Your health care at Story County Medical Center is a cooperative effort between you, your physician and the Medical Center staff. This facility maintains policies, procedures and ongoing programs to ensure that all personnel protect the following rights of each patient.

Notice of Rights

Each patient has the right to be informed orally and in writing in a language that the patient understands of all of the patient’s legal rights at the time of admission and to be kept informed of changes in these rights. Receipt of such information, and any amendments to it, must be acknowledged in writing. The patient has a right to periodic review of information pertaining to rights. Each patient has the right to be informed of any other rights and rules and regulations governing his or her conduct and responsibilities as a patient of the facility.

Each patient has the right to be fully informed of all services provided by the facility, services that the patient may be charged with, the amount of the charge, and services for which the patient may not be charged, and any charges for those services and any adjustments made in the same. Each patient has access to and an may request an explanation to patient billings. If eligible for financial assistance the patient has the right to be informed of those services for which the patient will or will not be charged and the amount of such charges.

Each patient has the right to be informed orally and in writing in a language that the patient understands about how to apply for and use financial assistance, and how to receive refunds for previous payments covered by such benefits. All rights and responsibilities of the patient devolve to the patient’s next-of-kin, guardian, or sponsoring agency(ies) where the patient is adjudicated incompetent pursuant to law. This statement contains the general rights of each patient and is not all-inclusive. Specific provisions implementing these general rights are included in the facility’s policies and procedures, which are available upon request.

Exercise of Rights

Each patient will have access to treatment regardless of race, color, creed, sex, beliefs, national origin, age, diagnosis, handicap, or of payment for care.

Each patient has the right to considerate and respectful care and to be treated with honesty, dignity, respect and with reasonable accommodation of individual needs except where the health, safety, or rights of the individual or other patients would be endangered. It is recognized that every patient is an individual who has feelings, preferences, personal needs and requirements.

Each patient has the right to retain and use personal possessions, including some furnishings, and appropriate clothing, as space permits unless to do so would infringe upon the rights or health and safety of other patients.

Each patient will not be relocated within the facility, arbitrarily. Each patient, and if known, the patient’s legal representative or interested family member has the right to receive notice before the patient’s room or roommate in the facility is changed.

Each patient has the right to examine upon reasonable request the results of the most recent survey of the facility conducted by a federal or state agency as well as any plan of correction which exists with respect to the facility. Each patient has the right to receive information from agencies acting as client advocates, and be afforded the opportunity to contact these agencies.

Each patient has the right to consult with a specialist at the patient’s request and expense, to choose his or her physician, and to have his or her physician and legal representative or interested family member notified within 24 hours (except when a medical emergency makes this impossible or impractical or when the patient is adjudged incompetent) if the patient is involved in an accident resulting in injury, there is a significant change in the patient’s condition, the patient’s treatment needs to be changed significantly, or a decision is made involving a change in the patient rights under federal or state laws or regulations.

Each patient has the right to choose and know the identity of the physician or other practitioner primarily responsible for their care as well as the identity and professional status of others providing services to them while in the hospital.

Each patient has the right to be fully informed in advance in language that the patient understands about care and treatment or any changes in such that may affect the patient’s well-being. Each patient not adjudged incompetent also has the right to participate in the planning of and changes in the patient’s total care and medical treatment and to make choices based upon the information provided.

Each patient has the right to know the information regarding his or her medical condition unless medically contraindicated.

Each patient has the right to formulate an advance directive.

Each patient has the right to refuse to participate in experimental research and has the right to refuse treatment to the extent permitted by law and to be informed of medical consequences of such reprisal.

Each patient has the right to self-administer drugs unless the interdisciplinary team has determined for each patient that this practice is unsafe.

Each patient has the right to be treated according to the same policies and practices regarding transfer, discharge, and the provision of services under the state plan for all individuals regardless of source of payment. The patient has the right to continuity of care and is transferred or discharged only for the patient’s welfare when the patient’s needs cannot be met in the facility, if the safety or health of individuals in the facility is endangered, as a result of improved health so that the patient no longer needs the services provided by the facility, if the facility ceases to operate, or after reasonable and appropriate notice, for nonpayment for the patient’s stay (except as prohibited by third party contracts).

1. In the event discharge or transfer becomes necessary, the patient has the right to sufficient preparation and orientation to ensure a safe transition from the facility, and will be given at least 30 days advance notice except in the case of emergency circumstances, the health or safety of other patients in the facility would be endangered, where the patient has not resided in the facility for 30 days, the patient’s health improves sufficiently to allow a more immediate transfer or discharge, or the patient’s urgent medical needs require more immediate transfer and when the patient has not resided in the facility for 30 days.
2. The patient’s physician will document the transfer.
3. Notice of transfer: The facility will notify the patient and if known, a family member or legal representative of the patient, of the transfer or discharge and the reasons for the move in a written letter signed by Administration and reviewed by the Medical Center’s attorney. The letter shall be in a language and manner they understand. The advance notice will be recorded and include the reason for the transfer/discharge; the effective date of the transfer/discharge; the location to which the patient will be transferred or discharged (if known); the statement that the patient has the right to appeal the action to the State; and the name address and telephone number of the state long term care ombudsman. The letter shall also include the following advocacy agencies, their address, and telephone number, if the patient has the following diagnosis:

• Mental Illness: Alliance for the Mentally Ill; Story County Community Life
• Developmental Disability: Iowa Protection/Advocacy; Story County Community Life

Each patient has the right for notice, agency hearing, and the provision of counseling and discharge planning prior to any involuntary discharge or transfer, Notice of transfer or discharge shall contain the name, address and telephone number of the state long-term care ombudsman. Other requirements of notice may apply for patients who have developmental disabilities or who are mentally ill.

Each patient has the right to have the patient’s bed held under designated circumstances and upon payment of the prescribed charge for the bed. Each patient and a family member or legal representative has the right to receive written information explaining the designated circumstances and relevant policies. If a patient’s transfer or therapeutic leave exceeds the state approved bed-hold policy and the patient continues to require the services of the facility after hospitalization or therapeutic leave and is eligible for financial assistance, such patient shall be re-admitted to the facility as soon as a bed in a semi-private room becomes available.

Each patient has the right not to be discriminated against by the facility in any way based on the patient’s source of payment. Nor can the facility charge, solicit, accept or receive as a precondition of admission, expedited admission, or continued stay in the facility under the state plan, anything of value, over and above what is lawfully required to be paid. The facility may require individuals having legal access to patient’s income or resources available to pay for facility care to sign a contract, without incurring personal financial liability, to provide the facility payment.

Privacy and Safety

Each patient has the right of reasonable safety within the hospital; to be free from physical, verbal, sexual or mental abuse, corporal punishment, involuntary seclusion, and any physical restraints or psychoactive drugs administered for purposes of discipline or convenience and not required to treat the patient medical symptoms unless pursuant to written physician’s orders for a specific limited period of time to ensure the physical safety of the patient or other patients or as a result of certain emergency circumstances established under federal law.

Each patient has the right to privacy in accommodations, visits with spouse, treatment, personal care, written and telephone communications. Each patient has the right to privacy in fulfillment of personal needs as well as during meetings of patient groups, visits by the patient’s spouse, family, clergy, attorney and others, but this does not require the facility to provide a private room. If a patient’s spouse is also a patient and both spouses consent to the arrangement, they may share a room provided accommodations are available.

Each patient has the right to communicate, associate, and meet publicly and privately with any persons of the patient’s choice, unless to do so would infringe upon the rights of other patients, or if contraindicated and documented by the patient’s physician (or if appropriate, a Qualified Mental Retardation Professional) in the patient’s medical records.

Each patient has the right to privacy in written communications, including the right to send promptly and receive promptly unopened mail and have access to stationary, postage and writing implements at the patient’s own expense. Each patient has the right to have reasonable, regular access to a telephone to receive and place confidential calls.

Confidentiality and Patient Records

Each patient has the right of access to and confidential handling of the patients medical or personal records as provided by law. This information will only be released to an individual outside the facility with the patient’s prior consent except as required by law, or under third party payment contracts, or in the case of transfer to another health care institution. Each patient has the right to inspect and purchase photocopies of all records pertaining to the patient, upon written request and 2 hours notice to the facility. Each patient has the right to be fully informed in language that he or she can understand of his or her total health status, including but not limited to, his or her medical condition.

Patient Responsibilities

Each patient has the following responsibilities:

• Each patient should provide accurate and complete information regarding his or her health status.
• Each patient should follow recommended treatment plans.
• Each patient should abide by hospital rules and regulations affecting patient care and conduct and be considerate of the rights of other patient s and hospital personnel.
• Each patient should fulfill his or her financial obligations as soon as possible following discharge.

Money and Property

Each patient has the right to manage his or her own personal finances, or if he or she so chooses, to designate another party to manage them for him or her. The facility may not require patients to deposit their personal funds with the facility. The facility will maintain patient personal funds of less than $50.00 in a non-interest bearing account of petty cash fund if requested by the patient. Patient funds will not be commingled with facility funds or the funds of any other person. The facility may not impose a charge against the personal funds of a patient for any item or service for which payment is made under financial assistance. Upon the death of a patient with a personal fund deposited with the facility, the facility must convey promptly the patient’s funds, and a final accounting of those funds, to the individual administering the patient’s estate.

Each patient or his or her legal representative has the right to have reasonable access to his or her financial record and to have the financial record made available on request to the patient or his or her legal representative.

Grievance Procedures

Each patient has the right to file a complaint with a state survey and certification agencies respecting patient treatment, abuse, neglect and misappropriation of patient property in the facility without fear of reprisal or discrimination for voicing the grievances. Each patient has the right to prompt efforts by the facility to resolve grievances the patient may have, including those with respect to the behavior of other patients. In the case of a patient adjudged incompetent under state law by a court of competent jurisdiction, the rights of the patient will be exercised by the person appointed under state law to act on the patient’s behalf.

Concerns

You may express concerns by:

• Writing comments on impatient or outpatient patient surveys.
• Expressing concerns directly to care givers in charge of patient care.
• Contacting a State agency directly regardless of whether or not the hospital grievance system is used.
• Requesting formal action.

The Medical Center Administrator or Associate Administrator must be notified for formal action and investigation of a grievance. This may be done by writing letters to Administration at 630 6th Street Nevada, Iowa, 50201 or calling and asking to speak to Administration at (515) 382-2111. Upon receipt of a concern, administration has the responsibility to review, investigate and respond to the party initiating the grievance. This investigation will be initiated within 48 hours of notification of the concern. A written notice of administrations decision containing the name of the medical center contact person, steps taken to investigate the grievance, results of the grievance process, and the completion date will be sent to the party initiating the concern. This response will occur within 2 weeks of the initial complaint.

Groups and Activities

Each patient is encourage to participate at the patient’s discretion in social, religious and community group activities that do not interfere with the rights of other patients in the facility unless contraindicated by the patient’s physician (or, if appropriate, a Qualified Mental Retardation Professional) and so documented in the patient’s medical record.

Each patient has the right to self-determination and choice in participation in activities, schedules, health care and significant aspects of his or her life in the facility. This includes the right to organize and participate in patient groups in the facility, and the right of the patient’s family to meet with other patient’s families in the facility.

Each patient has the right to refuse to perform any services for the facility or other patients. Each patient has the right to perform both voluntary and paid service for the facility when the need or desire for work is documented in the plan of care, which the patient has approved by executing a formal agreement. The agreement will specify the nature of the services and whether they are voluntary or for pay. Compensation will be provided at a prevailing rate.

Visitors

Each patient has the right to immediate access by any representative of the Secretary, United States Department of Health and Human Services, any official properly acting for the state, the patients individual physician, the state long-term care ombudsman’s office and (as appropriate) other state agencies entitled to visit with patients under federal or state law, and members of the patients immediate family or other relatives, subject to the patients right to deny or withdraw consent for such visits. Each patient has the right to receive others at any reasonable hour at times other than established visiting hours, particularly at times of critical illness subject to the patient’s right to deny or withdraw consent for such visits.