1.

The patient has the right to refuse treatment, to refuse to participate in experimental research, and to formulate an advance directive.
Ellinwood District Hospital will honor a patient's right to refuse and request treatments. The hospital will make available advance directive information and blank forms that the patient and/or representative may or may not complete to indicate the patient's wishes. The staff, in providing patient care, will carry out these wishes according to Kansas law and according to treatment capabilities of this facility. Advance directives presented to this facility will be maintained in the patient's medical record.

2.

The patient, unless deemed incompetent by state law, has the following rights:
• To choose a personal attending physician/practitioner;
• To participate in planning care and treatment or changes in care and treatment;
• To receive complete and current information concerning his or her diagnosis, treatment and prognosis, to the degree known.
The swing bed patient has the right to choose a personal practitioner and/or find an alternate practitioner when needed. The patient's right includes being informed of his/her health status, being involved in care planning and treatment, being informed of any continuing health care requirements following dismissal. The patient has the right to make informed decisions regarding his or her care or may delegate decision-making to specific persons. These patient health care decisions must be deemed medically appropriate and necessary.

3.

The patient has the right to confidentiality of his or her clinical records.
Ellinwood District Hospital authorizes that access to necessary information regarding the patient be limited only to practitioners, consultants, staff, and individuals designated by law, in order to provide effective patient services and treatment.

4.

The patient may access information contained in his or her clinical record.
A patient has the right to inspect and/or obtain a copy of his or her own health information, within a reasonable timeframe and at an appropriate cost. The patient may designate individuals who may access records; the records shall be available to the patient representative if the patient is incompetent. Certain information may be limited due to legal and confidentiality issues.

5.

The patient has the right to refuse to perform services for the facility, or to perform services for the facility if he or she chooses, when the facility has documented the need or desire for work in the patient's plan of care.
The following conditions must apply for a patient to work in this facility:
• The patient's plan of care specifies the nature of services performed;
• Description of whether services are voluntary or paid;
• Compensation for paid services is at or above prevailing rates;
• Patient agrees to the work arrangement described in his or her plan of care.

6.

The patient has the right to privacy in written communication, including:
• The right to send and promptly receive mail unopened;
• The ability to have access to stationery, postage and writing implements at his or her own expense.
The hospital staff will distribute unopened mail to patients the same day it is delivered to this facility. Patients
may send outgoing mail from the business office on any day mail is delivered to this facility. Patients may
obtain writing materials and purchase postage from the nursing or office staff. (Continued on Back)

7.

A patient has the right to share a room with his or her spouse when both are hospital swing bed patients, and the couple both consent to the arrangement.
When a room is available for a married couple to share, Ellinwood District Hospital will permit them to share if they so choose. If one spouse is admitted later, a shared room will be provided as quickly as possible.

8.

The patient has the right to personal privacy and safety.
Ellinwood District Hospital will make accommodations for personal privacy and dignity during personal hygiene activities (e.g. bathing, dressing, etc.), during medical/nursing treatments, communication needs, and when requested as appropriate. The staff attempts to maintain a safe environment through patient monitoring, preventive measures, and proper infection control techniques.

9.

The patient has the right to be free from restraint of any form (physical restraint or drug used as a restraint) that is not medically necessary.
A restraint can only be used if needed to improve the patient's well being and less restrictive interventions have been determined to be ineffective. A restraint must be ordered by the practitioner, for a specific reason and for a specified time period—with frequent patient evaluation. A restraint cannot be used as a means of coercion, discipline, convenience, or staff retaliation.

10.

The patient has the right to file a patient grievance, when a patient issue cannot be resolved promptly by staff present, with the expectation of prompt resolution.
A patient complaint or grievance may be verbal or written. The staff will make available a GPHA Reporting
form that may be completed and given to the administrator or other staff member, or submitted to the GPHA
Compliance Officer. A grievance may also be filed with: Kansas Foundation for Medical Care
2947 SW Wanamaker Drive
Topeka,KS 66614 #800-432-0407

11.

Communication with individuals is the right of each patient, with access to persons inside and outside the facility.
The hospital will assure communication needs are met and will make a telephone available to the patient and/or family. At the patient's request, our staff will assist the patient in making needed contacts, i.e. family or patient representative, practitioner, clergy, etc.

12.

The patient has the right to be free of all forms of abuse and/or harassment, to receive respectful care at all times and under all circumstances, and to have his or her personal dignity maintained.
Ellinwood District Hospital will not allow any form of abuse, neglect or harassment whether from staff, other patients, or visitors. The staff will respect each patient's dignity in providing his or her care and treatment.

13.

The patient has the right to request and receive a detailed explanation of the cost of services, and which costs are covered by his or her insurance.
The hospital business office will submit charges to the patient's insurance, and then provide billing information to the patient or representative. The office staff welcome further account inquiries during weekday business hours.