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Statement of Patient Rights

As a healthcare facility, we are committed to delivering quality medical care to you, our patient, and to making your stay as pleasant as possible. The following "Statement of Patient Rights," endorsed by the administration and staff of this hospital, applies to all patients. In the event that you are unable to exercise these rights on your own behalf, these rights are applicable to your designated/legal representative. As it is our goal to provide medical care that is effective and considerate within our capacity, mission, and philosophy, applicable law and regulation, we submit this to you as a statement of our policy.

• You have the right to respectful care given by competent personnel, which reflects consideration of your personal value and belief systems and which optimizes your comfort and dignity.
• You have the right to know what hospital rules and regulations apply to your conduct as a patient.
• You have the right to expect emergency procedures to be implemented without unnecessary delay.
• You have the right to good quality care and high professional standards that are continually maintained and reviewed.
• You have the right to expect good management techniques to be implemented within the hospital, the avoidance of unnecessary delays, and when possible, the avoidance of personal discomfort through effective pain management.
• You have the right to medical and nursing services without discrimination based upon race, color, religion, gender, sexual preference, handicap, national origin, or source of payment.
• You have the right to make decisions involving your healthcare. Those rights apply to the family and/or guardian of newborns, children, and adolescents.

While the hospital recognizes your right to participate in your care and treatment to the fullest extent possible, there are circumstances under which you may be unable to do so. In these situations (e.g., if you have been adjudicated incompetent in accordance with law, or found by your physician to be medically incapable of understanding the proposed treatment or procedure, are unable to communicate your wishes regarding treatment, or are an unemancipated minor) your rights are to be exercised, to the extent permitted by law, by your designated representative or other legally designated person.

• You have the right to make decisions regarding the withholding of resuscitative services or the forgoing of or the withdrawal of life-sustaining treatment within the limits of the law and the policies of this institution.
• You have the right, upon request, to be given the name of your attending physician, the names of all other physicians or practitioners directly participating in your care, and the names and professional status of other healthcare personnel, including medical students, residents or other trainees, having direct contact with you.
• You have the right to every consideration of privacy concerning your medical care program. Case discussion, consultation, examination, and treatment are considered confidential and should be conducted discreetly giving reasonable visual and auditory privacy when possible, to have someone present while physical examination, treatment, or procedure is being performed, as long as they do not interfere with diagnostic procedures or treatment, and to request a room transfer if another patient or a visitor in the room is unreasonably disturbing you and another room equally suitable for your care need is available.
• You have the right to have all information, including records, pertaining to your medical care treated as confidential except as otherwise provided by law or third-party contractual arrangement.
• You have the right to have your medical records read only by individuals directly involved in your care, by individuals monitoring the quality of your care, or by individuals authorized by law or regulation. The hospital shall provide you, or your designated/legal representative, upon request, access to all information contained in your medical records, unless access is specifically restricted by the attending physician for medical reason.
• You have the right to be communicated with in a manner that is clear, concise and understandable. If you do not speak English or are hearing impaired, you may request an interpreter or any auxiliary aid.
• You have the right to full information in layman's terms, concerning diagnosis, treatment, and prognosis, including information about alternative treatments and possible complications. When it is not medically advisable that such information be given to you, the information shall be given on your behalf to your designated/legal representative.

Except for emergencies, the physician must obtain the necessary informed consent prior to the start of any procedure or treatment, or both.

• You have the right not to be involved in any experimental, research, donor program, or educational activities unless you have, or your designated/legal representative has, given informed consent prior to the actual participation in such a program. You or your designated/legal representative may, at any time, refuse to continue in any such program to which informed consent has previously been given.
• You have the right to accept medical care or to refuse any drugs, treatment, or procedure offered by the hospital, to the extent permitted by law, and a physician shall inform you of the medical consequences of such refusal.
• You have the right to participate in the consideration of ethical issues surrounding your care, within the framework established by this organization to consider such issues. If you are concerned about any ethical issues related to your care, an Ethics Consultation service is available. To access this service, request it through your doctor or nurse.
• You have the right to formulate an "advance directive" or to appoint a surrogate to make healthcare decisions on your behalf. These decisions will be honored by this hospital and its healthcare professionals within the limits of the law and this organization's mission values and philosophy.

If applicable, you are responsible for providing a copy of your "advance directive" to the hospital.

You are not required to have or complete an "advance directive" in order to receive care and treatment in this facility.

• You have the right to assistance in obtaining consultation with another physician at your request and expense.

When this hospital cannot meet the request or need for care because of a conflict with our mission or philosophy or incapacity to meet your needs or requests, you may be transferred to another facility when medically permissible. Such a transfer should be made only after you or your designated/legal representative has received complete information and explanation concerning the needs for, and alternatives to, such a transfer. The transfer must be acceptable to the other institution.

• You have the right to examine and receive a detailed explanation of your bill.
• You have the right to full information and counseling on the availability of known financial resources for your healthcare.
• You have the right to expect that the healthcare facility will provide a mechanism whereby you are informed upon discharge of continuing healthcare requirements following discharge and the means for meeting them.

You cannot be denied the right of access to an individual or agency that is authorized to act on your behalf to assert or protect the rights set out in this section. If disabled, you have the right to expect reasonable and equal access to the facilities, services and programs of this hospital.

Information regarding your rights as a patient should be provided to you during the admissions process or at the earliest possible appropriate moment during the course of your hospitalization.

• You have the right, without recrimination, to voice complaints regarding your care, to have those complaints reviewed and, when possible, resolved.

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Statement of Patient Responsibilities

As a patient, you should assume responsibility for the following:

The hospital expects that you or your designated/legal representative will provide accurate and complete information about present complaints, past illnesses, hospitalizations, medications, "advance directives," and other matters relating to your health history or care in order for you to receive effective medical treatment.

In addition, you are responsible for reporting whether you clearly comprehend a contemplated course of action and what is expected of you.

The hospital expects that you will cooperate with all hospital personnel and ask questions if directions and/or procedures are not clearly understood.

You are expected to be considerate of other patients and hospital personnel, to assist in the control of noise and visitors in your room, and to observe the smoking policy of this institution. You are also expected to be respectful of the property of other persons and the property of the health center.

In order to facilitate your care and efforts of the hospital personnel, you are expected to help the physicians, nurses, and allied medical personnel in their efforts to care for you by following their instructions and medical orders.

Duly authorized members of your family or designed/legal representative are expected to be available to hospital personnel for review of your treatment in the event you are unable to properly communicate with our healthcare givers.

It is understood that you assume the financial responsibility of paying for all services rendered, whether through third-party payers (your insurance company) or being personally responsible for payment for any services that are not covered by your insurance policies.

It is expected that you will not take drugs that have not been prescribed by your attending physician and administered by hospital staff and that you will not complicate or endanger the healing process by consuming alcoholic beverages or toxic substances during your hospital stay.

Being a good patient does not mean being a silent one. If you have questions, problems, or unmet needs ... please let us know. If you would like further clarification of the "Rights and Responsibilities" as they pertain to you, please contact the Director of Patient Care Services on your unit.

This Statement of Patient Rights was developed in collaboration with the Hospital Association of Pennsylvania, the Pennsylvania Society of Patient Representation and Consumer Affairs, and the Joint Commission on Accreditation of Healthcare Organizations.

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Patient Privacy and Confidentiality

The Uniontown Hospital staff respects your privacy concerns. We hope to enhance the quality of your visit by honoring the privacy of information choices that you've selected. The following information will explain what you can expect with each of your options. We will do our best to protect your privacy, but we ask for your understanding and cooperation.

Uniontown Hospital maintains the strictest confidentiality in providing your care. Consultations, examinations and discussions about your treatment are held in strict privacy by our staff. All records pertaining to your care are considered to be confidential, unless you instruct us otherwise.

Controlling the Release of Information is a very important practice. Admitting staff will ask if you want your name, location and condition released to the general public. If you agree to this, anyone asking for you by your full name will be given your location/room number and may also be given your condition in general terms. Release of Information also means that you will receive phone calls and visitors (unless specific arrangements are otherwise made with your nurses station). Members of the clergy will also be able to access your religious affiliation under this option.

If you choose No Release of Information, Uniontown Hospital will not release your name, location/room number or condition to anyone. Inquires about you will be answered, "I'm sorry, but I have no information on that person." No Release of Information also means that you will not receive any phone calls or visitors. In addition, No Release of Information means that members of the clergy will not be given your name. Patients choosing not to release information must provide the Admissions Office with written authorization for denial to release information. We ask for your understanding and cooperation as we make every effort to protect your privacy.

Any concerns about your privacy options can be discussed with your nurse or the Director of Patient Care Services on your unit.

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Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review carefully.

► Who will follow this notice?

The information practices in this notice will be followed by:

• Any health care professional who is allowed to enter information into your health record (such as nurses or members of the hospital’s medical staff);
• All departments of the companies listed above;
• All employees, staff, and volunteers of the organization;
• Any business associate with whom we share health information.

The above individuals may share medical information with each other for treatment, payment, or health care operations purposes described in this notice.

► Our Pledge Regarding Medical Information

We realize that medical information about you and your health is personal. We are committed to protecting that information. We create a record of the care and services you receive to provide quality care and to comply with the law. This notice applies to all the records of your care that we keep, whether created by the organization’s personnel or another physician. Another physician may have different policies or notices regarding that physician’s use and disclosure of your medical information maintained in his/her office.

We are required by law to:

• Make sure that medical information about you is kept private;
• Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
• Follow the terms of the notice that is currently in effect.

► How we may use and disclose medical information about you

• Treatment – We may use and disclose medical information about you for treatment (such as sending medical information about you to a specialist as part of a referral).
• Payment – We may use medical information about you for payment (such as sending a bill, which may contain information about a surgery you had, to your insurance company).
• Health Care Operations – We may use medical information about you for normal health care operations (such as comparing patient data to improve quality of care, combining information about many patients to decide which services the organization should offer, or for accreditation purposes).
• If you are admitted to the hospital, we may include certain limited information about you in our hospital directory, unless you tell us otherwise. We will only list your name, location, general condition (good, fair, etc), and religious affiliation. We will release all but your religious affiliation to anyone who asks for you by name. Your religious affiliation may be disclosed to a clergy member, even if they don’t ask for you by name.
• We may use or disclose medical information about you without your prior authorization for limited purposes permitted under the Federal Privacy Rule. Subject to certain requirements we may release medical information about you for public health purposes (such as reporting disease, injury, or vital events), for health product recalls, abuse or neglect reporting, health oversight activities (such as audits or investigations to determine compliance with relevant laws), research that has received the necessary approval, to a coroner or medical examiner as required, funeral arrangements, organ donation, worker’s compensation purposes, if you are an inmate of a correctional institution, or in an emergency. We may disclose medical information when required by law or certain judicial or administrative proceedings such as in response to a court order or subpoena.
• We may contact you for appointment reminders, or to tell you about treatment options.
• We may contact you to tell you about our health-related products and services that may be of interest to you.
• If you are treated at the hospital, we may use such information as name, address, phone number, and dates you received service to contact you for fundraising purposes. If you do not want to be contacted for fundraising efforts, notify the Business Ethics Department at 500 West Berkeley Street, Uniontown, PA 15401.
• We may disclose medical information about you to a family member or friend who is involved in your care, or to disaster relief organizations so that your family may be contacted.
• If you are a member of the armed forces, we may release information to the military or veterans’ authorities.
• We may release medical information to prevent a serious threat to the health or safety of another person or the public, for certain national security or intelligence activities, or to protect the President or other authorized persons or heads of state.

► Other Uses of Medical Information

Other uses and disclosures not covered in this notice will be made only with your written permission. If you do permit another use or disclosure, you may later change your mind and cancel your permission in writing. Please understand that we cannot take back any disclosures we had already made while we had your permission.

► Changes to this Notice

We reserve the right to change this notice. Changes will apply to medical information we already hold. We will post a copy of the Notice in our facilities and on our website (www.uniontownhospital.com).

► Your Rights Regarding Medical Information About You

• Except under limited circumstances, you have the right to inspect and copy medical information about you by submitting a written request. If you request a copy, we may charge a fee for the costs of copying, mailing, and related supplies. If we deny your request to inspect and copy, you may submit a written request for review of that decision.
• If you feel that medical information about you is incorrect or incomplete, you may submit in writing a request to amend the record. We may deny your request if the information was not created by us, is not part of the medical record maintained by us, or if we determine that the information is accurate. If your request is denied, you will receive a written explanation of the denial and information about further rights you would have at that point.
• You have a right to obtain a list of the disclosures of your medical information other than for treatment, payment, health care operations, or where you specifically permitted a disclosure. Your request must state a time period not longer than six years and may not be prior to April 14, 2003. The first disclosure list in a 12-month period is free; for additional lists, we may charge for the costs of providing the list. We will notify you of the fee ahead of time.
• You have the right to request (in writing) a restriction or limitation on the medical information we use or disclose for treatment, payment, or health care operations or to someone involved in your care except as required by law or in an emergency. We will consider your request but we are not legally required to accept it. We will inform you of our decision regarding your request.
• You have the right to request that medical information about you be communicated in a confidential manner, such as a different address. You must submit the request in writing.
• You have the right to receive a paper copy of this notice, even if you received a copy electronically.

If you wish to exercise any of these rights, please contact the Medical Records Department at Uniontown Hospital, Fayette Medical Associates or Fayette Home Care.

► Questions

If you have any questions about this notice, please contact the Privacy Officer at 500 West Berkeley Street, Uniontown, PA 15401 (724) 430-5980.

► Complaints

If you believe your privacy rights have been violated you may submit, in writing, a complaint to the Privacy Officer at 500 West Berkeley Street, Uniontown, PA 15401 or you may call the Business Ethics Hotline 1-888-220-LINE.

You may also submit a complaint to the U.S. Department of Health and Human Services Office for Civil Rights.

You will not be penalized for filing a complaint.

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Uniontown Hospital, 500 West Berkeley Street, Uniontown, PA 15401 • (724) 430-5000
© 2006 Uniontown Hospital. All Rights Reserved.