Your Rights and Responsibilities

Your Rights and Responsibilities 

This hospice complies with applicable Federal civil rights laws and does not discriminate on the basis of sex, race, color, religion, ancestry, national origin, sexual orientation, disability, medical condition, marital status, or registered domestic partner status. Patients and their representative (if any), have the right to be informed of the patient’s rights in a language and manner the individual understands. As a Hospice provider we protect and promote the exercise of these rights. 

As a patient, you have the right: 

1. To exercise your right as a hospice patient. 
2. To be treated with consideration, respect, dignity and individuality including privacy in treatment and personal care; and have your property treated with respect. 
3. To be free from verbal, mental, sexual and physical abuse, including injuries of unknown source, neglect and misappropriation of property. 
4. To receive effective pain management and symptom control. 
5. To participate in developing your hospice plan of care.
6. To refuse care or treatment. 
7. To choose your attending physician.
8. To have a confidential clinical record, and have access to or to request the release of information in your clinical record in accordance with the HIPAA Privacy Rule and as outlined in your Notice of Privacy Practices. 
9. To receive information about the services covered under the hospice benefit. 
10. To receive information about the services that the hospice will provide and the specific limitations on those services. 
11. To 24 hour/7 day/week availability of nursing services by calling the office number. 
12. To know the name of the responsible person supervising your hospice care, and the manner in which the person may be contacted during work hours and for emergencies. 
13. To make health care decisions (acceptance or refusal of certain medical treatment) including exercise of Advance Directives. We will explain your options and you will receive a copy of our Hospice Policy on Advance Directives. 
14. To be advised orally and in writing of: 

• The extent to which payment for hospice services may be expected from Medicare, Medicaid, or any other federally-funded or federal aid program known to the hospice provider; 
• The charges for services that may not be covered by Medicare, Medicaid, or any other federally-funded or federal aid program known to the hospice provider; • The charges you may have to pay before care is initiated; and 
• Any changes in the information provided about charges for services when they occur. 

15. To be informed of accessible auxiliary aids and language services and how to access these services.

 If you believe we have failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you may contact: Shane Campbell, RN, MBA, CHC, Chief Compliance Officer
Phone: 979-436-7537 Email: [email protected] 

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https:// ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: Centralized Case Management Operations U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 Phone: 800-368-1019 TTY/TDD: 800-537-7697 

Complaint forms are available at http:// www.hhs.gov/ocr/office/file/index.html.