartida xxxxxx, waa in aan haystaa masuuliyad sharci oo aan sidaas ku sameeyo. Haddii ogolaansho la ii siiyo ilmo yar, waa in aan ahaadaa waalidka asal ahaan dhalay oo la ogolaadayn (taas macnaheedu waa magacaygu uu ku yaalo shahaadada dhalashada ee ilmahayga) ama waalid korsade ah (taas macnaheed waxa weeye aan leeyahay sharci ahaan ilmo aan korsado), oo xuquuqdaydana waa in aanay xayirin amar maxkamaddeed (tusaale ahaan xaalado furitaan). Haddii aan ahay xubin qoys, qaraabo, daryeel bixiye, ama shakhsi kale oo ogolaansho siinaya daryeelka qof yar ama qof wayn, masuuliyad sharci uma haysto aan ku ogolaado daryeelka caafimaadka iyaddo masuuliyada si cad uu ii siiyay aniga bukaan jiifku, bukaan jiifka wakiil kiisa sharci, maxkamad, ama hab sharciyeed. Haddii aan ku dhaqmayo masuuliyada amarka maxkamaddu isiiso ama awooda qareenka, waxaa la i waydiin karaa in aan bixiyo nuqul warqaddahan xogta ah, oo warqaddahan xogta ah ee sidaas waa in ay ogolaataa ICHS, ka hor inta aanan matelin bukaan jiif kale. Waxaan in dheeraad ah fahmay in xuquuqdayda sidii wakiil shakhsiyeed laga yaabo in la xayiro haddii sharciyada ku habboon ogolaadaan. Tusaale ahaan, dadka yar yar waxaa loola dhaqmaa sidii dad waa wayn iyo awood buuxda oo xx xxxxx si loo maamulo macluumaadkooda caafimaad haddii ay buuxiyaan shuruudaha oo laga daweeyo cudurka maskaxda, cudurka galmadda lagu kala qaado, ama arrimo caafimaad oo taranka la xidhiidha. Waxana aqoonsaday shuruudahan iyo xayiraadahan.

Magaca Turjubaanka
Saxeexa		Taariikhda
( ) nuqulka lagu siiyay:

Saxeexa (Waalidka / Mas'uulka haddii uu ka yar 18) Taariikhda Bukaan jiifka / Magaca Wakiilka (DAABAC) Taariikhda

Ma ogolaanaysaa daryeelkaaga caafimaad?

Saxeexa Waalid/Waali Taarikh Dhalasho

Haa; Maya* (eeg hoos)

*Caddee xidhiidhka aad la leedahay bukaan jiifka: hooyada; aabaha; xxxxxxxx/wakiilka maxkamaddu dooratay;

kale (caddee):                                                    .

Bayaanka Masuuliyada Wakiilka (Qaraabada oo Keliya)

Waxaan ahayn qaraabada ka masuulka ah daryeelka ilmaha yar. Halkan waxaan ka caddaynayaa oo ku xaqiijinayaa hoosta ciqaabta dhaarta beenta ah ee waafaqsan RCW 9A.72.085 in aan leeyahay masuuliyada sharci si loo sameeyo go’aanada daryeelka caafimaad ee ilmaha yare e kor ku qoran. Waxaan fahmay in aan la i waydiin doonin in aan bixiyo warqaddo xog ah oo masuuliyadayda sharci si aan u ogolaansho u siiyo ilmaha yar wakhtigan, iyaddoo Adeeg bixiyahaygu uu haysto sababta uu ku waydiiyo ansax ahaanshaha bayaankan mooyee. Si kastaba ha ahaatee, waxa la iwaydiin karaan in aan soo saaro warqaddo xog ah oo taageerta wakhti kasta. Bayaankan waxa uu ansax ahaan doonaa lix (6) bilood.

Saxeexa:                                  Taariikhda:        

English	Somali
Patient Rights and Responsibility	Xxxxxxxx Xxxxxxxx iyo Masuuliyada
You have the right to:	Waxaad xaq u leedahay:
• Choose a health care provider that provides you with quality care.	• Dooro adeeg bixiye caafimaad oo ku siiya daryeel tayo leh.
• Receive care in a safe, private, and respectful setting by knowledgeable personnel.	• Ku hel daryeelka goob badbaado ah, xxxx xx, oo ixtiraam leh oo ay joogaan shaqaale aqoon leh.
• Receive services in a manner that respects your language, culture and beliefs.	• Ku hel adeegyada qaabab tixgeliya luqaddaada, dhaqanka iyo caqiidooyinka.
• Receive information about your care and treatment in terms you can understand.	• Ku he macluumaadka ku saabsan daryeelkaaga iyo daawaynta xaalado aa xxxxx xxxxx.
• Receive services without discrimination based on race, color, sex, marital status, sexual orientation, age, creed, religion, ancestry, gender identity, genetic information, use of service animals, national origin, veteran status, citizenship status, or the presence of any sensory, mental or physical disability or the ability to pay.	• Hela adeegyada takoor la’aan aan ku salaysnayn isir, xxxxx, xxxxx, heerka guurka, qaabka galmadda, da’da, caqiiqadada, diinta, tafiirta, aqonsiga jinsiga, macluumaadka hidda sidaha, isticmaalka xawayaanka adeega, asalka qaranka, heerka ruug caddaaga, heerka muwaadinimada, ama joogitaanka xxxxxxxx, naafanimada maskaxda ama jidhka ama kartida lacag lagu bixiyo.
• Receive information about ICHS hours, providers, services, fees and payment policies in a language that is easy for you to understand.	• Ka hel macluumaad ku saabsan saacadaha ICHS, adeeg bixiyayaasha, adeegyada, kharashka, iyo xeerarka lacag bixinta luqad kuu fudud adigu inaad fahanto.
• Be notified if your care involves the training of healthcare providers.	• Lagugu wargeliyo haddii daryeelkaagu uu khuseeyo tababarka adeeg bixiyayaasha daryeelka caafimaad.
• Privacy of your healthcare information except as required by law or insurance company contracts.	• Gaar ahaanshaha macluumaadka daryeelkaaga caafimaad laga reebo sida sharcigu u baahanyahay ama qandaraasyada shirkada caymiska.
• Read and receive copies of your medical records within a reasonable amount of time.	• Akhri oo ku hel nuqulada diiwaanada caafimaad gudaha wadarka wakhtiga.
• Know that when an emergency occurs and you are transferred to another facility, a responsible person/family member will be notified.	• Garo marka gurmadku dhaco oo laguu wareejiyo xarun kale, qof masuu ah/xubin qoyska ah ayaa lagu wargelin doonaa.
• Request assistance with information on advance directives for your healthcare.	• Codso caawimo wadata macluumaad ku saabsan dardaaran hore loo sii qoray ee daryeelkaaga caafimaad.
• Be notified in advance to allow you to choose whether or not you would like to participate in experimental clinical research studies.	• Hore ha lagugu sii wargeliyo inaad doorato haddii aad jeclaan lahayd ama aanad jeclayn inaad ka qayb xxxxx daraasadaha cilmi baadhida caafimaad.
• Respectfully express dissatisfaction with the care you receive through a patient complaint/grievance policy.	• Si ixtiraam leh u muuji qanac la'aanta daryeelka aad ku hesho cabashada bukaanka/xeerka cabashada.
• Restrict the use and disclosure of PHI.	• Xayir isticmaalka iyo shaacinta PHI.
• Receive confidential communications.	• Hel wada xidhiidh qarsoodi ah.
• Receive a copy of the Notice of Privacy Practices (NOPP).	• Ka hel nuqul Ogaysiiska Dhaqanada Gaar ahaanshaha (NOPP).
• Receive an accounting of disclosures of PHI.	• Hel shaacanaha xisaabaadka ee PHI.
• Revoke a prior authorization.	• Ka noqo oggolaanshe hore.
• File a complaint for privacy violations by calling ICHS’Compliance Hotline at 0-000-000-0000 or contact the Office for Civil Rights:	• Ku soo gudbi xad gudubka gaar ahaanshaha addoo soo wacaya Xxxxxx Cabashada Tooska ah ee ICHS lambarkan 0-000-000-0000 ma la soo xidhiidh Xafiiska Xxxxxxxx Xxxxxxx:
Office for Civil Rights	Office for Civil Rights
U.S. Department of Health and Human Services	U.S. Department of Health and Human Services
0000 Xxxxx Xxxxxx-M/S: RX-11	0000 Xxxxx Xxxxxx-M/S: RX-11
Seattle, WA 98121-1831	Seattle, WA 00000-0000

Voice Phone (000)000-0000	Telefoonka Codka (000)000-0000
FAX (000)000-0000	FAGASKA (000)000-0000
TDD (000)000-0000	TDD (000)000-0000
You have the responsibilities to:	Waxaad haysataa masuuliyada aad ku:
• Ask questions if you do not understand what you are being told.	• Waydiiso su'aalaha haddii aanad fahmin waxa laguu sheego.
• Tell us everything you know about your health history, current health, and any changes in your health.	• Noogu sheegto inaad ogtahay taariikhdaada caafimaad, iyo isbeddel kasta oo caafimaadkaaga ah.
• Tell us about all medications, herbs, supplements, and over the counter (OTC) medications you may be taking.	• Noogu sheegto dhammaan dawooyinka, dhirta dawada ah, kaabbida, iyo dawooyinka iyaga oon la qorin la iibsado (OTC) ee aad qaadan karto.
• Participate in your care by making decisions, following directions and accepting responsibility for your choices.	• Kaga qayb xxxxx daryeelkaaa addoo go'aamo ka gaadhaya, raacaya tilmaamaha oo aqbalaya masuuliyada ikhtiyaaradaada.
• Follow the treatment plan agreed upon with your provider. This includes following instructions of other health care professionals as they carry out the orders of the provider.	• Aad ku raacdo qorshaha daawaynta xx xxxxxx heshiiyay adeeg bixiyahaaga. Tan waxaa ka mid ah tilmaamaha soo socda ee xirfad yaqaanada daryeelka caafimaad oo kale marka ay fulinayaan amarada adeeg bixiyaha.
• Choose a family member or other person to represent you if you are unable to make your own health care decisions.	• Doorato xubin qoyska ama qof kale si uu kuu metelo adiga haddii xxxxx xxxxx u lahayn inaad gaadho go'aanadaada daryeelka caafimaad.
• Treat other patients, visitors, volunteers and ICHS staff and property with courtesy and respect.	• Ula dhaqano bukaanada, booqdayaasha, mutadawaciinta iyo shaqaalaha ICHS iyo hantida si xishmad iyo ixtiraam leh.
• Arrive on time for all appointments and let us know in advance you are unable to keep an appointment.	• Ku timaado wakhti buure ah dhammaan ballamaha oo aad hore noo sii ogaysiiso inaanad awood u lahayn inaad ballanka dhowrto.
• Provide accurate information for processing any insurance coverage, and to pay any co-payments, co-insurance amounts, and deductibles as requested in a timely manner.	• Bixiso macluumaad sax ah wixii habbaynta daboolida kharashka caafimaad ah, oo aad ku bixiso wixii kharash la wada bixinayo, qadarada caymiska wadaaga ah, iyo jar jaridda sida loo codsado wakhti habboon.
• Inform your provider about any existing advance directive or medical power of attorney.	• Aad ku wargeliso adeeg bixiyahaaga wixii dardaaran hore loosii qoray oo jiray ama awooda qareenka caafimaad.
• Conduct yourself in an appropriate manner while receiving services from ICHS staff or at ICHS facilities and events. Failure to follow instructions from ICHS staff, comply with policies and treatment agreements, or when refusal of treatment prevents the delivery of safe and appropriate care, the relationship with the patient may be terminated with notice.	• Aad ula dhaqanto naftaada qaab habboon marka aad adeegyada ka helayso shaqaalaha ICHS ama xarumaha ICHS iyo dhacdooyinka. Ku guul daraysiga in la raaco tilmaaaha shaqaalaha ICHS, loo hoggaansamo xeerarka iyo heshiisyada daawaynta, ama marka diidmada daawayntu ka hortaggo gudbinta daryeelka badbaada leh ee habboon, xidhiidhka lala leeyahay bukaanka waxaa lagu joojin karaa ogaysiiskan.
Patient’s Signature/Print Name Date	Saxeexa Bukaanka/Daabac Magaca Taariikhda
ATTENTION: Language assistance services are available to you free of charge. Please contact the Compliance Officer at 1-855- 515-0143 or 000-000-0000 (TTY).	DIGTOONI: Caawimada adeegyada luqadda waxaa laguugu heli karaa adiga bilaash. Fadlan kala xidhiidh Sarkaalka U hoggaansanaata lambarkan 1-855- 515-0143 ama 000-000-0000 (TTY).

International Community Health Services

P.O. Box 3007

Seattle, WA 98114-3007

(000) 000-0000

TAARIIKH CAAFIMAAD 🞎 Lab 🞎 Dhedig

Magac Bukaan:                                  Taariikh Dhalasho:             Lambar Teleefon:                 Luqadda la Doortay:                         Cinwaan:                                  

Qowmiyad: 🞎 Hindi Maraykan / Dhalad Alaska 🞎 Ayshiyan 🞎 Madow ama Afrikan Ameerikan 🞎 Dhalad Haawaay 🞎 Dad Jasiirad Baasiifig oo Kale 🞎 Cadaan 🞎 Ka badan hal sinji 🞎 Ma jecli inaan sheego

Magac Dhakhtar:                   Taariikhda baadhista jidhka ee ugu dambeysay:      

Bukaanku hadda ma wuxu ku jiraa daryeel dhakhtar? HAA MAYA

Bukaanku hadda ma qaataa wax ah dawooyin/daroogo/kiniin? HAA MAYA

Hadday haa tahay, waa maxay sababtu?                                                      Hadday haa tahay, fadlan qor                             

Bukaanku diidmo ama alerji ma u leeyahay (ama diidmo ma u yeeshay) wax ah dawooyin? HAA MAYA

Hadday haa tahay, xxxxxx xxxxxx:                                            Bukaanku diidmo ama alerji ma u leeyahay cinjirka (latex)? HAA MAYA

Bukaanku ma yeeshay wax ah diidmooyin jidh oo aan caadi ahayn ama la fahmin wakhti lagu jiray hawlgal qalliin? XXX XXXX Xxxxxx ha tahay, xxxxxx xxxxxx:                              

Bukaanku wuxu leeyahay caymis ama inshuuranis ilko (waxa ku jira Medicaid, SCHIP, iwm.) HAA MAYA Magaca Shirkadda Caymiska:                           

Magaca Diiwaansanaha Caymiska:                  Waxa la Isu Yahay Bukaanka:                Caymis #:               Koox #:             Dhalashada Diiwaansanaha Caymiska:        

Taariikh Hirgalid:   Taariikh Dhicid:           Adeegga Macaamiisha taleefonkooda:        

Bukaanka xxxxx ma soo mareen mid ka mid ah waxyaabahan soo socda? (Fadlan calaamadee kulli inta khuseysa.)

Cadaadis Dhiig oo Aan Caadi Ahayn	🞎	Lahaansho Qallal/Suuxdin	🞎	Lafo-khafiifsan	🞎
ADD (Attention Deficit Disorder) (Ciladda Yaraanta Feejignaanta)	🞎	Suuxid/Miyir-beelid Marmar ah	🞎	Dhiig-bax Mudo Xxxxx Jiray	🞎
Walfid ama Balwad Aalkolo/Khamri	🞎	Dhibaatooyin ah Caloosha iyo Xiidmaha (GERD)	🞎	Qalab Lagu Rakibay	🞎
Dhiig-yaraan	🞎	Dhibka Indhaha ee Gulukooma (Glaucoma)	🞎	Daryeel Laga Siiyaay Cudur Maskaxda ah	🞎
Xanuun Laf Laabato /Ruumatiisim	🞎	Dhib ah Maqalka	🞎	Saaris Beeryaro	🞎
Albaab/Faalaf Wadne oo Artifishal ah (Artificial Heart Valve)	🞎	Cudur/Qalitaan ah Wadnaha	🞎	Qandho Ruumatiisim	🞎
Laabato ah Artifishal oo Lagu Rakibay	🞎	Sanqadh Wadne	🞎	Cudur Wadne oo Ruumatiisim Leh	🞎
Cudurka Neefta	🞎	Qalabka Garaaca Wadnaha Hagaajiya	🞎	Cudurka Dhiigga xx Xxxxx Xxxx (Sickle Cell)	🞎
Dhibaato Habaabid Difaac Jidh (Autoimmune) (Lupus/MS)	🞎	Joogsi La’aan Dhiig (Hemophilia)	🞎	Dhib ah Sanbuuqda Sanka	🞎
Kaansar	🞎	Cagaarshow/Joonis 🞎 A 🞎 B 🞎 C	🞎	Faalig (Stroke)	🞎
Daweynta ah Raajo/Shucaac	🞎	HIV/AIDS Laga Helay	🞎	Dhib ah Qanjidhka Qoorta	🞎
Daweyn ah Kiimiko (Chemotherapy)	🞎	Dhib ah Kalyaha/Sifeyn Kaadi	🞎	Tiibay/Tiibisho	🞎
Kolesterool	🞎	Naafonimo ah Waxbarashada	🞎	Burooyin	🞎
Cudur Wadne oo Uu Ku Dhashay	🞎	Cudur ah Beerka	🞎	Boogo	🞎
Sonkorow/Macaan	🞎	Cudur Wadne	🞎	Cudur Galmo la Isugu Gudbiyo	🞎
Cilad ah Cunista Cuntada	🞎	Faalafka Laba-geeslaha ah ee Wadnaha oo Soo Dhacay (Mitral Valve Prolapse)	🞎	Kursi Curyaan	🞎
Daroogo Loo Qaato Raaxaysi	🞎	Cilado ah Dareemeyaasha ama Maskaxda	🞎	Lumid/korodh miisaan oo dhakhso ah	🞎
Sambab Barar (Emphysema)	🞎	Xubin Jidh oo LaguTallaalay	🞎

Bukaanka ma soo maray cudur kale oo culus, cisbitaal dhigid ama shil? HAA MAYA

Hadday haa tahay, xxxxxx xxxxxx:

Bukaanku hadda sigaar ma cabbaa ama ma isticmaalaa waxyaabahan ka sameysan tubaako ee soo socda?

🞎 Sigaar	🞎 Sigaarka Waaweyn	🞎 Beeb	🞎 Tubaakada la Calaashado	🞎 Midna
Bukaanku hadda ka hor ma isticmaalay wax laga sameeyay tubaako?			HAA XXXX	Xxxxxx haa tahay, immisaa laga joogaa?
Bukaanku ma cabbaa cabbitaan ah aalkolo/khamri?			HAA XXXX	Xxxxxx haa tahay, qaddar intee le’eg?
Bukaanka tallaaladu ma u jadiidsan yihiin ama ma u dhan yihiin?			HAA MAYA

BUKAANKA HAWEEN AH, fadlan goobo gali HAA ama MAYA.

Uur ma leedahay? HAA MAYA Ma naas-nuujisaa? HAA MAYA Ma qaadataa dawooyinka xadeynta dhalmada? HAA MAYA

Faallooyin:

TAARIIKHDA ILKAHA Taariikhda u Tagistii Dhakhtarka Ilkaha ee Ugu Dambeysay:
Fadlan calaamadee kulli inta khuseysa bukaanka.	HAA
Bukaanka ciridku ma dhiigaa marka uu cadayanayo ama burush marinayo ama xadhko ku xoqoyo?	🞎
Bukaanka ilkihiisu dareen ma u leehiyiin cuntooyinka/cabbitaanada kulul ama qabow?	🞎
Bukaanka ilkihiisu dareen ma u leeyihiin cuntooyinka/cabbitaanada macaan ama dhanaan?	🞎
Bukaanku xanuun ma ka dareemaa mid ka mid ah ilkahiisa?	🞎
Bukaanku ma leeyahay nabaro ama burooyin ah afka ama u dhow?	🞎
Bukaanka ma ku dhaceen dhaawacyo ah madaxa, qoorta ama daanka?	🞎
Bukaanku ma leeyahay madax-xanuun marrar badan ah?	🞎
Bukaanku ma isku xejiyaa ama isku xoqaa ilkaha oo ma jiriqsadaa?	🞎
Bukaanku ma iska qaniinaa dibnaha ama canka marrar badan?	🞎
Bukaanku ma isku arkay mid ka mid ah kuwan soo socda?	🞎
🞎 Sanqadh ah daanka 🞎 Xanuun (ah laabato, dheg, dhinac waji) 🞎 Dhib ah furista ama xidhista afka 🞎 Dhib ah calaajinta
Bukaanka ma loo sameeyay shaqo xx xxxx toosin?	🞎
Bukaanku abidkii ma yeeshay dhiig-bixid mudo xxxxx socotay xx xxx xxxx saarid?	🞎
Bukaanka abidkii ma la siiyay cashar ama fariimo ku saabsan habka saxda ah xx xxx cadaydo ama burush loo mariyo ilkaha?	🞎
Bukaanka abidkii ma la siiyay cashar ama fariimo ku saabsan daryeelka ciridka?	🞎

Faallooyin:

KU DHAQANKA OGAYSIISKA GAAR AHAANSHAHA MAHAD NAQ

Si aad ugu hogaansanto caymiska Caafimaad ee Qaadasahda iyo Xeerka la Xisaabtanka (HIPAA), Sharciga Gaar ahaanshaha, ICHS ayaa loo baahanyahay si uu kuu siiyo Ku dhaqankayaga Ogaysiiska Gaar ahaanshaha. Tani waa in lagugu wargeliyo adiga in aanu xx xxxxx diiwaanka adeegyada daryeelka caafimaad ee aanu bixino. Waxaad waydiin kartaa in aad aragto nuqul diiwaankaas ah. Waxaa dhici karta in aad sidoo kale waydiiso in aad saxdo diiwaanka. Uma shaacin doono diiwaankaaga kuwa kale iyaddoo aan nagu jihayso in aanu sidaas samayno mooyee ama iyaddoo sharcigu ogolaado mooyee ama uu nagu khasbo in aan sidaas samayno. Wixii macluumaad dheeraad ah, fadlan la xidhiidh waaxdayada Diiwaanka Caafimaad:

International District Clinic	(000) 000-0000
Xxxxx Park Clinic	(000) 000-0000
Bellevue Clinic	(000) 000-0000
Shoreline Clinic	(000) 000-0000

Foomkan waxaa lagu xxxx doonaa diiwaankaaga caafimaad.

Saxeexayga xxxxx waxaan ku qirayaa helitaanka Ku dhaqanka Ogaysiiska Gaar ahaanshaha.

Magaca Buuxa ee Bukaan jiifka (DAABAC) Taariikhda dhalasho ee bukaanka

Saxeexa bukaanka ama wakiil amar haysta (haddii bukaanka ka yar yahay 18) Taariikh

Magaca oo baabacan ee wakiilka u saxeexay bukaanka Xidhiidhka

Fiiro

**Koobi ayaa la siiyay bukaanka ama wakiilka amar haysta.**

Ogeysiiska Hab-dhaqannada Asturnaanta

(Taariikhda Hirgalidda Sibtember 2013)

OGEYSIISKANI WAXA UU SHARAXAYAA SIDA MACLUUMAADKA CAAFIMAADKA XX XXXXX KUGU SAABSAN LOO ISTICMAALI DOONO LOONA BIXIN DOONO IYO SIDA ADIGU AAD MACLUUMAADKAN KU HELI KARTID.

XXXXXX SI TAXADIR LEH U AKHRI.

Waxa sharcigu naga rabaa in aanu illaalino asturnaanta macluumaadka caafimaadka ee badbaadsan oo aanu ku xxxxx ogeysiiska waajibaadkayaga sharci iyo hab-dhaqannadayada asturnaanta ee la xidhiidha macluumaadkaas. Waxa la naga rabaa in aanu adeecno qodobada Ogeysiiska Hab-dhaqannada Asturnaanta xx xxxxx jira, laakiin waxa noo dhawrsan xaqa in aanu wax ka beddelno qodobadaas wakhti kasta. Wixii isbeddelo ah waxay noqon doonaan kuwo hirgalaya isla markiiba waxana aad ka heli kartaa bartayada internetka (xxx.xxxx.xxx).

SIDA AANU U ISTICMAALI KARNO UNA BIXINA KARNO MACLUUMAADKAAGA CAAFIMAADKA EE BADBAADSAN

Xxxxxx Xxxxxxxxx. Waxa aanu macluumaadkaaga caafimadka u isticmaali karnaa in aanu ku xxxxx daweyn. Waxa aanu macluumaadka caafimaadka xx xxxxx kugu saabsan siin karnaa dhakhaatiir, kalkaalisooyin ama shaqaalaha cisbitaalka xx xxxx ee lug ku leh daryeelka lagugu siinayo cisbitaalka. Tusaale ahaan, waxa laga yaabaa in dhakhtarkaagu u baahdo inuu takhasusleyaal kala tashado daryeelkaaga. Macluumaadkaaga caafimaadka ee badbaadsan ayaa lala wadaagi doonaa si looga caawiyo xxxx xxxxxxx baahiyahaaga daryeel caafimaad.

Lacag-bixin. Waxa aanu isticmaali karnaa ama bixin karnaa macluumaadkaaga caafimaad ee badbaadsan si kharashka daweynta iyo adeegyada aad ka heshid International Community Health Services (“ICHS” ama “anaga”) loogu dalaco adiga, shirkad caymis ama cid saddexaad. Tusaale ahaan, waxa laga yaabaa in aanu u baahano in aanu caymiskaaga caafimaadka xxxxx macluumaad ku saabsan qalitaan laguu sameeyay si caymiskaaga caafimaadku noo siiyo lacag ama adiga kuugu soo celiyo kharashka qalitaanka. Macluumaadkaaga caafimaadka ee badbaadsan ma siin doono lacag-bixiye ah cid saddexaad iyada oo aan adiga lagaa haysan oggolaansho iyada oo sharcigu oggol yahay in sidaa la sameeyo mooyaane. Waxa aad xaq u leedahay inaad weydiisatid xadeyn la saaro bixinta macluumaadka caafimaadka ee badbaadsan ee la siin lahaa caymis caafimaad ama cid kale marka macluumaadkaasi ku saabsan kaliya daryeel caafimaad ama adeeg uu lacag naga siiyay adiga ama qof kale oo wakiil kaa ahaa (oo aan ahayn caymis caafimaad), waxana la naga rabaa in aanu aqbalno codsi sidaas oo kale ah.

Hawlaha Daryeelka Caafimaadka. Waxa laga yaabaa in aanu isticmaalo oo bixino macluumaadkaaga caafimaadka ee badbaadsan si loo fuliyo hawlo daryeel caafimaad. Isticmaaladaas iyo bixinnadaasi waxay lagama-maarmaan u yihiin in la sugo in dhammaan bukaankayagu ay helaan daryeel tayo leh. Tusaale ahaan, waxa laga yaabaa in aanu isticmaalno macluumaad caafimaad si loo qiimeeyo adeegyo daryeel caafimaad oo lagu siiyay ama si loo qiimeeyo waxqabadka shaqaalahayaga.

ISTICMAALADA XXXX XX LA OGGOL YAHAY EE LAGU SAMEYN KARO MACLUUMAADKAAGA CAAFIMAADKA EE BADBAADSAN IYADA OO AAN LOO BAAHAN OGGOLAANSHO HORMARIS AH OO LAGAA HELO

Shuraako Ganacsi. Qaar ka mid ah adeegyada laga bixinayo ICHS waxa loo maraa qandaraasyo xxxx xxxx shuraako ganacsi. Tusaalooyinka waxa mid ah shaybaadh, xisaab-hubiyeyaal dibadda ah, qareeno dibadda ah iyo kuwo kale. Markasta oo aanu heshiis u dhexeeya shuraako ganacsi iyo ICHS uu keenayo isticmaalka ama bixinta macluumaadkaaga caafimaadka ee badbaadsan, waxa aanu yeelan doonaa heshiis qoran oo badbaadin doona asturnaanta macluumaadkaaga caafimaadka ee badbaadsan.

Isgaadhsiin Lala Yeesho Cid Caawimaad ka Geysanaysa Gurmad Masiibo - Waxa laga yaabaa in aanu xxxxx macluumaadka caafimaadka ee badbaadsan cid caawimaad ka geysanaysa gurmad masiibo si qoyskaaga loo ogeysiin karo xaaladdaada, sida aad tahay, iyo goobtaada.

Xusuusin Ballamo - Waxa laga yaabaa in aanu xxxx xxx xidhiidhno si laguu xusuusiyo inaad leedahay ballan ku saabsan xxxxxx ama adeegyo daryeel caafimaad oo ah ICHS.

Daweyn Beddelaad ah – Waxa laga yaabaa in aanu macluumaadka caafimaadka ee badbaadsan isticmaalno si laguugu sheego ama laguugu taliyo ikhtiyaaro daweyn oo suurtogal ah ama beddelaadyo laga yaabo in aad xiiseynaysid.

Cilmi-baadhis - Xaaladaha qaarkood markay jiraan, ICHS waxa laga yaabaa inay isticmaasho oo bixiso macluumaad caafimaad dadweyne sababta oo ah ujeedooyin cilmi-baadhis caafimaad. Xaaladaha badidooda, waxa aanu ku weydiin doonaa inaad bixisid oggolaansho xxxx xx haddii cilmi-baadhuhu uu heli doono magacaaga, adreeskaaga, ama macluumaad kale oo sheegaya qofka aad tahay. Ka hor inta aanaanu macluumaad caafimaad u isticmaalin ama u bixin cilmi-baadhis. Xaaladaha badidooda, waxa aanu ku weydiin doonaa inaad bixisid oggolaansho xxxx xx haddii cilmi-baadhuhu uu heli doono magacaaga, adreeskaaga, ama macluumaad kale oo sheegaya qofka aad tahay. Waxa laga yaabaa, hase yeeshee, in aanu macluumaad caafimaad oo adiga kugu saabsan xxxxx dad diyaarinaya mashruuc cilmi-baadhis in alaale inta macluumaadka caafimaadku aanu dibadda uga bixin ICHS.

Sida Uu Amrayo Sharcigu - Waxa aanu macluumaadkaaga caafimaadka ee badbaadsan bixin doonaa marka in sidaa la sameeyo uu rabo sharciga federalka, gobolka, ama degmada.

Si Looga Baxsado Halis Culus oo ku Soo Fool Leh Caafimaadka ama Ammaanka - Waxa laga yaabaa in aanu isticmaalmo oo bixino macluumaadka caafimaadka ee badbaadsan marka ay lagama-maarmaan tahay si looga hortago halis culus oo ku soo aadan caafimaadkaaga ama caafimaadka iyo ammaanka dadweynaha ama qof kale. Hase yeeshee, bixin kasta oo la sameeyo waxay noqonaysaa mid la siiyo qof awoodi kara inuu ka hortago halista.

Deeqda Xxxxx iyo Cad Jidh - Haddii aad tahay deeq-bixiye xubin jidh, waxa laga yaabaa in aanu macluumaadkaaga caafimaadka ee badbaadsan siino hay’adaha ka shaqeeya keenista xubin jidh ama rakibidda xubin, il, ama cad ama xxxxx xxxx deeq-bixin xubin, taasoo xx xxxx ay lagama-maarmaan ugu tahay in la fududeeyo deeq-bixinta iyo rakibidda xubin ama cad jidh.

Ciidanka iyo Soo-yaalka Ciidan - Haddii aad ka tirsan tahay ciidamada qalabka sida, waxa laga yaabaa in aanu macluumaadkaaga caafimaadka ee badbaadsan u bixino sida ay u rabaan madaxda taliska ciidanka. Waxa kale oo laga yaabaa in aanu macluumaadka caafimaadka ee badbaadsan ee ku saabsan qof ka tirsan ciidan xxxxxxx xxxxx madaxa ciidan xxxxxxx xx haboon.

Magdhow Shaqaale - Waxa laga yaabaa in aanu bixino macluumaadkaaga caafimaadka ee badbaadsan oo xxxxx magdhowga shaqaalaha ama barnaamijyo la mid ah. Barnaamijyadaasi waxay bixiyaan kaalmooyin marka ay jiraan dhaawacyo ama cuduro la xidhiidha shaqo.

Caafimaadka Dadweynaha - Sida uu rabo sharcigu, waxa laga yaabaa in aanu macluumaadka caafimaadka ee badbaadsan siino hay’adda caafimaadka dadweynaha ama maamul sharci ah oo u xilsaaran ka hortagga ama xakameynta cudur, dhaawac, ama naafo.

Hawlaha Kormeerka Caafimaadka - Waxa laga yaabaa in aanu macluumaadka caafimaadka ee badbaadsan siino hay’ad kormeer caafimaad sababta oo ah hawlo uu oggolaaday sharcigu. Hawlahaas kormeeridda waxa ka mid ah, tusaale ahaan, xisaab-xxxxx, baadhitaano, xxxxx, iyo liisan bixin. Hawlahaasi waxay lagama-maarmaan u yihiin in dawladdu la socoto nidaamka daryeelka caafimaadka, barnaamijyada dawladda, iyo adeecidda xeerarka xuquuqda madaniga.

Dacwado iyo Muran - Haddii aad ku jirtid dacwad ama muran, waxa laga yaabaa in aanu macluumaadkaaga caafimaadka ee badbaadsan bixino si looga jawaabo amar maxkamad ama maamul. Waxa kale oo laga yaabaa in aanu macluumaadkaaga caafimaadka ee badbaadsan bixino si looga jawaabo yeedhis maxkamad, codsi daah ka qaadis, ama hab kale oo sharci ah oo uu la yimaado qof kale oo ku jira muranka.

Fulinta Sharciga - Waxa laga yaabaa in aanu macluumaadkaaga caafimaadka ee badbaadsan bixino haddii in sidaas la sameeyo uu weydiisto sarkaal fulin sharci:

• Iyada oo laga jawaabayo amar maxkamad, yeedhis maxkamad, amar imaansho maxkamad, amar yeedhis maxkamad, ama hab la mid ah;

• Si loo garto oo loo helo xx-xxxxx, qof baxsad ah, markhaati goobjooge ah, ama qof la waayay;

• Iyada oo ku saabsan dhibane dambi haddii, marka ay jiraan xaalado xxxx xx oo xadidan, aanaanu awoodin in aanu helno oggolaanshaha qofka;

• Iyada oo ku saabsan geeri aanu rumeysanahay inay ku timid fal dambi;

• Iyada oo ku saabsan dhaqan dambi ah oo ka dhacay ICHS;

• Marka ay jiraan xaalado kedis ama degdeg ah si looga warbixiyo dambi; goobta dambiga ama dhibaneyaasha; ama aqoonsiga, sharaxaadda, ama goobta qofka galay dambiga.

Geeri Baadheyaal, Baadheyaal Caafimaad, iyo Maamuleyaal Aasid - Waxa laga yaabaa in aanu macluumaadkaaga caafimaadka ee badbaadsan xxxxx geeri xxxxxx ama xxxxxx caafimaad. Tan wax laga yaabaa inay lagama-maarmaan tahay, tusaale ahaan, si loo garto qof dhintay ama loo go’aamiyo sababta geeri. Waxa kale oo laga yaabaa in macluumadka caafimaadka ee ku saabsan bukaanka cisbitaal aanu xxxxx maamuleyaal aasid taasoo xx xxxx ay lagama-maarmaan ugu tahay gudashada waajibaadkoodka.

Hawlaha Ammaanka Qaranka iyo War-ururinta - Waxa laga yaaba in aanu macluumaadkaaga caafimaadka ee badbaadsan xxxxx saraakiisha federalka ee amar haysta sababta oo ah war-ururin, lid-war-ururin, iyo hawlo ammaan qaran oo kale oo uu oggolaaday sharcigu.

ISTICMAALO IYO BIXINNO CAYIMAN OO U BAAHAN OGGOLAANSHO

Badi isticmaalka iyo bixinta qoraalada daweynta maskaxda, isticmaalka iyo bixinta macluumaadka caafimaadka ee badbaadsan ee ujeedkiisu yahay suuq-geyn, bixinta noqonaysa iibin macluumaad caafimaad oo badbaadsan, iyo isticmaalo iyo bixinno kale oo ku saabsan macluumaad caafimaad oo badbaadsan oo aan lagu sheegin Ogeysiiskan waxa kaliya ee la sameyn doonaa marka lagaa haysto oggolaansho qoran. Haddii aad ICHS siisid oggolaansho in la isticmaalo ama la bixiyo macluumaadka caafimaadka ee badbaadsan, waxa aad dib uga noqon kartaa oggolaanshahaas, wakhti kasta, qoraal ahaan. Haddii aad dib uga noqotid oggolaanshahaaga, waanu joojin doonaa in aanu macluumaadkaaga caafimaadka ee badbaadsan u isticmaalno ama u bixino sababaha uu sheegayo oggolaanshahaaga qoran. Waa inaad fahamtid in aanaanu awoodin in aanu dib u xxx xxxxxx wixii bixin ah ee aanu hore u sameynay iyada oo la adeegsanayay oggolaanshahaaga, iyo in la naga rabo in aanu hayno diiwaanada daryeelka aanu ku siinay.

Isgaadhsiin Lala Yeesho Qoyska iyo Saaxiibo - Waxa laga yaabaa in aanu macluumaadkaaga caafimaadka ee badbaadsan la wadaagno xubno qoys ama saaxiibo lug ku leh daryeelkaaga iyo/ama bixinta kharashka daryeelkaaga haddii aad noo sheegtid in aanu sidaa sameyn karno, ama haddii aanad diidin wadaagista macluumaadkan. Waxa kale oo laga yaabaa in aanu macluumaad muhimad leh la wadaagno dadkaas haddii, anaga oo isticmaalayna garaadkayaga xirfadeed, aanu rumeysan nahay in aanad diidanayn.

XUQUUQDAADA KU SAABSAN MACLUUMAADKAAGA CAAFIMAADKA EE BADBAADSAN

Inkasta oo diiwaankaaga caafimaad uu yahay hanti ay leedahay ICHS, adiga ayaa iska leh macluumaadkaaga caafimaadka ee badbaadsan. Waxa aad leedahay xuquuqda soo socota ee ku saabsan macluumaadkaaga caafimaadka ee badbaadsan:

Xxxx Xxxxxxxxxxx - Waxa aad xaq u leedahay koobi waraaq ah oo ah Ogeysiiskan. Waxa aad na weydiisan kartaa in aanu ku xxxxx koobi wakhti kasta. Waxa kale oo koobi ah ogeysiiskan aad ka heli kartaa bartayada internetka: xxx.xxxx.xxx.

Xaqa Inaad Fiirisid oo Koobigareysid - Waxa aad xaq u leedahay inaad fiirisid oo koobi ka heshid macluumaadka daryeelka caafimaadka qaarkood ee kugu saabsan uuna ku jiro diiwaanada lacag-dalacidda. Waa inaad codsigaaga ku soo gudbisid qoraal ahaan kuna soo hagaajisid:

International Community Health Services Attn: Health Center Manager

PO Box 3007, Seattle WA 98114-3007

Haddii aad weydiisatid koobi ah macluumaadkaas caafimaad ee badbaadsan, waxa laga yaabaa in aanu kharash saarno hawlaha koobigareynta, ku soo dirista boosta, ama alaabta xxxx xx la xidhiidha codsigaaga.

Waxa dhici karta in aanu diidno codsigaaga inaad fiirisid oo koobigareysid marka ay jiraan xaalado xadeysan oo cayiman. Haddii laguu diido inaad heshid diiwaankaaga caafimaadka, waxa aad weydiisan kartaa in diidmada dib looga fiirsado. Waanu adeeci doonaa natiijada ka soo baxda dib-u-fiirinta.

Xaqa Weydiisasho Wax-ka-beddelid - Waxa aad xaq u leedahay inaad weydiisatid in macluumaadkaaga caafimaadka ee badbaadsan wax laga beddelo adiga oo codsi qoraal ah siinaya Maamulahayaga Xarunta Caafimaadka. Waxa aanu xaq u leenahay in aanu diidno codsigan marka ay jiraan xaaladaha qaarkood. Waxa aad soo qoran kartaa hadal khilaafid haddii codsigaaga la diido. Hadalka khilaafidda waxa lagu kaydin doonaa diiwaankaaga caafimaadka, waxana lagu dari doonaa bixin kasta oo lagu sameeyo diiwaanadaada.

Xaqa Xisaabin Lagu Sameeyo Bixinta - Waxa aad xaq u leedahay inaad heshid xisaabinta bixinta. Kani wuxu ku saabsan yahay diiwaanka bixinnada qaarkood ee aanu ku sameynay macluumaadkaaga caafimaadka ee badbaadsan iyada oo waafaqsan sharciga.

Waa inaad codsigaaga oo qoraal ah u keentid Maamulaha Xarunta Caafimaadka. Waxa dhici karta in aanu ku saarno kharashka siinta diiwaanka. Waanu ku ogeysiin doonaa kharashka meesha ku jira, waxana aad dooran kartaa inaad codsigaaga dib uga noqotid ama wax ka beddeshid wakhtigaas ka hor inta aanuu ku fuulin wax kharash ah. Maamulaha Xarunta Caafimaadka waxa xxxxxx xidhiidhi karaa adreeska soo socda:

International Community Health Services Attn: Health Center Manager

PO Box 3007, Seattle WA 98114-3007

Xaqa Codsiga Xadeynta - Waxa aad xaq u leedahay inaad na weydiisatid in aanu xadeyno isticmaalada iyo bixinnada qaarkood ee ku saabsan macluumaadka caafimaadka ee badbaadsan. Tusaale ahaan, waxa aad na weydiisan kartaa in aanu xad u yeelno macluumaadka caafimaadka ee badbaadsan ee aanu xxxxx qof lug ku leh daryeelkaaga ama bixinta kharashka daryeelkaaga. Waxa aad na weydiisan karta in aanaanu isticmaalin ama in macluumaadkaaga caafimaadka ee badbaadsan ee ku saabsan qalitaan laguu sameeyay aanaanu siin xubin qoys ama saaxiib. Waa inaad codsigaaga qoraal ahaan ugu soo gudbisid Maamulaha Xarunta Caafimaadka. Codsigaaga dhexdiisa, waa inaad noogu soo sheegtid (1) ka uu yahay macluumaadka aad rabtid in la xadeeyo; (2) inaad rabtid in la xadeeyo isticmaalkayaga, bixinta ama labadaba; iyo (3) cidda aad rabtid in lagu dabaqo xadeynta, tusaale ahaan, macluumaad la siin lahaa xaaskaaga/saygaaga; hase yeeshee, qasab naguma ah in aanu aqbalno xadeynta la codsaday.

Xaqa Codsiga Isgaadhsiin Qarsoodi ah - Waxa aad xaq u leedahay inaad na weydiisatid in marka ay jiraan arrimo caafimaad qaarkood aanu kuula soo xidhiidhno hab xxxx xx ama kaala soo xidhiidhno goob xxxx xx. Tusaale ahaan, waxa aad na weydiisan kartaa in aanu kaala soo xidhiidhno kaliya shaqada ama boostada.

Si aad u weydiisatid isgaadhsiin qarsoodi ah, waa inaad codsigaaga qoraal ahaan ugu soo gudbisid Maamulaha Xarunta Caafimaadka. Kuma weydiin doono sababta codsigaaga. Waa in codsigaagu sheegayo sida ama goobta aad rabtid in lagaala soo xidhiidho. Waanu tixgalin doonaa dhammaan codsiyada caqli-gal ah.

Xaqa in Lagu Soo Ogeysiiyo Xadgudub – Waxa aad xaq u leedahay in lagu soo ogeysiiyo xadgudub lagu sameeyay macluumaad caafimaad oo badbaadsan oo baylah ahaa.

Cabashooyin

Haddii aad aaminsan tahay in lagu xadgudbay xuquuqdaada asturnaanta, waxa aad la xidhiidhi kartaa ICHS Compliance Officer (Sarkaalka Adeecidda ee ICHS) oo lambarkiisu yahay 206.788.3658 ama cabashadaada qoraal ahaan ugu soo gudbi ICHS Compliance Officer (Sarkaalka Adeecidda ee ICHS) oo adreeskiisu yahay PO Box 3007; Seattle, WA 98114-3007.

Waxa kale oo aad cabasho ka xereysan kartaa Secretary of the U.S. Department of Health and Human Services (Xoghayaha Wasaaradda Caafimaadka iyo Adeegyada Bini’aadanka ee Maraykanka).

Tayada daryeelkaagu ma gali doonto halis ama lagaama aargoosan doono sababta oo ah cabasho aad xereysatay.

Haddii aad qabtid wax su’aalo ah oo ku saabsan ogeysiiskan, fadlan ICHS Compliance Officer (Sarkaalka Adeecidda ee ICHS) kala xidhiidh 206.788.3658.