Community Health Network values the relationship it has with its patients. We recognize that patients who are experiencing services or programs within our facilities have certain rights and responsibilities as individuals.
Community Health Network presents these rights and responsibilities to the patient in the Patient Handbook and Surgical Patient Handbook. They are also displayed in posters throughout the facilities and are available in brochure format.
In recognizing these specific patient rights and responsibilities, Community Health Network (CHN) will contribute to more effective patient care and greater patient satisfaction. All CHN personnel and medical staff will take steps to assure that the patient rights are observed. These rights apply to all patients including the neonate, child, adolescent and adult.
Our healthcare team supports your right to participate to the fullest extent possible in planning for your care and treatment. We want you to be aware that, as a patient under our care, you, or your legally designated representative, are afforded specific rights and responsibilities under State law.
Every patient has the right to be provided a listing of these rights and responsibilities upon admission to our hospital. In the spirit of working with you to achieve the best possible outcome in meeting your health care needs, we present the following list of your rights and responsibilities:
1. You have the right to the hospital’s reasonable response to your requests and needs for treatment or service within the hospital’s capacity, mission, and applicable laws and regulations.
2. You have the right to considerate and respectful care; to be addressed by your proper name and without undue familiarity; to be listened to when you have a question; and to receive an appropriate and helpful response. You will be treated courteously and with the utmost recognition of your dignity.
3. You have the right to expect that every consideration will be given to your personal privacy. To the extent possible, privacy will be afforded during all phases of your care including case discussion, consultation, examination, and treatment.
4. You have the right to determine with whom you wish to communicate, including hospital staff. You have the right to designate who will be allowed to visit you during your stay.
5. The hospital respects your right to express your spiritual beliefs and cultural practices to the extent that those expressions do not harm others or interfere with their care. If your cultural practices or spiritual beliefs are contrary to your recommended treatment, you have the right to be informed of the consequences of your decisions.
6. You have a right to fair and equitable treatment or protection under all hospital policies, procedures and rules. You will be provided care and treatment at a level equal to any other patient with the same condition.
7. You have the right to a prompt and safe transfer to another healthcare facility upon your request or when there is a need for treatment or service that cannot be met at Berlin Memorial Hospital. Except in cases of emergency, you are entitled to a full explanation of the need for transfer. To ensure continuity of care, laws pertaining to transfers between hospitals must always be observed, including agreement of the receiving hospital to accept your transfer to their facility.
8. You have the right to be treated in a safe, clean and pleasant healthcare environment.
9. You have the right to know the name of the physician and/or practitioner coordinating your care, as well as any current information concerning your diagnosis, treatment, and prognosis in terms you can understand. This includes your right to know the existence of any professional relationship among individuals treating you, as well as their relationship to any other healthcare or educational institution involved in your care.
10. You have the right to receive, from your physician, information necessary to give informed consent prior to the start of any procedure or treatment. Except in emergencies, your consent or that of your legally authorized representative, will be obtained before any treatment is administered.
11. The dying patient has the right to care directed toward fostering the patient’s comfort and dignity. Treatment of primary and secondary symptoms, that respond to treatment, will be provided as desired by the patient or surrogate decision maker, including the effective management of pain. Care and treatment will be provided that acknowledges the patient’s and family's psychosocial and spiritual concerns regarding dying and the expression of grief.
12. You have the right to formulate advance directives (Living Wills and/or Durable Power Of Attorney For Health Care documents) directing treatment and/or designating a surrogate decision maker. The Hospital will honor the intent of those directives to the extent permitted by law and hospital policy. Any person acting on your behalf as a legally designated representative shall be permitted to exercise all rights and responsibilities contained in this document on your behalf.
13. You have a right to safe and effective pain management including: information about pain and pain relief measures, a concerned staff committed to pain prevention, healthcare providers who respond quickly to reports of pain, and state-of-the-art pain management.
14. To the extent permitted by law, you have the right to refuse treatment. You will be informed of the medical consequences of your refusal. Also, to the extent permitted by law, you have the right to forgo or withdraw life sustaining treatments and withhold resuscitative services.
15. You have the right to expect that all communications and records pertaining to your care will be treated as confidential. You have the right to expect your medical record to be read only by people directly involved in your treatment or monitoring its quality, and by other persons only with written authority or as authorized by law.
16. You have a right to examine and receive an explanation of your bill, regardless of payment source, except where prohibited by law. Upon request, you have the right to receive information regarding financial assistance programs available through the hospital.
17. You have a right to access your hospital medical records documenting the care you received as a patient – except when legally prohibited.
18. You have a right to access means of public communication, such as sending or receiving mail and telephone calls. Berlin Memorial Hospital will provide assistance to individuals with impaired vision, hearing, or speech. Access to an interpreter will be provided as needed.
19. You have the right to participate in the consideration of ethical issues that arise in your care. You may request consultation from Community Health Network’s Medical Ethics Advisory Committee to help you resolve such matters.
20. You have the right to be informed of any proposed treatment that is experimental or is part of a research/educational project. If you decline participation in treatment that is experimental or research oriented, you will be provided the best care and treatment that the hospital can otherwise provide.
21. You have the right to express your opinions, concerns, or complaints without fear of reprisal. You have the right to be told about our policy and procedure for resolving complaints. You may initiate the process for handling your concern or complaint by informing your nurse of your concern. The manager of the unit providing your care will be able to provide you with additional information regarding how to submit a complaint, how complaints are processed, the time frame for reviewing complaints, when to expect a written response, and what outcomes of complaints may be.
You also have the right to file a complaint by contacting:
Division of Quality Assurance
Bureau of Health Services
1 West Wilson St.
P.O. Box 2969
Madison, WI 53701-2926
Phone: 608-266-8084 or 800-642-6552
Or you may choose to contact:
Office of Quality Monitoring
The Joint Commission
One Renaissance Blvd.
Oakbrook Terrace, Ill 60181
PROVISION OF INFORMATION You are responsible for providing, to the best of your knowledge, accurate and complete information about your present medical condition, past illnesses, hospitalizations, medications, and other matters relating to your health. You are responsible for reporting unexpected changes in your condition to your nurse, physician, or other staff providing treatment to you.
COMPLIANCE WITH INSTRUCTION You are responsible for following the treatment plan developed with your healthcare team. You should express any concerns you may have regarding your ability to comply with a proposed course of treatment so that efforts can be made to adapt the treatment plan to your specific needs and limitations. In situations where treatment plans cannot be altered or accommodations made to meet your specific requests, you will be informed of the consequences of noncompliance with the treatment plan. In such cases, you will accept full responsibility for any suboptimal results.
RULES AND REGULATIONS You are responsible for following Community Health Network’s rules and regulations regarding patient care and conduct.
RESPECT AND CONSIDERATION You are responsible for being considerate of the rights of other patients and personnel and for assisting in the control of noise, smoking, and distractions. You are responsible for being respectful of the property of other persons and of Berlin Memorial Hospital.
PROVISION OF PAYMENT It is your responsibility to provide the Hospital with accurate and timely information concerning your insurance coverage, including coverage by government programs. You are responsible for any charges not covered by third party payers. You should notify the Hospital Billing Office if you are unable to pay your bill. If you are applying for our Community Care Program for assistance with your bill, it is your responsibility to provide complete and accurate information in your application form and to provide verification of information as requested.
ADVANCE DIRECTIVES You are responsible for notifying hospital personnel if you have an advance directive (Durable Power Of Attorney For Health Care or Living Will). We request that you provide the Hospital a copy of your advance directive documents for inclusion in your permanent medical records. You should also notify us of any revisions that have been made to advance directive documents you have provided us in the past.
PAIN MANAGEMENT You have an important role in the management of your pain. Ask your healthcare providers what to expect regarding pain and pain management. Discuss pain relief options with your healthcare providers. Work with your healthcare providers to develop a pain management plan. Ask for pain relief when pain first begins, and give accurate responses to your healthcare provider’s questions regarding your level of pain and the effectiveness of treatments provided.
You may download a copy of Patient Rights and Responisbilities <HERE>