PATIENT RIGHTS &RESPONSIBILITIES

www.hmh.net

In the event that you have a complaint that has not beenresolved by the healthcare staff at the time of your complaint and you wish to file a grievance, you may do so by telephone call, letter, online, or in person, at the address, phone number, and website below:

Patient Advocate

Hardin Memorial Hospital913 North Dixie Ave.

Elizabethtown, KY 42701Phone: (270) 706-1327

Business Hours:Monday - Friday; 8:00 a.m. - 4:30 p.m.

Online:Go to www.hmh.net, click on the Patient/Visitor Information

tab, and under Patient Information click on Patient Grievance.Filing a grievance will not subject you to any form of adverse action or jeopardize your future access to care at Hardin Memorial Hospital. Your grievance will be reviewed and investigated, and you will receive a written response from us. We will attempt to make a written response within seven (7) days of our receipt of the grievance; however, due to the nature and complexity of your grievance, it may take longer in some instances to make a written response. If this is the case, we will inform you that we are still working to resolve your grievance and that a written response will be made within thirty (30) days of receiving your grievance.

In addition to contacting the organization’s Patient Advocate,grievances can also be directed to the Office of the Inspector General at the address or phone number below:

Kentucky Cabinet for Health and Family ServicesDivision of Healthcare Facilities and Services

(Licensing and Regulation)

Office of Inspector General275 E. Main St., 5E-AFrankfort, KY 40621

Phone: (502) 564-7963http://chfs.ky.gov/os/oig/dhcfs.htm

9. Arrange for any advance directives (living wills, durable medical powers of attorney, health care surrogate designation, etc.) if desired, and to communicate these advance directives to the hospital staff providing their care.10. Communicate any problems or concerns relating to your care to hospital staff.

If you would like further explanation of your rights andresponsibilities at Hardin Memorial Health, pleasecontact the Patient Advocate at (270) 706-1327.

We welcome hearing any concerns that you have aboutpatient safety. If you want to share a concern about yourcare or your family member’s care while receiving servicesat Hardin Memorial Health facilities, you may either:

• Ask a staff member to call the House Manager• Call the hospital operator by dialing (270) 737-1212 if calling from an off-site facility, and ask for the House Manager.

If you wish to share your concerns after you leave the facility, please contact a Patient Advocate at (270) 706-1327.

Report complaints to The Joint Commission online, by mail, fax or regular mail.

Online:www.jointcommission.org/report_a_complaint.aspx

E-mail:complaint@jointcommission.org

Fax:Office of Quality Monitoring, (630) 792-5636

Mail:Office of Quality Monitoring

The Joint CommissionOne Renaissance Blvd.

Oakbrook Terrace, IL 60181

913 North Dixie Avenue Elizabethtown, KY 42701

04/2012

YOUR RIGHT TO FILE A GRIEVANCE

REPORTING PATIENT SAFETY CONCERNS

1. Receive fair compassionate care at all times and under all circumstances.2. Be treated equally and receive the same level of care regardless of age, race, ethnicity, creed, religion, culture, language, sex, sexual orientation, gender identity or expression, socioeconomic status, physical or mental disability, lifestyle, or ability to pay.3. Receive free language assistance if you have limited English proficiency or are deaf or hard-of-hearing to ensure effective communication and equal access to services.4. Retain personal dignity and privacy and receive care sensitive to personal feelings and need for bodily privacy.5. Wear appropriate clothing and religious or other symbolic items, provided such items do not interfere with diagnostic procedures or treatment.6. Expect confidentiality/privacy in all communications pertaining to care and clinical records and have access to information contained in your medical record within a reasonable timeframe. Patients may request amendments to his/her medical record. Release of information without patient consent will be limited, as explained in the Notice of Privacy Practices.7. Receive care in a safe setting, be free from abuse and harassment, and have access to protective services as needed.8. Have a family member or representative and physician of choice notified promptly of your admission to the hospital.9. Receive personalized treatment through an individual treatment plan administered by qualified and experienced professional staff and participate in the development and implementation of your plan of care and treatment. Hardin Memorial Health respects each patient’s psychological, social/personal values, cultural, racial and spiritual preferences as part of that treatment plan.10. Request a consult with other physician(s) and/or independent specialist(s), at your own expense. 11. Access pastoral and other spiritual services.

23. Be informed of your rights before the provision or discontinuance of care, whenever possible.24. Communicate your concerns/grievances with the hospital to the Patient Advocate, to the hospital Ethics Committee, or to the Office of Inspector General (275 E. Main St., 5E-A, Frankfort, KY 40621 or (502) 564- 7963), without being subject to coercion, discrimination, reprisal, or unreasonable interruption of care, treatment, and services.

1. Provide, to the best of your knowledge, accurate and complete information about your health, including recent complaints, past illnesses, hospital stays, use of all medications, allergies and adverse reactions to medications, and other pertinent matters relating to your health.2. Follow any instructions, rules, and regulations that affect your hospital stay, including safety and infection control guidelines.3. Ask questions when you do not understand information or instructions.4. Report unexpected changes in your condition to your physician or hospital staff member.5. Understand and follow the instructions for your ongoing treatment. If you believe you cannot follow through with your treatment, you are responsible for telling your doctor.6. Show respect and consideration for the needs of other patients, staff members and physicians involved with your care, assist with the control of noise and number of visitors, and show respect and consideration for hospital property and that of the other patients.7. Provide information regarding your demographic and insurance information and work with the hospital to arrange payment for services.8. Be aware of the decisions you make in your daily life and the consequences of those decisions on your personal health. Take responsibility for outcomes if you do not comply with care instruction, treatment and service plans put forth by your medical team.

12. Receive visitors of your choosing unless such visits are considered medically or therapeutically contraindicated, such as when a patient is receiving a treatment/ intervention; when there are concerns about infection control; when a visit would interfere with the care, safety, privacy, or rights of other patients; or for security reasons. Visitation privileges are not denied solely on the basis of age, ethnicity, culture, language, race, color, national origin, religion, sex, sexual orientation, gender identity, disability, or socioeconomic status of the visitor or patient. You may also withdraw or deny visitors at any time.13. Examine and receive an explanation of your bill. 14. Be informed of hospital rules and regulations that affect your activities and behavior as a patient. 15. Formulate advance directives (i.e., Living Will, Durable Medical Power of Attorney, Health Care Surrogate Designation, etc.) and to have hospital staff and practitioners comply with these directives in accordance with federal and state laws.16. Be free from restraints and seclusion, of any form, that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation.17. Receive appropriate assessment and management of pain. The patient and healthcare provider will establish and implement a plan for pain relief.18. Make informed decisions regarding care/treatment/ services, including being informed of your health status/prognosis; requesting or refusing treatment to the extent permitted by law; and being told of the medical consequences of decisions made by you or your representative.19. Be told of any medical procedures and tests, reasonable alternatives, the reason for the procedure/test, and who will be performing them.20. Know the identity of all doctors and other professionals participating in your care.21. Refuse to participate or discontinue clinical trial programs or to be used in the gathering of data for research purposes, regardless of your payment source - government, personal or third party.22. Expect reasonable continuity of care to assure that you are advised of your outpatient care options, requirements, and of your follow-up care needs.

CONSISTENT WITH THE POLICIES AND VALUES OF HARDIN MEMORIAL HEALTH, YOU AS A PATIENT, HAVE A RIGHT TO:

IN ADDITION TO YOUR RIGHTS AS A PATIENT, YOU HAVE THE

RESPONSIBILITY TO: