Patient Rights & Responsibilities

Patient Rights

As a patient at UMSC, you are entitled to several fundamental rights to ensure you receive respectful, safe, and quality care. These rights include:

Informed Decisions

You have the right to receive clear and complete information about your health condition, treatment options, and expected outcomes, enabling you to make informed decisions about your care.

Privacy and Confidentiality

Your medical records and personal health information are kept confidential. You have the right to access your medical records and have private discussions regarding your care.

Participation in Care

You have the right to be involved in planning your care, including discharge planning and decision-making processes.

Pain Management

You have the right to have your pain addressed and be involved in decisions about managing it.

Freedom from Abuse and Restraints

You are entitled to receive care in a safe environment, free from all forms of abuse, neglect, and unnecessary restraints or seclusion.

Advance Directives

You have the right to create advance directives, which express your wishes regarding health care decisions if you become unable to communicate.

Complaints and Grievances

You have the right to voice concerns or complaints about your care and receive a prompt response. If unresolved, you can file a formal grievance with the facility or appropriate state agency.

Patient Responsibilities

Patients also have responsibilities to help ensure the effectiveness and quality of care:

Providing Information

You should provide accurate and complete information about your health, medical history, and insurance coverage.

Following Instructions

Adhere to the recommended treatment plan and follow hospital rules and regulations.

Respect for Others

Consider the rights and privacy of other patients and staff and treat them with respect.

Financial Obligations

Ensure timely payment of healthcare bills and address any financial concerns with the facility.

Advance Directives

Share your advance directive information with your healthcare providers to ensure your wishes are known and respected.

Additional Resources

Office of Patient Experience

For assistance or to express concerns, you can contact the Office of Patient Experience at your healthcare facility.

Department of Health and Senior Services

If issues remain unresolved, you can reach out to the Department of Health and Senior Services for further support.

Local

111 South Jefferson Street, Lancaster, WI 53813

608-723-6416

Grant County Health Department

State

1 West Wilson Street, Madison, WI 53703

608-266-1865

Wisconsin Department of Health Services

Federal

200 Independence Avenue, S.W., Washington, D.C. 20201

1-877-696-6775

HHS.gov

Patient Rights and Responsibilities

You have the right to….

• Considerate, respectful, and dignified care and respect for personal values, beliefs, and preferences.
• Access to treatment without regard to race, ethnicity, national origin, color, creed/religion, sex, gender identity, age, mental disability or physical status or diagnosis will be made based on medical evidence and treatment capability.
• Respect of personal privacy.
• Receive care in a safe and secure environment.
• Exercise your rights without being subjected to discrimination or reprisal.
• Know the identity of persons providing care, treatment or services and, upon request, be informed of the credentials of healthcare providers and, if applicable, the lack of malpractice coverage.
• Expect the facility to disclose, when applicable, physician financial interests or ownership in the facility.
• Receive assistance when requesting a change in primary or specialty physicians or anesthesia providers if other qualified physicians or anesthesia providers are available.
• Receive information about health status, diagnosis, the expected prognosis and expected outcomes of care, in terms that can be understood, before a treatment or a procedure is performed.
• Receive information about unanticipated outcomes of care.
• Receive information from the physician about any proposed treatment or procedure as needed in order to give or withhold informed consent.
• Participate in decisions about the care, treatment, or services planned and to refuse care, treatment or services, in accordance with law and regulation.
• Be informed, or when appropriate, your representative be informed (as allowed under state law) of your rights in advance of furnishing or discontinuing patient care whenever possible.
• Receive information in a manner tailored to your level of understanding, including provision of interpretative assistance or assistive devices.
• Have family be involved in care, treatment, or services decisions to the extent permitted by you or your surrogate decision maker, in accordance with laws and regulations.
• Appropriate assessment and management of pain, information about pain, pain relief measures and participation in pain management decisions.
• Give or withhold informed consent to produce or use recordings, film, or other images for purposes other than care, and to request cessation of production of the recordings, films, or other images at any time.
• Be informed of and permit or refuse any human experimentation or other research/educational projects affecting care or treatment.
• Confidentiality of all information pertaining to care and stay in the facility, including medical records and, except as required by law, the right to approve or refuse the release of your medical records.
• Access to and/or copies of your medical records within a reasonable time frame and the ability to request amendments to your medical records.
• Obtain information on disclosures of health information within a reasonable time frame.
• Have an advance directive, such as a living will or durable power of attorney for healthcare and be informed as to the facility’s policy regarding advance directives/living will. Expect the facility to provide the state’s official advance directive form if requested and where applicable.
• Obtain information concerning fees for services rendered and the facility’s payment policies.
• Be free from restraints of any form that are not medically necessary or are used as a means of coercion, discipline, convenience or retaliation by staff.
• Be free from all forms of abuse, harassment, neglect, and exploitation from staff, other patients, or visitors.
• Access to language assistance service, free of charge, by a qualified interpreter for individuals with limited English proficiency or individuals with a disability.
• Expect the facility to establish a process for prompt resolution of patients’ grievances and to inform each patient whom to contact to file a grievance. Grievances/complaints and suggestions regarding treatment or that is (or fails to be) furnished may be expressed at any time. Grievances may be lodged with the state agency directly using the contact information provided below.

If a patient is adjudged incompetent under applicable State laws by a court of proper jurisdiction, the rights of the patient will be exercised by the person appointed under State law to act on the patient’s behalf.

If a state court has not adjudged a patient incompetent, any legal representative or surrogate designed by the patient in accordance with State law may exercise the patient’s rights to the extent allowed by State law. _________________________________________________________________________________________________________

You are responsible for…

• Being considerate of other patients and personnel and for assisting in the control of noise, smoking and other distractions.
• Respecting the property of others and the facility.
• Identifying any patient safety concerns.
• The disposition of your valuables; the surgery center does not assume responsibility
• Observing prescribed rules of the facility during your stay and treatment.
• Providing a responsible adult to transport you home from the facility and remain with you for 24 hours if required by your provider.
• Reporting whether you clearly understand the planned course of treatment and what is expected of you and asking questions when you do not understand your care, treatment, or service or what you are expected to do.
• Keeping appointments and, when unable to do so for any reason, notifying the facility and physician.
• Providing caregivers with the most accurate and complete information regarding present complaints, past illnesses and hospitalizations, medications – including over-the-counter products, substance use, dietary supplements, and any allergies or sensitivities, unexpected changes in your condition or any other patient health matters.
• Reporting any changes in your health status to caregivers or physician (for example, if you experience symptoms that are not expected or described in the discharge instructions given by your provider).
• Promptly fulfilling your financial obligations to the facility, including charges not covered by insurance.
• Informing your providers about any living will, medical power of attorney, or advance directive that could affect your care. ___________________________________________________________________________________________________

You may contact the following entities to express any concerns, complaints, or grievances you may have:

Facility Administrator: Susan Gourley at (608) 473-1700. If you do not feel comfortable calling this, you may call the Wisconsin Department of Safety & Professional Services (4822 Madison Yards Way Madison, WI 53705) at (608) 266-2112 or your Medicare Beneficiary Ombudsman at (800) 633-4227 or at medicare.gov. The Medicare Ombudsman’s role is to ensure that all Medicare beneficiaries receive the information and help they need to understand their Medicare options and to apply their Medicare rights and protections.

Upper Mississippi Surgery Center

454 Badger Road

Hazel Green, WI 53811

Phone: (608) 473-1700