Patient and Family Rights and Responsibilities 

While you are a patient at our hospital, we will treat you with the respect due each person. You are entitled to high quality care that responds to your physical, emotional, social, psychological and spiritual well-being.
 
 

Rights Related to Respect and Dignity 

  • Patients may not be denied appropriate hospital care because of the patient’s race, creed, color, national origin, ancestry, religion, sex (including gender identity), sexual orientation, marital status, age, newborn status, handicap or source of payment.
  • Patients shall be treated with consideration, respect and recognition of their individuality and personal needs, including the need for privacy in treatment.
  • Patients, or when appropriate, the patient’s representative (as allowed under State law), are informed of the patient’s rights, in advance of furnishing or discontinuing patient care whenever possible.
  • Patients or his or her designated representative shall be given, at the time of admission, a copy of the hospital’s policies on patient rights and responsibilities through the patient rights brochure.
  • Patients shall be entitled to know who has overall responsibility for the patient’s care.
  • Except in emergencies, patients may not be transferred to another facility without being given a full explanation for the transfer, without provision being made for continuing care and without acceptance by the receiving institution.
  • Patients have the right to refuse transfer, even in the case of an emergency.
  • The organization respects the rights of the patients served.
  • Patients will be presented information in a manner he or she understands.
  • Patients receive information about the staff responsible for his or her care, treatment, or services.
  • Patients have the right to an environment that preserves dignity and contributes to a positive self-image.
  • Patients have the right to receive religious and spiritual services. 
 

Rights Related to Complaints, Grievances, Advocacy and Resolution Process

  • Patients procedures for initiation, review and resolution of patient complaints, grievances, advocacy and resolution may be filed with the following:
    • Within the Organization
      • Quality or discrimination grievances, contact Risk Management (920) 884-5719.
      • Financial grievances, contact Financial Services (920)884-5637.
      • Privacy grievances, contact Privacy Officer (920) 433-8513.
      • In writing, send correspondence to: PO Box 13508, Green, Bay, WI 54307-3508.
    • Local
      • Abuse, neglect, safety grievances
      • Brown County Human Services (920) 448-6000
      • In writing, 111 North Jefferson St., Green Bay, WI 54301
      • Sheboygan County Human Services (920) 459-6400
      • In writing, 1011 North 8th Street, Sheboygan, WI 53081
      • Oconto County Human Services (920) 834-7000
      • In writing, 501 Park Ave., Oconto, WI 54153
    • State
      • To report any concern or register a grievance contact Wisconsin Department of Health Services – Bureau of Health Services of the Division of Quality Assurance 800-642-6552
      • In writing, send correspondence to: 819 N 6th St. # 609B, Milwaukee, WI 53203
    • Federal
      • Privacy or patient rights grievances, contact U.S. Department of Health and Human Services Offices for Civil Rights 800-368-1019
      • In writing, send correspondence to 233 North Michigan Avenue Suite 240, Chicago, IL 60601
    • The Joint Commission
      • Report any concerns or register a grievance contact the Joint Commission at 800-994-6610
      • In writing, Office of Quality and Patient Safety, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181
  • Medicare inpatients must be provided a standardized notice “An Important Message from Medicare” within 2 days of admission and within 2 calendar days before discharge which informs patients of their right to file a complaint regarding quality of care, if they disagree with a coverage decision or if they wish to appeal a premature discharge.
  • Patients will receive written notice of the hospital decision that contains the name of the hospital contact person, the steps taken on behalf of the patient to investigate the grievance, the results of the grievance process, and the date of completion.
  • Patients have the right to access protective and advocacy services. Staff from Spiritual Care (920) 433-8162 or Case Management (920) 433-8638 act as your advocates


Rights Related to Plan of Care

  • Patients shall have the opportunity to participate to the fullest extent possible:
    • In the development and implementation of his/her inpatient treatment/care plan
    • In the development and implementation of his/her Outpatient treatment/care plan
    • In the development and implementation of his/her Discharge plan
    • In the development and implementation of his/her Pain management plan
    • In decisions regarding continuation or discontinuation of care
  • Patients or his or her representative (as allowed under State law) has the right to make informed decisions regarding his or her care including being informed of his or her health status, being involved in care planning and treatment, and being able to request or refuse treatment. This right must not be construed as a mechanism to demand the provision of treatment or services deemed medically unnecessary or inappropriate.
 

Rights Related to Advance Directive

  • Patients have the right to formulate advance directives and to have hospital staff and practitioners who provide care comply with these directives.
  • Patients have the right to collaborate in decisions about his or her care, treatment, or services.
  • Patients have the right to give or withhold informed consent.
  • Patients may refuse treatment to the extent permitted by law and shall be informed of the medical consequences of the refusal.
  • Patients have the right to have their decisions addressed related to care, treatment, and services received at the end of life.
 

Rights Related to Notifying Admission

  • Patients have the right to have a family member or representative of his or her choice and his or her own physician notified promptly of his or her admission to the hospital.
 

Rights Related to Privacy, Confidentiality and Medical Records

  • Patients have the right to personal privacy.
  • Patients have the right to access information contained in his or her clinical records within a reasonable time frame.
  • Patient’s medical record, including all computerized medical information, shall be kept confidential.
  • Patients or any authorized person shall have access to the patient’s medical record as required by law.
  • Patients have the right to give or withhold informed consent to produce or use recordings, films, or other images of the individual served for purposes other than his or her care.


Rights Related to Safety

  • Patients have the right to receive care in a safe setting that has an effective abuse prevention plan that contain elements of prevention, screening, identifying, training, protecting, investigating, reporting and responding.
  • Patients have the right to be free from all forms of abuse (physical, mental, neglect, verbal, sexual), corporal punishment, exploitation or harassment.
 

Rights Related to Consent, Treatment or Research

  • Patients, the patient’s legally authorized representative or any person authorized in writing by the patient shall receive, from the appropriate person within the facility, information about the patient’s illness, course of treatment and prognosis for recovery in terms the patient can understand.
  • Except in emergencies, the consent of the patient or the patient’s legally authorized representative shall be obtained before treatment is administered.
  • Patients or the patient’s legally authorized representative shall give prior informed consent for the patient’s participation in any form of research.
  • Patients are protected and rights are respected during research, investigation, and clinical trials.
 

Rights Related to Patient Billing

  • Patients are permitted to examine his or her hospital bill and receive an explanation of the bill, regardless of source of payment, and every patient shall receive, upon request, information relating to financial assistance available through the hospital. 
 

Rights Related to Restraints

  • Patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others and must be discontinued at the earliest possible time.
 

Rights Related to Psychiatric and Chemical Dependency

  • Patients who receive treatment for mental illness, a developmental disability, alcohol abuse or drug abuse shall be recognized as having, in addition, the rights listed under s. 51.61, Stats., and ch. DHS 94. 
 

Rights Related to Visitation

  • Patients may designate persons who are permitted to visit the patient during the patient’s stay.
  • Patients (or support person, where appropriate) are informed of his or her visitation rights, including any clinical restriction or limitation on such rights, when he or she is informed of his or her other rights under this section.
  • Patients (or support person, where appropriate) are informed of the right, subject to his or her consent, to receive the visitors whom he or she designates, including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend, and his or her right to withdraw or deny such consent at any time.
  • Patients are not restricted, limited, or otherwise denied visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability.
  • Patient visitors have the right to enjoy full and equal visitation privileges consistent with patient preferences.
 

Rights Related to Staff and Patient Rights

  • Staff assigned to direct patient care have the responsibility to be informed of and demonstrate their understanding of the policies on patient rights and responsibilities through orientation and appropriate inservice training activities. 
 

Rights Related to HSHS St. Clare Medical Hospital in Swing Bed

  • Patients have the right to choose his or her medical, dental, and other licensed independent practitioner care providers.
  • Patients have the right to communicate with his or her medical, dental, and other licensed independent practitioner care providers.
  • Patients in swing bed have the right to receive and restrict visitors.
  • Patients have the right to transportation services, as appropriate to his or her care or service plan.
 

Responsibilities of Patients

  • Patients are responsible for showing mutual respect and consideration to providers, staff and property, as well as other individuals and their property.
  • Patients are responsible for following the organization’s policies and procedures, instructions, rules and regulations to support quality care and a safe environment.
  • Patients are responsible for providing a complete and accurate medical history.
  • Patients are responsible for asking questions when they do not understand their care, treatment, or services or what they are expected to do.
  • Patients are responsible for following instructions for their plan of care, treatment, or services, and expressing concerns about their ability to follow the proposed plan of care, treatment, or services.
  • Patients are responsible for accepting consequences for the outcomes of care, treatment, or services if they do not follow the planned care, treatment, or services.
  • Patients are responsible for providing required information concerning payment and charges.
  • Patients are responsible for meeting financial commitments and obligations in a timely manner.
  • Patients are responsible for sharing expectations of and satisfaction with the organization.
 
 
Notice of Nondiscrimination:  English

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