You have important rights and responsibilities as a patient at Chelsea Community Hospital. Our Hospital is a private not-for-profit community hospital accredited by the Joint Commission of Accreditation for Health Care Organizations. Specialty programs of the Hospital also meet guidelines established by specialty societies or other appropriate bodies. Our practice is based on the philosophy of partnering with the patient in all aspects of care.

Each patient is strongly encouraged to read and exercise his or her rights and responsibilities. Please help us help you by making known to us at the earliest time possible any personal requirements you have for reasonable accommodation related to a special need. If you are a minor or have a legal guardian, a Patient Advocate under the Michigan Durable Power of Attorney for Healthcare, or an authorized patient representative, the rights and responsibilities related to information and decisions will apply to your guardian, advocate or representative. Under these circumstances, you have the right to be informed and are encouraged to share your wishes with your guardian, advocate or representative.

Patient Rights: Our Commitment to You! Treatment You have the right to appropriate and safe treatment and accommodations, regardless of age, race, color, sex, creed, national origin, religion, sexual preference, marital status, physical or mental handicap, political affiliation, or source of payment.

You have the right to:

* Have a physical and/or mental examination before or soon after admission.

* Participate in the development and implementation of a written plan of care and have a complete, up-to-date record of your condition.

* Know the identity and professional status of individuals providing service to you, know which physician or other practitioner is primarily responsible for your care and know the relationship of the Hospital to any other health care or educational institutions involved in your care.

* Obtain from your physician current information concerning your diagnosis (to the degree known), treatment choices, medications and any known prognosis. This information should be communicated in terms that you can reasonably understand.

* Have access to information contained in your medical record within a reasonable time frame.

* Participate in decisions involving your health care. You will not be subjected to any procedure without your consent. To the degree possible, your decisions and consents will be based on your receipt of clear, concise explanations of your condition and all proposed technical procedures, including the nature of the procedure, alternatives to the procedures, risks involved and probable consequences. Your right does not include the provision of treatment or services that are medically unnecessary or inappropriate.

* Receive health care that takes into consideration the psychosocial, spiritual and cultural values that influence the way you view your illness. You or your designated representative may also participate with the health care team in the consideration of ethical issues that arise in your care. This is most commonly done informally through your team or can also occur through a consultation with the Hospital Ethics Committee. The Ethics Committee is a group of individuals from different healthcare professions which provides resources and education regarding ethical issues in health care. The Ethics Committee may be contacted by patients, families or staff through Hospital Administration (734-475-3911).

* Have continual assessment of any pain you may experience, whether acute or chronic, and have safe and appropriate pain relief measures provided. You are encouraged to share your experiences of pain and the effectiveness of pain relief measures. Education will be provided, as appropriate, regarding the most effective means for your personal pain relief while in the Hospital and, if needed, at home.

* Be informed by the health care team of Advance Directives rights and laws and be given opportunity to appoint a Patient Advocate to represent your wishes should you become unable to participate in your health care decision-making. The Hospital will comply with your directives to the extent permitted under state and federal law.

* Be free from physical restraints or a drug being used as a restraint, unless ordered by a physician for a limited period of time when it is necessary to protect you from injury to yourself or others. We work with patients and families in using many other options for patient safety prior to consideration of patient restraint. We will also actively involve your family in promoting your safety to the extent they are able and willing. You will never be placed in a restraint as a means of coercion, discipline, convenience or retaliation by staff.

* Consult with a specialist and change your attending physician, at your own request and expense. * Receive a complete explanation of the need for transfer to another facility and the alternatives to such a transfer. You will not be transferred without an agreement from the receiving facility.

* Be informed by the responsible practitioner or his or her delegate of any continuing health care requirements following discharge from the Hospital.

* Refuse treatment to the extent permitted by law, to be informed of the medical consequences of your actions, and to leave the Hospital when you desire to do so, unless your physician believes your judgment is impaired to a degree that would jeopardize you or someone else's safety.

* To have special privacy and safety measures in place as your personal situation requires.

*Be informed of and give consent to any research, educational project, or experimental procedure directly involving you. Refusal to participate in such projects will not jeopardize or affect your care in any way. Personal Reasonable personal comfort and safety related to Hospital's practices and the environment will be provided. You have the right to: * Know the Hospital's rules and regulations.

* Be free from mental and physical abuse, neglect and/or harassment.

* Freedom of movement, limited only by Hospital regulations and/or treatment reasons. These limits will be discussed with you and your family.

* Request a transfer to another room.

* Associate with people outside of the Hospital by means of visitors, telephone, and/or written communication at reasonable times. This includes the right to communicate, without limitation, with your attorney or a court, or with other people, when the communication may involve legal questions. Exceptions may be made for treatment reasons and will be discussed with you and your family.

* Accommodation of special needs such as a foreign language interpreter, an interpreter for the hearing impaired, Seeing Eye dog or related assistive measures. The Hospital will work with you to effectively address your needs.

* Practice your religion or faith, wear religiously symbolic items and to see a spiritual advisor.

* Refuse to perform services for the Hospital that are not included for therapeutic purposes in your plan of care.

* Refuse to talk with or see anyone not officially connected with the Hospital, including visitors.

* Retain and use appropriate personal clothing and property as long as they do not interfere with diagnostic procedures/ treatments, do not infringe upon the rights of other patients and/or are not in direct violation of Hospital rules and regulations. If something is taken from you for these reasons, you will be given a receipt for it and it will be returned to you at the time of discharge (unless the property is illegal or injurious to you). Respect, Privacy and Confidentiality You have the right to:

* Receive considerate and respectful care and the right, within the law, to personal and informational privacy.

* Be interviewed and examined in surroundings which give reasonable privacy. This includes the right to have a person of your own sex present during certain parts of a physical examination or procedure and not to remain disrobed any longer than is required for treatment purposes.

* Refuse to be fingerprinted, audio taped or photographed by still, motion picture or video camera.

* Expect that any discussion or consultation involving your case will be conducted discreetly, and that individuals not directly involved in your case will not be present without your permission.

* Expect that your medical records and other records and information pertaining to your case will be received only by individuals who are directly involved with your treatment or the monitoring of quality; your information will be treated as confidential. Information from your medical record will be released only with your written permission, or as needed by transfer to another health care facility or as required by law or third party payors.

Civil Rights

You shall be accorded the same civil rights as any resident of the State of Michigan and/or the United States of America, unless legally stated otherwise. This included the right to vote in local, state, and federal elections; to make contracts or a will; to marry; to hold or transfer property; to manage your own affairs and personal finances and to recommend changes in the Hospital's policies and services.

Hospital Charges

Regardless of the source of payment for your care, you have the right to request an itemized and/or summary explanation of your bill for services rendered in the Hospital. You have the right to receive, upon request, information related to financial assistance. You have the right to be notified in a timely manner of termination of your eligibility for third party reimbursement to the extent that the Hospital has been made aware.

Violation of Rights

We want to hear from you regarding any concerns, questions and/or suggestions you have about having your rights met. Please feel free to tell us if you believe your rights have been violated, including being dissatisfied with any part of your treatment. It is our goal to resolve any concerns you may have as soon as possible. Your concerns can be shared with Hospital staff, outside advocates, or any other person of your choice, free from interference and without affecting your care. You are encouraged to first talk with the staff and/or their supervisors directly. If a satisfactory resolution is not reached, you may contact the Patient Rights Advisor (x3952), Administration or Hospital Counsel while in the Hospital or after discharge. You may obtain the related contact numbers from any staff person or from the Hospital telephone operator (734-475-1311). Alternatively you are free to contact the State of Michigan (Department of Commerce Bureau of Occupational and Professional Regulations Complaint and Allegations Division; P.O. Box 30018, Lansing, MI 48909 (517-373-9196) whether or not you have used the Hospital's grievance process.

Your Responsibilities as a Patient or Authorized Patient Representative

Treatment

You are responsible to participate in your treatment as you are able.

Your responsibilities include:

* Providing, to the best of your knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, family health history and other matters relating to your health.

* Reporting unexpected changes in your condition to the responsible practitioner.

* Following the treatment plan recommended by your physician, nurse, or other allied health personnel. If you do not understand or accept your plan of care and what is expected of you, you are responsible for notifying an appropriate member of your health care team. You are responsible for your actions if you exercise your right to refuse treatment or not follow the practitioner's instructions. However, if your refusal interferes with the practitioner's ability to treat you adequately, the practitioner may terminate your treatment upon reasonable notice. Personal Your personal responsibilities include:

* Making your personal needs known.

* Respecting other patients' and Hospital personnel's rights and needs including assisting in the control of noise, smoking, and the number and conduct of visitors.

* Treating others respectfully regardless of age, race, color, sex, creed, national origin, religion, sexual preference, marital status, physical or mental handicap or political affiliation.

* Being respectful of the property of other persons and of the Hospital.

* Following the Hospital's rules and regulations. Respect, Privacy and Confidentiality Your responsibilities include:

* Exercising your right to privacy.

* Respecting other patients' privacy. Civil Responsibility You may be civilly or criminally liable if you deliberately hurt another person or destroy or steal property.

Hospital Charges

You are responsible for assuring that the financial obligations of your health care are fulfilled as promptly as possible. This includes giving timely and accurate information regarding ability to pay for service and giving permission to the Hospital to provide third party payors with appropriate information. It is your responsibility to be familiar with the nature and extent of your insurance coverage. The Hospital makes no guarantee concerning third party reimbursement for your care. Any charges for care that are not reimbursed will be your responsibility.

Violation of Rights

It is important that you initiate action on your behalf if you feel your rights have been violated or if you have a complaint. Our goal is to honor your rights and provide you with a positive healthcare experience.

References:

Commission on the Accreditation of Rehabilitation Facilities Standards

Healthcare Finance Administration Regulations

Joint Commission on Accreditation of Healthcare Organizations Standards

Michigan Department of Mental Health Administrative Rules

Michigan Mental Health Code

Michigan Public Health Code

Patient's Bill of Rights adapted by the American Hospital Association 42 C.F.R. Part 2 (Federation Drug and Alcohol Treatment Regulations)

Come to the beautiful wooded campus of Chelsea Community Hospital, and see for yourself why Chelsea is ranked among the top hospitals in the nation for patient satisfaction.