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The written statement of Patient Rights and Responsibilities  includes, but is not limited to, the patient’s right to (see statement) : ∙ Have his or her property and person treated with respect, consideration, and recognition of patient dignity and individuality. ∙ Patient and representative have the right to be informed in writing of the patient’s rights in a language and manner the individual understands. You will receive notice of patient’s right and responsibilities, free of charge, translated or with the use of competent interpreter if necessary, no later than the second visit from a skilled professional. ∙ Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; including injuries. ∙ Make complaints to the HHA regarding treatment or care that is (or fails to be) furnished, and the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA.  (We will provide the State Hot‐line phone numbers for complaints, and if applicable we will provide the Accreditation body phone number for complaints) ∙ Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to: ∙ Completion of all assessments; the care to be furnished, based on the comprehensive assessment; Establishing and revising the plan of care; The disciplines that will furnish the care; The frequency of visits; Expected outcomes of care, including patient‐identified goals, and anticipated risks and benefits; Any factors that could impact treatment effectiveness; and Any changes in the care to be furnished ∙ Receive all services outlined in the plan of care, you or your representative will receive clinical education. ∙ Have a confidential clinical record. Access to or release of patient information and clinical records, free or charges , in timely manner .  EDUCATION ABOUT YOUR RIGHTS, BE ADVISED OF THE FOLLOWING : ∙ The extent to which payment for HHA services may be expected from Medicare, Medicaid, or any other federally funded or federal aid program known to the HHA; or any payer source. The charges for services that may not be covered by Medicare, Medicaid, or any  other federally‐funded or federal aid program known to the HHA; or any other program, insurance. The charges the individual may  have to pay before care is initiated; and a ny changes in the information provided when they occur. Advise the patient and  representative (if any), of these changes as soon as possible, in advance of the next home health visit. We will comply with the patient  notice requirements (as part of our Service Agreement). ∙ Receive proper written notice, in advance of a specific service being furnished, if the we believes that the service may be non‐covered care; or in advance of the HHA reducing or terminating on‐going care. ∙ Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local Agencies. ∙ Be advised of the names, addresses, and telephone numbers of the following federally‐funded and state‐funded entities that serve the area where the patient resides: Agency on Aging, Center for Independent Living, Protection and Advocacy Agency, Aging and Disability Resource Center, Quality Improvement Organization ∙ Be free from any discrimination or reprisal for exercising his or her rights or for voicing grievances to the HHA or an outside entity. ∙ Be informed of the right to access auxiliary aids and language services, and how to access these services free of charges ∙ Can identify visiting personnel members through agency generated photo identification ∙ Choose a health care provider, including an attending physician ∙ Receive appropriate care without discrimination in accordance with physician orders ∙ Be informed of any financial benefits when referred to an Agency ∙ When additional state or federal regulations exist regarding patient rights, we included those components. The patient has the right to be informed and exercise their rights as a patient of the Agency.  If the patient has been adjudged to lack legal capacity to make health care decisions as established by state law by a court of proper  jurisdiction, the rights of the patient may be exercised by the person appointed to act on the patient's behalf. If a state court has not  adjudged a patient to lack legal capacity to make health care decisions as defined by state law, the patient’s representative may exercise  the patient's rights (we will sent required documentation in timely manner) . If a patient has been adjudged to lack legal capacity to make  health care decisions under state law by a court of proper jurisdiction, the patient may exercise his or her rights to the extent allowed by  court order. ∙ We will protect and promote the exercise of these rights. We also develops a statement of patient responsibilities. ∙ Receive information about the care/services covered under the Medicare Home Health benefit. ∙ Receive information about the scope of services that the HHA will provide and specific limitations on those services. ∙ Refuse care or treatment after the consequences of refusing care or treatment are fully presented. ∙ The patient’s family or guardian may exercise the patient’s rights when the patient has been judged incompetent. ∙ Can identify visiting personnel members through proper identification. ∙ Be  free  from  mistreatment,  neglect,  or  verbal,  mental,  sexual,  and  physical  abuse,  including  injuries  of  unknown  source,  and misappropriation of patient property. ∙ Confidentiality and privacy of all information contained in the patient record and of Protected Health Information. ∙ Be advised on agency’s policies and procedures regarding the disclosure of clinical records. ∙ Choose a healthcare provider, including choosing an attending physician ∙ Be informed of patient rights regarding the collection and reporting of OASIS information ∙ Be informed that OASIS information will not be disclosed except for legitimate purposes allowed by the Privacy Act ∙ Be informed of anticipated outcomes of care/ services and of any barriers in outcome achievement page 17 PATIENT RIGHTS :  as Our Client You Have the Right to Exercise Your Rights, and/or to Designate a Representative to Exercise them for you (page 1/2) sample