Patient Rights & Responsibilities
Rio Grande Hospital respects your rights as a patient and recognizes that you are an individual with unique healthcare needs. We want you to know your rights as a patient as well as your obligations to yourself, other patients, your physicians and this hospital. These rights may be exercised through you individually or through your surrogate decision-maker / legal representative.
Your Rights as a Patient
You have the right to:
- Be informed of your patient rights in advance of receiving or discontinuing care when possible.
- Have impartial access to care and visitation, No one is denied access to treatment or visitation because of disability, national origin, culture, age, color, race, religion, gender identity, or sexual orientation. No one is denied examination or treatment of an emegency medical condition because of their source of payment.
- Give informed consent for all treatment and procedures and receive an explanation in layman terms of:
- Recommended treatment or procedure
- Risks and benefits of the treatment or procedure
- Likelihood of success, serious side effects, and risks including death
- Alternatives and consequences if treatment is declined
- Explanation of the recovery period
- Whether physicians or qualified medical providers other than the operating physician will be performing important parts of the surgery or administering the anesthesia.
- Participate in all areas of your care plan, treatment, care decisions, and discharge plan.
- Have appropriate assessment and management of your pain.
- Be informed of your health state / prognosis.
- Be treated with respect and dignity.
- Personal privacy, comfort and security to the extent possible during your stay.
- Be free from restraints of seclusion imposed as a means of coercion, discipline, convenience or retaliation by staff.
- Confidentiality of all communication and clinical records related to your care.
- Have access to telephone calls, mail, etc. Any restrictions to access will be discussed with you, and you will be involved in the decision when possible.
- Have the right to choose a “visitor” who may visit you, including but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend, and your right to withdraw or deny such choice at any time. You also have the right to an identified “support person” who can make visitation decisions should you become incapacitated.
- Have access to interpreter services at no cost to you or your companion when you do not speak or understand the language, as well as communication aides, at no cost, for the deaf, blind, speech impaired, etc. as appropriate.
- Have access to pastoral / spiritual care.
- Receive care in a safe setting.
- Be free from all forms of abuse or harassment.
- Have access to protective services (e.g., guardianship, advocacy services, and child/adult protective services).
- Request medically necessary and appropriate care and treatment.
- Refuse any drug, test, procedure, or treatment and be informed of the medical consequences of such a decision.
- Consent to or refuse to participate in teaching programs, research, experimental programs, and/or clinical trials.
- Receive information about Advance Directives. Setup or provide Advance Directives and have them followed. Designate a surrogate decision-maker (legal representative) as permitted by law and as needed.
- Participate in decision-making regarding ethical issues, personal values or beliefs.
- Have a family member or representative of your choice and your physician promptly notified of your admission to the hospital.
- Know the names, professional status and experience of your caregivers.
- Have access to your clinical records within a reasonable timeframe.
- Be examined, treated, and if necessary, transferred to another facility if you have an emergency medical condition or are in labor, regardless of your ability to pay.
- Request and receive, prior to the initiation of non-emergent care or treatment, the charges (or estimate of charges) for routine, usual and customary services and any co-payment, deductible, or non-covered charges, as well as the facility’s general billing procedures including receipt and explanation of an itemized bill. This right is honored regardless of the source(s) of payment. If you have financial issues or questions, please contact: Mary Samora (719) 657-2510 or (719) 657-4101
- Be informed of the hospital’s complaint and grievance procedure and whom to contact to file a concern, complaint or grievance.
You have the right to voice complaints to the attention of any facility employee regarding the quality of care and services you receive. If your concerns are not being resolved with your immediate caregiver or the department manager, please call a patient services representative:
Lottie Whitmer, RN – (719) 657-2510 or (719) 657-4090
Candice Allen, MS,RN,CNO – (719) 657-2510 or (719) 657-4120
You may also contact the Administrator/CEO: Arlene Harms – (719) 657-2510 or (719) 657-4104
You may also directly contact The Health Facilities Division of the Colorado Department of Public Health and Environment at: 4300 Cherry Creek Drive S., Denver, CO 80222-1530, Phone: 303-692-2827 or 800-886-7689, and the Office of Civil Rights at: 999 18th Street, South Terrace, Suite 417, Denver, CO 80202 Phone: 303-844-2024; TDD 303-844-3439; Fax: 303-844-2025, regardless of whether you first used the Hospital’s complaint or grievance process. Medicare beneficiaries may contact the KEPRO at 1-844-430-9504 or Medicare at 800-633-4227. You also have the right to file a complaint with the Colorado Board of Medical Examiners, the State Board of Dental Examiners or the Colorado Podiatry Board if you have concerns with your physician, dental or podiatric patient care services, excluding fee disputes.
Your Responsibilities as a Patient
You have the responsibility to:
- Ask questions and promptly voice concerns.
- Provide, to the best of your knowledge, accurate and complete information about your health status, including your complete medical history.
- Report changes in your condition or symptoms, including pain, and request assistance of a member of the health care team.
- Participate in the planning of your care, including discharge planning.
- Follow your recommended treatment plan.
- Be considerate of other patients and staff.
- Secure your valuables.
- Follow facility rules and regulations.
- Respect property that belongs to the facility or others.
- Understand and honor financial obligations related to your care, including understanding your own insurance coverage.
NOTE: A copy of the patient bill of rights and resposibilities is provided upon registration.
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Rio Grande Hospital and its clinics (Creede Family Practice of Rio Grande Hospital, Monte Vista Medical Clinic, Rio Grande Hospital Clinic and Rio Grande Hospital Clinic at South Fork) are required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. Your health information is personal and we are committed to protecting it. Your health information is also very important to our ability to provide you with quality care and to comply with certain laws. This Notice applies to all records about your care that occurs at out facility, whether the records are made by hospital personnel or by your physician. If you have questions about any part of this notice or if you want more information about the privacy practices at Rio Grande Hospital or its clinics please contact:
Compliance/Privacy Office at 719-657-4090
Effective Date of This Notice: 09/15/2013
|A. How Rio Grande Hospital May Use or Disclose Your Health Information
B. When Rio Grande Hospital May Not Use or Disclose Your Health Information
C. Your Health Information Rights
|1. Right to Request Special Privacy Protection
|2. Right to Request Confidential Communications
|3. Right to Inspect and Copy
|4. Right to Amend
|5. Right to Accounting of Disclosures
|6. Right to Paper or Electronic Copy of this Notice
D. Changes to this Notice of Privacy Practices
A. How Rio Grande Hospital May Use or Disclose Your Health Information
Rio Grande Hospital collects health information about you and stores it in a chart and on a computer and in an electronic health record/personal health record. This is your medical record. The medical record is the property of Rio Grande Hospital, but the information in the medical record belongs to you. The law permits us to use or disclose your health information for the following purposes:
- Treatment. We use medical information about you to provide your medical care. We disclose medical information to our employees and others who are involved in providing the care you need. For example, we may share your medical information with other physicians or other health care providers who will provide services that we do not provide. Or we may share this information with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a test. We may also disclose medical information to members of your family or others who can help you when you are sick or injured, or after you die.
- Payment. We use and disclose medical information about you to obtain payment for the services we provide. For example, we give your health plan the information it requires before it will pay us. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you or we may disclose certain portions of your PHI to our business associates who perform billing and claims processing for us. We have a written contract with each of these business associates that contains terms requiring them and their subcontractors to protect the confidentiality and security of your medical information.
- Health Care Operations. We may use and disclose medical information about you to operate this facility. For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff. Or we may use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs and business planning and management. We may also share your medical information with our “business associates,” such as our billing service, that perform administrative services for us. We may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you, when they request this information to help them with their quality assessment and improvement activities, their patient-safety activities, their population-based efforts to improve health or reduce health care costs, their protocol development, case management or care-coordination activities, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, or their health care fraud and abuse detection and compliance efforts. We may share your information with a health information exchange for the purpose of continuity of your healthcare however you will have the right to opt out of such an exchange of information.
- Appointment Reminders. We may use and disclose medical information to contact and remind you about appointments. If you are not home, we may leave this information on your answering machine or in a message left with the person answering the phone.
- Sign in Sheet. We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.
- Notification and Communication with Family. We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or, unless you had instructed us otherwise, in the event of your death. In the event at a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. We may also disclose information to someone who is involved with your care or helps pay for your care. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
- Marketing. Provided we do not receive any payment for making these communications, we may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments, therapies, health care providers or settings of care that may be of interest to you. We may similarly describe products or services provided by this practice and tell you which health plans this practice participates in. We may also encourage you to maintain a healthy lifestyle and get recommended tests, recommend that you participate in a disease management program, provide you with small gifts, tell you about government sponsored health programs or encourage you to purchase a product or service when we see you, for which we may be paid. Finally, we may receive compensation which covers our cost of reminding you to take and refill your medication, or otherwise communicate about a drug or biologic that is currently prescribed for you. We will not otherwise use or disclose your medical information for marketing purposes or accept any payment for other marketing communications without your prior written authorization. The authorization will disclose whether we receive any compensation for any marketing activity you authorize, and we will stop any future marketing activity to the extent you revoke that authorization.
- Sale of Health Information. We will not sell your health information without your prior written authorization. The authorization will disclose that we will receive compensation for your health information if you authorize us to sell it, and we will stop any future sales of your information to the extent that you revoke that authorization.
- Required by Law. As required by law, we will use and disclose your health information, but we will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the requirement set forth below concerning those activities.
- Public Health. We may, and are sometimes required by law to disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child, elder or dependent adult abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure. When we report suspected elder or dependent adult abuse or domestic violence, we will inform you or your personal representative promptly unless in our best professional judgment, we believe the notification would place you at risk of serious harm or would require informing a personal representative we believe is responsible for the abuse or harm.
- Health Oversight Activities. We may, and are sometimes required by law to disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by law.
- Judicial and Administrative Proceedings. We may, and are sometimes required by law, to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.
- Law Enforcement. We may, and are sometimes required by law, to disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.
- Coroners. We may, and are often required by law, to disclose your health information to coroners in connection with their investigations of deaths.
- Organ or Tissue Donation. We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.
- Public Safety. We may, and are sometimes required by law, to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
- Proof of Immunization. We will disclose proof of immunization to a school that is required to have it before admitting a student if you have agreed to the disclosure on behalf of yourself or your dependent.
- Specialized Government Functions. We may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.
- Worker’s Compensation. We may disclose your health information as necessary to comply with worker’s compensation laws. For example, to the extent your care is covered by worker’s compensation, we will make periodic reports to your employer about your condition. We are also required by law to report cases of occupational injury or occupational illness to the employer or worker’s compensation insurer.
- Change of Ownership. In the event that this facility is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another physician or medical group.
- Breach Notification. In the case of a breach of unsecured protected health information, we will notify you as required by law. In some circumstances our business associate may provide the notification. We may also provide notification by other methods as appropriate.
- Fundraising. We may use or disclose your demographic information, the dates that you received treatment, the department of service, your treating physician, outcome information and health insurance status in order to contact you for our fundraising activities. If you do not want to receive these materials, notify the Privacy Officer listed at the top of the Notice of Privacy Practices and we will stop any further fundraising communications. Similarly, you should notify the Privacy Officer if you decide you want to start receiving these solicitations again.
B. When Rio Grande Hospital May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, Rio Grande Hospital will, consistent with tis legal obligations, not use or disclose health information which identifies you without your written authorization. If you do authorize Rio Grande Hospital to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
C. Your Health Information Rights.
- Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and disclosures of your health information by a written request specifying what information you want to limit, and what limitations on our use or disclosure of that information you wish to have imposed. If you tell us not to disclose information to your commercial health plan concerning heath care items or services for which you paid for in full out-of-pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any other request, and will notify you of our decision.
- Right to Request Confidential Communications. You have the right to request that you receive your health information in a specific way or at a specific location. For example, you may ask that we send information to a particular e-mail account or to your work address. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
- Right to Inspect and Copy. You have the right to inspect and copy your health information, with limited exceptions. To access your medical information, you must submit a written request detailing what information you want access to, whether you want to inspect it or get a copy of it, and if you want a copy, your preferred form and format. We will provide copies in your requested form and format if it is readily producible, or we will provide you with an alternative format you find acceptable, or if we can’t agree and we maintain the record in an electronic format, we will provide your choice of a readable electronic or hardcopy format. We will also send a copy to any other person you designate in writing. We will charge a reasonable fee which covers our costs for labor, supplies, postage, and if requested and agreed to in advance, the cost of preparing an explanation or summary, as allowed by federal and state law. We may deny your request under limited circumstance. If we deny your request to access your child’s records or the records of an incapacitated adult you are representing because we believe allowing access would be reasonably likely to cause substantial harm to the patient, you will have a right to appeal our decision. If we deny your request to access your psychotherapy notes, you will have the right to have them transferred to another mental health professional.
- Right to Amend. You have a right to request that we amend your health information that you believe is incorrect or incomplete. You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your health information, and will provide you with information about Rio Grande Hospital’s denial and how you can disagree with the denial. We may deny your request if we do not have the information. If we did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if you would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is. If we deny your request, you may submit a written statement of your disagreement with that decision, and we may, in turn, prepare a written rebuttal. All information related to any request to amend will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.
- Right to an Accounting of Disclosures. You have a right to receive an accounting of disclosures of your health information made by Rio Grande Hospital, except that Rio Grande Hospital does not have to account for the disclosures provided to you or pursuant to your written authorization, or as described in paragraphs 1 (treatment), 2 (payment), 3 (health care operations), 6 (notification and communication with family) and 18 (specialized government functions) of Section A of this Notice of Privacy Practices or disclosures for purposes of research or public health which exclude direct patient identifiers, or which are incident to a use or disclosure otherwise permitted or authorized by law, or the disclosures to a health oversight agency or law enforcement official to the extent this medical practice has received notice from that agency or official that providing this accounting would be reasonably likely to Impede their activities.
- Right to a Paper or Electronic Copy of this Notice. You have a right to notice of our legal duties and privacy practices with respect to your health information, including a right to a paper copy of this Notice of Privacy Practices, even if you have previously requested its receipt by e-mail.
If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact our Privacy Officer listed at the top of this Notice of Privacy Practices.
D. Changes to this Notice of Privacy Practices
We reserve the right to amend this Notice of Privacy Practices at any time in the future. Until such amendment is made, we are required by law to comply with this Notice. After an amendment is made, the revised Notice of Privacy Protections will apply to all protected health information that we maintain, regardless of when it was created or received. We will keep a copy of the current notice posted in our reception area, and a copy will be available at each appointment. We will also post the current notice on our website.
Complaints about this Notice of Privacy Practices or how Rio Grande Hospital handles your health information should be directed to our Privacy Officer listed at the top of this Notice of Privacy Practices.
If you are not satisfied with the manner in which Rio Grande Hospital handles a complaint, you may submit formal complaint to:
Region VIII Office of Civil Rights
US Department of Health and Human Services
999 18th St., Suite 17
Denver, CO 80202
Voice Phone: (800) 368-1019
FAX: (303) 844-2025
TDD: (800) 537-7697
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington DC 20201
The complaint form may be found at: www.hhs.gov/sites/default/files/hip-complaint-form-0945-0002exp-04302019.pdf
You will not be penalized in any way for filing a complaint.