PATIENT RIGHTS AND RESPONSIBILITIES

As a patient of William Newton Hospital (WNH) or any department within, including the rural health clinics of Health Professionals of Winfield, William Newton Hillside Family Medicine, Dexter Rural Health Clinic, Moline Rural Health Clinic, Cedar Vale Rural Health Clinics, and Tallgrass Rural Health Clinic, you have the right to:

1. Be informed of your rights as a patient in advance of, or when discontinuing, the provision of care. You may appoint a representative to receive the information;
2. Avoid discrimination of any kind: As a recipient of Federal financial assistance, it is the policy of William Newton Hospital not to not exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, or national origin; physical or mental disability; sex or sexual orientation; cultural, economic, educational or religious background; source of payment for care; or age in the admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by WNH directly or through a contractor or any other entity with which William Newton Hospital arranges to carry out its programs and activities;
3. Considerate and respectful care provided in a safe environment free from all abuse or harassment;
4. Remain free from seclusion or restraints of any form that is not medically necessary or used as a means of coercion, discipline, convenience, or retaliation by staff;
5. Know the name of the physician who has primary responsibility for coordinating your care and the names and professional relationships of other physicians and health care providers who will see you;
6. Receive information from your physician about your illness, course of treatment and prospects for recovery in terms that you can understand;
7. Receive as much information about any proposed treatment and procedure as you may need in order to give informed consent or to refuse the course of treatment. Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved in the treatment, alternate course of treatment or non-treatment and the risks involved in each and to know the name of the person who will carry out the procedure or treatment;
8. Participate in the development and implementation of your plan of care and actively participate in decisions regarding your medical care. To the extent permitted by law, this includes the right to request and/or refuse treatment;
9. Formulate advance directives regarding your health care and have hospital staff and practitioners who provide your care in the hospital comply with these directives to the extent provided by state law;
10. Have your personal physician and a family member or representative of your choice notified promptly of your admission to the hospital;
11. Privacy concerning your medical care program and the details of your privacy rights, including choosing to not be listed in the hospital admissions directory;
12. Confidential treatment of all communications and records pertaining to your care and stay in the hospital. Your written permission will be obtained before your medical records can be made available to anyone not directly concerned with your care or billing for your care;
13. Access to information contained in your medical record within a reasonable time (usually 48 hours) and instructions on how to request amendments or restrictions;
14. Appropriate responses to any reasonable request you may make for service;
15. Leave the hospital even against the advice of your physician;
16. Continuity of care and to know in advance the time and location of appointment as well as the name and qualifications of the person providing the care;
17. Communicate a concern regarding the quality of care received or if you feel your discharge date is premature. Your nurse or the Administration office will help you file a patient grievance, or you may choose to contact the Kansas Department of Health and Environment with a concern: (800) 842-0078; healthfacilities@kdheks.gov; 1000 SW Jackson, Topeka, KS 66612;
18. Receive, on request, a written notification of the grievance determination, including the steps taken during investigation, the results of the investigation and the grievance completion date. This response will normally be sent to you within 7 to 10 days;
19. Be advised if hospital/physician proposes to engage in or perform human experimentation affecting your care or treatment. You have the right to refuse to participate in such research projects;
20. Be informed of continuing health care needs following your discharge from the hospital;
21. Examine and receive an explanation of your bill regardless of source of payment;
22. Know which hospital rules apply to your conduct while a patient (see 'Patient Responsibilities' below);
23. Have all patient rights apply to the person who may have legal responsibility to make decisions regarding medical care on your behalf;
24. Receive effective pain management;
25. Receive visitors of your choice and within the hospital visitation policy without regard to race, color, national origin, religion, sexual orientation, disability, or relationship status.
26. Pay out-of-pocket for your services in full without notification of your insurance carrier.

PATIENT RESPONSIBILITIES
As a patient at William Newton Hospital, you have the following responsibilities:
1. Provide accurate and complete information concerning your present complaints, past illness and hospitalizations and other matters relating to your health;
2. Make it known whether you clearly comprehend the course of your medical treatment and what is expected of you;
3. Follow the treatment plan established by your physician, including the instructions of nurses and other health professionals as they carry out the physicians orders;
4. Keep appointments and notify the hospital or physician when you are unable to do so;
5. Assume responsibility for your actions if you refuse treatment or not follow your physician's orders;
6. Assure that the financial obligations of your hospital care are fulfilled as promptly as possible;
7. Follow hospital policies and procedures;
8. Show consideration for the rights and property of other patients and hospital personnel.

Contact your nurse or the Administration office with questions.

Rev. 9-2013