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∙ Receive information about the scope of services that the HHA will provide AND SPECIFIC LIMITATIONS ON THOSE SERVICES ∙ For a minor or a patient needing assistance in understanding these rights and responsibilities, both the patient and the parent, legal guardian, or other responsible person are fully informed of these rights and responsibilities ∙ Be able to identify visiting personnel members through proper identification ∙ The Agency protects and promotes the exercise of the patient’s rights; which are listed in the standard. ∙ Receive careprovidedequally to all regardless of age, sexual preference, color, creed, ethical or political beliefs, mental or physical handicap, national origin, payer source, race, religion or sex by appropriately trained professional staff.  Expect that the personnel involved in your care are qualified through education and experience and utilize current knowledge/skills to provide the services outlined in the plan of care. ∙ To be protected from exploitation by The Home Health Agency Personnel who are prohibited from accepting personal gifts and borrowing from patients/their families/caregivers. ∙ Receive information about care and treatment to be provided in writing and in a manner that you understand from the Home Health Agency And from others outside the organization. Be fully informed of and changes in the care or treatment to be furnished by The Home Health Agency And from other outside the organization. ∙ Expect appropriate care instructions from the agency personnel to better understand your healthcare needs and your plan of treatment. ∙ Expect confidentiality of all information related to your care, within applicable laws and regulations. ∙ Be informed of your rights under state law to formulate advance directives. ∙ Have periodic reviews and updates made to the plan of care. ∙ Refuse prescribed treatment after explanation of the possible consequences resulting from the refusal is provided to you and your physician notified of your decision. ∙ Terminate the services provided by the agency after an explanation of the possible consequences resulting from voluntary termination with notification of your physician of termination. ∙ Have relationships with home care personnel that are based on honesty and ethical standards of conduct. ∙ Be involved in decisions about your care, treatment and/or services. Actively participate in the care planning process.  Be advised of any change in the plan of care before the change is made. ∙ Know how to reach agency personnel 24 hours per day 7 days per week. ∙ Have your family, as appropriate and as allowed by law, with your permission or the permission of your surrogate decision maker, be involved in your care, treatment and/or service decisions. Be informed and when appropriate, have your family informed with your permission, about the outcomes of care, treatment and/or services, based on the current body of knowledge, along with any barriers to outcome achievement. ∙ Exercise your rights, or your legally responsible representative may exercise your rights if you have been judged incompetent. ∙ Be involved in resolving dilemmas about your care, treatment and/or services.  Voice grievances, without discrimination or reprisal regarding treatment or care, by contacting a Clinical Manager or the Director of Nursing or Executive Director.  Be informed of the procedure to follow to voice concerns regarding care or lack of respect for property and/or to your person. ∙ Be informed by the Director of Nursing, his/her designee or the staff member responsible for your care, treatment and/or services of the unanticipated outcomes of your care, treatment and/or services, based on the current body of knowledge. ∙ Expect detailed invoices, when you are responsible for payment, identifying when and by whom services were provided and applicable charges.  Expect referral to alternative community services to meet needs for additional services or financial needs. ∙ Access your clinical records, free of charges, during business hours with agency and physician approval under the restrictions of the HIPAA Privacy Rule. ∙ Be informed by knowledgeable personnel about your medical condition, to the extent known and be given an opportunity to participate in designing a care plan that addresses your needs and preferences, and updating it as your condition changes. ∙ Have your reports of pain believed and assessed appropriately and comprehensively. Receive information about pain and pain relief measures.  Receive care from a concerned team of healthcare professionals committed to pain prevention and management and who respond quickly and appropriately to reports of pain.  Be informed, and have your family informed when appropriate, of your role in managing pain, along with the potential limitations and side effects of pain treatments, based on the current body of knowledge. ∙ Be advised in advance of the name(s) and discipline of staff member(s) primarily responsible for your care, treatment, and/or services, and the proposed frequency of visits. ∙ Be informed about the nature and purpose of any technical procedure that will be performed as well as who will perform the procedure. ∙ Be informed of any financial benefits when referred to another organization. ∙ Refuse care, treatment and/or services within the confines of the law after being fully informed, and to be told the consequences of your action.  When you are not legally responsible, the surrogate decision maker, as allowed by applicable law, has the right to refuse care, treatment and/or services on your behalf. ∙ Access, request amendments to, and receive an accounting of disclosures regarding your personal health information, as permitted under applicable laws. ∙ Be informed within a reasonable amount of time of anticipated termination of service or transfer to another organization. ∙ Be fully informed of services or treatments provided when payment will be made by Medicaid or any other state or federal program.  Be informed of charges for which the patient may be liable within 15 days from the date which The Home Health Agency became aware. ∙ Be fully informed of what to so in an emergency. ∙ Be fully informed in writing of the availability of the State Hotline number to report abuse, neglect or exploitation of a disabled adult or elderly person. 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 2/2) (PATIENT’S SIGNATURE IN THE SERVICE AGREEMENT ACKNOWLEDGES THAT HE/SHE RECEIVED THE PATIENT’S RIGHTS NOTICE) page 18 sample