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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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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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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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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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