PATIENT’S BILL OF RIGHTS AND RESPONSIBILITIES
The staff of Integrity Wellness Center recognizes you have rights while you are a patient receiving medical care. In return, there are responsibilities for certain behavior on your part as the patient.
A patient has the right to
Ø be treated with respect, consideration, and dignity, and provided appropriate privacy.
Ø a prompt and reasonable response to questions and requests.
Ø have patient disclosures and records treated confidentially and be given the opportunity to approve or refuse the release of information.
Ø be provided information about treatment, planned course of treatment, alternatives, risks and expected outcomes and be given the opportunity to participate in decisions involving care.
Ø receive information about his rights, patient conduct and responsibilities, services available at The Integrity Health Wellness Centers,
provisions for care after-hours and in an emergency, fees for services, and payment policies.
Ø know if medical treatment is for purposes of experimental research and to give his consent or refusal to participate in such experimental research.
Ø receive information to assure understanding of any marketing or advertising regarding the competence and/or capabilities of the organization.
Ø receive information about how providers are credentialed to provide care at this facility.
Ø change primacy or specialty physicians if other qualified physicians are available.
A patient is responsible for
Ø using the best ability to provide to the health care provider accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to the patient’s health.
Ø reporting to the health care provider any unexpected changes in patient’s health condition.
Ø reporting to the health care provider whether there are questions about the contemplated course of action and expected patient responsibilities.
Ø keeping appointments and following the treatment plan recommended by the provider.
Ø actions if treatment is refused or the health care provider’s instructions are not followed.
Ø assuring that the financial obligations for services are fulfilled as promptly as possible.
Ø following health care facility rules and regulations affecting patient care and conduct.
COMPLAINTS
If you have a question or concern about your rights or responsibilities, please let us know. We want to assure that we provide you with excellent service, including answering your questions and responding to your concerns.
GRIEVANCE PROCESS
If you have a complaint regarding your care of service at IWC please let it be known by asking for the Director of Nursing or the Administrator. We want to hear from you if you have a concern.
You may also call the Texas Department of State Health Services at (888) 973-0022 or write: Texas Department of State Health Services, Director of Health Facility Licensure and Compliance, 1100 West 49th Street, Austin, Texas 78756-3199.
For information or grievance procedures to the Medicare Ombudsman please visit: www.cms.hhs.gov/center/ombudsman.asp
OWNERSHIP DISCLOSURE
IWC is privately owned and no physician has a financial interest in the surgery center. If you have questions regarding this matter, please ask for the administrator.
ADVANCED DIRECTIVE POLICY
ALL PATIENTS HAVE THE RIGHT TO PARTICIPATE IN THEIR OWN HEALTH CARE DECISIONS AND TO MAKE ADVANCED DIRECTIVES OR TO EXECUTE POWERS OF ATTORNEY THAT AUTHORIZE OTHERS TO MAKE DECISION ON THEIR BEHALF BASED ON THE PATIENT’S EXPRESSED WISHES WHEN THE PATIENT IS UNABLE TO MAKE DECISIONS. THIS SUGERY CENTER RESPECTS AND UPHOLDS THOSE RIGHTS. HOWEVER, UNLIKE IN AN ACUTE CARE HOSPITAL SETTING, THE SURGERY CENTER DOES NOT ROUTINELY PERFORM “HIGH RISK” PROCEDURES, MOST PROCEDURES PERFORMED IN THIS FACILITY ARE CONSIDERED TO BE OF MINIMAL RISK. OF COURSE, NO SURGERY IS WITHOUT RISK. YOU WILL HAVE THE OPPORTUNITY TO DISCUSS THE SPECIFICS OF YOUR PROCEDURE WITH YOUR PHYSICIAN WHO CAN ANSWER YOUR QUESTIONS AS TO ITS RISKS, YOUR EXPECTED RECOVERY AND CARE AFTER YOUR SURGERY. THEREFORE, IT IS OUR POLICY, REGARDLESS OF THE CONTENTS OF ANY ADVANCED DIRECTIVE OR INSTRUCTIONS FROM A HEALTH CARE SURROGATE OR ATTORNEY IN FACT, THAT IF AN ADVERSE EVENT OCCURS DURING YOUR TREATMENT AT THIS FACILITY WE WILL INITIATE RESUSCITATIOVE OR OTHER STABILIZING MEASURES AND TRANSFER YOU TO AN ACUTE CARE HOSPITAL FOR FURTHER EVALUATION. AT THE ACUTE CARE HOSPITAL FURTHER TREATMENT OR WITHDRAWAL OF TREATMENT MEASURES ALREADY BEGUN WILL BE ORDERED IN ACCORDANCE WITH YOUR WISHES, ADVANCED DIRECTIVE OR HEALTH CARE POWER OF ATTORNEY, YOUR AGREEMENT WITH THIS POLICY BELOW DOES NOT REVOKE OR INVALIDATE ANY CURRENT HEALTH CARE DIRECTIVE OR HEALTH CARE POWER OF ATTORNEY.
ACKNOWLEDGEMENT:
Please date and check one of the below
DATE: ________________________
I received a copy of my rights and have had an opportunity to ask questions.
I received a copy of my rights and have made comments pertaining to them or my concerns on the reverse of this sheet or as attached.
Patient or Guarantor Signature: ______________________________________________________
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