Hcp Form Nys

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    as a Hospital Patient

    in New York State

    Keep this booklet for reference.

    Review it carefully and share the

    information with your family and friends

    involved in your care.

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    Keep this booklet for reference. Review it carefully and share the information with your family and

    friends involved in your care.

    The state and federal governments require that all hospital patients in New York State be given

    certain information and materials when admitted to a hospital. This booklet collects that information

    in one place, explains the rights of each hospital patient and contains advice for the patients on how

    best to get assistance.

    The booklet is divided into two sections:

    TherstsectionofthisbookletexplainstherightsofeachhospitalpatientinNewYorkState.It

    also contains a Glossary to help understand terms commonly used in the hospital.

    The second section provides documents the law requires the hospital to provide to each patient

    while in a hospital in New York State.

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    1

    Contents

    About Your Rights ....................................................................................................................2

    About Your Special Needs .............................................................................................................2

    Concerns/Problems/Complaints About Your Hospital Care ........................................................3

    I You Think You Are Being Asked to Leave the Hospital Too Soon ............................................4

    You Have the Right to File a Complaint About:

    Doctors or Physician Assistants ................................................................................................5

    Other Health Care Proessionals ...............................................................................................5

    Questions or Complaints About Your Hospital Bill or Health Insurance ...................................6

    Access to Your Medical Records ....................................................................................................7

    Glossary..........................................................................................................................................8

    Regulations and Inormation ..............................................................................................12

    Patients Bill o Rights .................................................................................................................13

    An Important Message Regarding Your Rights

    as a Hospital Inpatient (or patients not covered by Medicare) .............................................14

    Admission Notice or Medicare Patients .....................................................................................16

    Important Message rom Medicare ............................................................................................17

    Deciding about Healthcare: A Guide or Patients and Families ................................................19

    Introduction ............................................................................................................................19

    Adult Patients Who Have the Ability to Make Inormed Decisions .......................................19Advance Directives/Health Care Proxies .................................................................................19

    Health Care Decision-Making in Hospitals and Nursing Homes...........................................20

    Decisions to Withhold or Withdraw Lie-Sustaining Treatment

    in Hospitals and Nursing Homes ............................................................................................21

    Decision-Making Standards or Legal Guardians and Surrogates .........................................22

    Resolving Disputes in Hospitals and Nursing Homes ............................................................23

    DNR Orders Outside the Hospital or Nursing Home .............................................................25

    Health Care Proxy ....................................................................................................................25

    Letter rom the New York State Department o Health(SPARCS data collection system) ........................................................................................33

    Maternity Inormation.................................................................................................................34

    Domestic Violence: Notice or Prenatal and Maternity Patients ................................................35

    Domestic Violence: Victims Rights Notice .................................................................................37

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    2

    About Your Rights

    As a patient in a New York State

    hospital, you have certain rights and

    protections guaranteed by state and

    ederal laws and regulations. These

    laws and regulations help ensure the qualityand saety o your hospital care. To help

    you understand your rights, the New York

    State Department o Health developed this

    booklet.

    Keep this booklet or reerence. Review

    it careully and share the inormation with

    amily and riends involved in your care.

    You have the right to participate in decisions

    about your health care and to understand

    what you are being told about your care andtreatment. For example, you are entitled

    to a clear explanation o tests, treatments

    and drugs prescribed or you. Dont hesitate

    to ask questions o your doctor, nurse or

    hospital sta members.You have a right

    to know whats going on.

    Every patient is unique, every hospital

    stay is dierent. It is important to know

    what specic rights apply to you and what to

    do i you eel you need help. Some rights andprotections, such as those that govern when

    you leave the hospital, depend on receiving

    correct written notices. You will also be

    provided with inormation explaining when

    and where to call or write or help.

    I you have a problem or i you dont

    understand something, speak to your

    nurse, doctor, social worker or patient

    representative.

    They can:

    helpyougetanswers;

    arrangespecialhelp;

    makecontactswithyourfamily;

    getforeignlanguageandsignlanguage

    interpreters;and

    generallymakeyourhospitalstay

    easier.

    About Your Special Needs

    Each hospital must make sta

    available to explain or answer

    questions about your rights and to

    provide inormation on how you can

    protect those rights.

    Ifyouarehearingorvisionimpaired,

    or i English is not your rst language,

    skilled interpreters must be provided

    to assist you. Translations and/or

    transcriptions o important hospital

    orms, instructions and inormation

    must be provided to you i you eel you

    need them.

    But you must speak up and ask

    questions.

    You can contact a patient representative

    beore you enter the hospital to be sure your

    special arrangements are made when you get

    there.

    Ifyouhaveaquestionaboutanyofthe

    inormation in this booklet or eel that

    your needs have not been adequately

    met, ask the patient representative orother hospital sta person or urther

    explanation or contact the New York

    State Department o Health (see

    page 3).

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    3

    I you have a concern, problem or complaint related to any aspect o care during your hospital

    stay, speak to your doctor, nurse or hospital sta member. I hospital sta has not resolved the

    problem, you may contact the New York State Department o Health by mail or phone.

    You may call the toll-ree number 1-800-804-5447 or you may le a complaint in writing and

    send it to:

    New York State Department o Health

    Centralized Hospital Intake Program

    433 River Street 6th Floor

    Troy, New York 12180

    Questions or Comments: [email protected]

    Concerns/Problems/ComplaintsAbout Your Hospital Care

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    4

    You have the right to appeal decisions

    made by your doctor, hospital sta or your

    managed care plan:

    aboutwhenyouaretoleavethe

    hospital;

    ifyoufeelyouarebeingaskedtoleave

    thehospitaltoosoon;

    ifyoubelieveyouhavenotbeengiven

    adequate or appropriate plans or your

    medical care and other services you

    mayneedafteryouleavethehospital;

    or

    ifneededservicesarenotinplace.The law requires that you receive advance

    notice in writing telling you:

    thedatethephysicianand/orhospital

    planstodischargeyou;

    howtoappealifyouwishtoremainin

    thehospital;and

    aspecialnumbertocallwithany

    problems related to leaving the

    hospital.

    See page 14 or more inormation.

    For Assistance/Help

    There is an Independent Proessional

    Review Agent (IPRA) or your area and

    your insurance coverage. Should you need

    assistance/help rom the IPRA, the hospital

    will provide you with a phone number/

    person to contact. See page 9 and 15 or

    more inormation.

    If You Think You Are Being Asked toLeave the Hospital Too Soon. . .

    For Medicare Patients Only

    I you eel that you are being asked to

    leave the hospital too soon and have notreceived advance notice telling you when

    to leave the hospital, a

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