A Statement of The Patient’s Rights
As a health care 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’s 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, then 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 these to you as a statement
of our policy.
You have the right to respectful care given by competent personnel that
reflects consideration of your personal value and belief systems and that
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
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 considering effective use of your time and to avoid your
You have the right to medical and nursing services without discrimination
based upon race, color,religion, gender, sexual preference, disability, national
origin, or source of payment.
You have the right, in collaboration with your physician, to make decisions
involving your health care. This right applies to the family and/or guardian of
neonates, children, and adolescents.
While this 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, are 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 or 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
health care 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. This includes the right, if
requested, to have someone present while physical examination, treatment, or
procedure is being performed, as long as they do not interfere with diagnostic
procedures or treatments, and to request a room transfer if another patient or a
visitor in the room is unreasonably disturbing you and another room equally
suitable or your care needs 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 arrangements.
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 reasons.
You have the right to receive information on how we will use your personal
health information. Our Notice of Privacy Practices provides you with a full
description of the ways in which we both use and protect your health
You have the right to request a restriction or limitation on the medical
information we use or disclose about you. You also have the right to revoke or
revise any authorization you have signed for any disclosure other than
treatment, payment or health care operations.
You have the right to request a copy of your medical records (note there may
be a fee for the copying of your medical records). If you feel that your
information on file is incorrect or incomplete, you may ask us to amend the
You have the right to request an accounting or list of certain disclosures we
have made of your medical information. The list may not include disclosures made
prior to April 2003.
You have the right to be communicated with in a manner that is clear, concise
and understandable. If you do not speak English, you should have access, where
possible, to an interpreter.
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
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.
You have the right to formulate an “advance directive,” or to appoint a
surrogate to make health care decisions on your behalf. These decisions will be
honored by this hospital and its health care professionals within the limits of
the law and this organization’s mission, values and philosophy. If you have an
advance directive, you are responsible for providing a copy of your advance
directive to the hospital. However, you are not required to have an advance
directive in order to receive care.
You have the right to assistance in obtaining a 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
request, you may be transferred to another facility when medically permissible.
Such a transfer should be made only after you or your designated/ legal
representative have received complete information and explanation concerning the
need 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
You have the right to full information and counseling on the availability of
known financial resources for your health care.
You have the right to expect that the health care facility will provide a
mechanism whereby you are informed upon discharge of continuing health care
requirements following discharge and the means for meeting them.
You cannot be denied the right of access to an individual or agency who is
authorized to act on your behalf to assert or protect the rights set out in this
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.
You have the right to appropriate assessment and management of pain.
You have the right to be free from any form of restraints – both physical and
drug – that is not medically necessary or is used as means of coercion,
discipline, convenience or retaliation by staff.
You have the right to be free from seclusion and restraint in any form
imposed as a means of coercion, discipline, convenience or retaliation by
It is the intent of this hospital to provide quality care and address any
concerns that you may have. Should you feel that your concerns are not
adequately addressed or would prefer not to discuss these issues with hospital
personnel, you have the right to refer complaints directly to the Pennsylvania
Department of Health at:
If you believe your privacy rights have been violated, you may file a
complaint in writing with our Privacy Officer or with the Secretary of the U.S.
Department of Health and Human Services.
A Statement of The Patient’s 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.
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 the 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
Duly authorized members of your family or designated/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 your health care
It is understood that you assume the financial responsibility of paying for
all services rendered either through third-party payors (your insurance company)
or being personally responsible for payment for any services that are not
covered by your insurance.
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 do not hesitate to call the Patient Representative at (610)