Patient Rights & Responsibilities

You, the patient, have the right:

1) To be informed about Vernon Memorial Healthcare’s services, health care providers, admission, transfer, discharge, billing policies, and your rights and responsibilities as a patient.

2) Not to be denied appropriate hospital care because of race, creed, color, national origin, ancestry, religion, sex, sexual orientation, marital status, handicap or source of payment.

3) To expect confidentiality regarding your health information.

4) To be treated with dignity and respect, and recognition of your individuality and personal needs, including the need for privacy during treatment.

5) To be treated in a safe, supportive and smoke-free environment.

6) To be entitled to know who has overall responsibility for your care.

7) To request restrictions or a limitation on the medical information we use or disclose about you for treatment, payments or healthcare operations. You also have the right to request a limit on the medical information we disclose to someone who is involved in your care. We are not required to agree with your request.

8) To receive a written notice of how your health care information may be disclosed and how you can get access to this information. To request this list or accounting of disclosures, you must submit your request in writing to the Manager of Health Information. Your request must state a time period, not longer than six years, and may not include dates before February 26, 2002. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list.

9) A right to request your health information is not shared with your payment source such as your insurance provider.

10) To inspect and copy your medical record, in accordance to law, with written request during regular business hours and at a reasonable cost through the Health Information Management Department. We may deny your request to inspect and copy in certain very limited circumstances. You may request the denial to be reviewed. Another licensed health care professional chosen by the hospital will review your request and the denial. We will comply with the outcome of the review.

11) To request your record be amended or corrected if inaccurate or incomplete. Your request must be made in writing and
submitted to the Manager of Health Information. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

a. Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
b. Is not part of the medical information kept by or for the hospital;
c. Is not part of the information which you would be permitted to inspect and copy;
d. Is accurate and complete;
 
12) To revoke any consent or authorization;

13) To choose how the hospital contacts you after discharge, i.e. lab results, appointments, billing. For example, you can ask that we only contact you at work or by mail.

14) To be able to restrict who will have access to your health information. To request restrictions, you must make your request in writing to the Health Information Manager. In your request you must tell us:

a. What information you want to limit
b. Whether you want to limit our use, disclosure or both; and
c. To whom you want the limits to apply, for example, disclosures to your spouse.

15) To express your concerns or complaints about your hospital stay to any of your caregivers or the Patient Advocate. You may call our Privacy Hotline at 637-4210. Issues may also be addressed to:

Vernon Memorial Healthcare
Sue Sullivan
Compliance Officer
608.637.4312

Dept. of Health Services
Bureau of Quality Assurance
1 West Wilson St., Room 450
Madison, WI 53701-2969
800.642.6552
http://dhs.wisconsin.gov

KEPRO (QIO)
5201 W. Kennedy Blvd.
Suite 900
Tampa, FL 33609
855.408.8557

16) To receive current information about your diagnosis, treatment and prognosis in terms you can understand.

17) Except in emergencies, consent to treatment, or your legal representative consent to treatment, will be obtained prior to treatment being administered.

18) To participate to the extent possible in planning for your care and treatment.

19) To give your consent prior to start of treatment or participation in any form of research.

20) To make informed decisions regarding your care and to refuse treatment and be informed of the consequences of the refusal.

21) To receive an explanation, if you need to be transferred, provision for your continuing care and acceptance by the receiving facility.

22) To examine and receive an explanation of your hospital bill and, when requested, receive information about financial assistance available through the hospital.

23) To formulate an advance directive regarding your medical decisions, and to expect the hospital to honor that directive.

24) To be informed of your rights regardless of your ability to see, hear, or any other communication challenges.

25) To receive visitors that you choose, and a right to deny a visitor at any time. See your “Visitation Rights” handout.

26) To be assured that a concerned staff is committed to pain prevention and management in caring for you, and to educate you concerning your role in your pain management as well as limitations and side effects of pain treatments.

You, the patient, have the responsibility:

 

1) To provide to the best of your knowledge any personal information including any changes in address, telephone numbers, employment, insurance or payor source.

 

2) To be considerate of the rights and property of other patients and staff and to adhere to smoking and visitation policies.

 

3) To maintain the privacy of health information regarding other patients acquired during your stay.

 

4) To cooperate in the planning of your care and treatment.

 

5) To provide a complete and accurate medical history.

 

Release of Protected Health Information