|Patient Health Information Authorization Form|
- The patient has the right to considerate, courteous, respectful care in a safe setting.
- The patient has the right to, and is encouraged to, obtain from physicians and other direct caregivers relevant, current, and understandable information - in the patient's own language - concerning diagnosis, treatment, and prognosis.
- Except in emergencies when the patient lacks decision-making capacity and the need for treatment is urgent, the patient is entitled to the opportunity to discuss, to be listened to, and to request information related to the specific procedures and/or treatments, the risks involved, the possible length of recuperation, and the medically reasonable alternatives and their accompanying risks and benefits.
Patients have the right to know the identity of physicians, nurses, and others involved in their care, as well as when those involved are students, residents, or other trainees. The patient also has the right to know the immediate and long-term financial implications of treatment choices, insofar as they are known. The patient has the right to have a family member (or representative of his/her choice) and his/her physician notified promptly of his/her admission to the hospital. All patients are entitled to information about outcomes of diagnostic tests, medical treatment and surgical interventions, anticipated or unanticipated. Any adverse or unanticipated outcome in care or treatment results in honest explanation to the patient or patient's representative as quickly as possible.
- The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to other appropriate care and services that the hospital provides or transfer to another hospital. The hospital should notify patients of any policy that might affect patient choice within the institution.
- The patient has the right to have an Advance Directive (such as a living will, or appointment of health care agent) concerning treatment or designating a surrogate decision-maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy. Health care institutions must advise patients of their rights under state law and hospital policy to make informed medical choices, ask if the patient has an Advance Directive, and include that information in patient records. The patient has the right to timely information about hospital policy that may limit its ability to implement fully a legally valid advance directive.
- The patient has the right to every consideration of privacy. Case discussion, consultation, examination, and treatment should be conducted so as to protect each patient's privacy.
- The patient has the right to expect that all communications and records pertaining to his/her care will be treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasize the confidentiality of this information when it releases it to any other parties entitled to review information in these records.
- The patient has the right to be free from restraints of any form that are not medically necessary. Physical and medicinal restraints are only used if needed to improve the patient's well-being and less restrictive measures have been found to be ineffective to protect the patient or others from harm.
- The patient has the right to appropriate assessment and management of pain.
- The patient has the right to review the records pertaining to his/her medical care within a reasonable time frame and to have the information explained or interpreted as necessary, except when restricted by law.
- The patient has the right to expect that, within its capacity and policies, the hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service and/or referral as indicated by the urgency of the case. When medically appropriate and legally permissible, or when a patient has so requested, a patient may be transferred to another facility. The institution to which the patient is to be transferred must first have accepted the patient for transfer. The patient must also have the benefit of complete information and explanation concerning the need for, risks, benefits, and alternatives to such a transfer.
- The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient's treatment and care.
- The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting care and treatment or requiring direct patient involvement, and to have those studies fully explained prior to consent. A patient who declines to participate in research or experimentation is entitled to the most effective care that the hospital can otherwise provide.
- The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate. The patient has the right to obtain an up-to-date list of all his/her current medications as a partner in continuity of care and medication accuracy.
- The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities. The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, i.e. Patient Care Advisory (Ethics) committee, Quality Manager. The patient has the right to be informed of the hospital's charge for services and available payment methods.
- The patient has the right to choose a family member, friend, or other individual to be their support person, who can be present with the patient to provide emotional support, comfort, and to alleviate fear. This person can be a part of the care process provided it does not interfere with the rights of other patients or interfere with the care process. Likewise, the patient designates who may visit him/her and can withdraw or deny visitors at any time. The hospital does not restrict, limit or deny visitation privileges based on race, color, national origin, religion, sex, gender identity, sexual orientation, or disability.