Patient Bill of Rights

It is a privilege to be able to care for you. As a patient of Fairfield Medical Center (FMC), you are assured of receiving the best possible healthcare by exercising the following rights:

• The right to have impartial access to treatment as the hospital prohibits discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression. To report discrimination or file a grievance, call the Human Resources Manager at XXX-XXX-XXXX. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights of Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or call 1-800-368-1019, 800-537-7697 (TDD).

• The right to receive considerate and respectful care at all times, which includes the right to discuss and exercise cultural and spiritual beliefs that do not interfere with your medical care or the well-being of others.

• The right to personal privacy and confidentiality, as permitted by law, and as outlined by the following rights:

• To refuse to speak with or see anyone not officially connected with FMC and not directly involved in your care.

  • To wear appropriate personal clothing and religious or other symbolic items, as long as they do not interfere with diagnostic procedures or treatments.

  • To have spiritual needs met by your personal pastor or by the FMC’s chaplain or volunteer chaplains. Chaplains are available 24 hours, seven days a week, and may be reached by calling FMC’s operator at “O.”

  • To be interviewed and examined in surroundings designed to assure reasonable audio-visual privacy, which includes the right to have a person of your own selection present during certain parts of a physical examination, treatment or procedures performed by a healthcare professional.

  • To expect that any discussion or consultation involving your case will be conducted discreetly, and that individuals not directly involved in your care will not be present without your permission.

  • To have your medical records read only by individuals directly involved in your treatment or the monitoring of its quality, and by other individuals only with your written authorization, or that of your legally authorized representative.

  • To review the medical records pertaining to your medical care and have the information explained or interpreted as necessary except where restricted by law.

  • To make an amendment to your medical record.

  • To expect that all communications and other records pertaining to your care, including the source of payment for treatment, be treated as confidential, except in cases required by law.

  • To request a transfer to another room if another patient or visitors in your room are unreasonably disturbing.

  • The right to report a privacy or compliance concern, please call XXX-XXX-XXXX.

• The right to expect reasonable personal safety within FMC.

• The right to request and receive special protective services offered by FMC’s staff and police when appropriate.

• The right to know the identity of the provider responsible for your care, and the identities and professional status of everyone participating in your care. This includes your right to know of the existence of any professional relationship among individuals who are providing treatment, as well as the relationship to any other healthcare or educational institutions involved in your care.

• The right to be kept informed, by the attending provider, of any developments in your diagnosis, treatment, known prognosis or any unanticipated outcomes of treatment or care. You have the right to know the immediate and long-term financial implications of the treatment choices, insofar as they are known.

• The right to communicate with others outside of FMC.

• The right to qualified interpreters when the primary language is not English at no cost. This includes access to qualified sign language interpreters, if needed.

• The right to request or designate visitors who are not immediate family members and for these designated visitors to receive the same visitation privileges, regardless of whether the visitors are legally related to the patient. FMC will ensure that all visitors enjoy full and equal visitation privileges consistent with patient preferences.

• The right to designate a lay caregiver, if an inpatient 55 years of age or older, and the right to have discharge instructions reviewed with the lay caregiver.

• The right to be involved in decisions involving your healthcare, including dilemmas about healthcare decisions, which include giving your voluntary consent to and competent understanding of any procedures undertaken. Should FMC propose to engage in research/educational projects that affect your care, you have the right to refuse to participate in this activity and to know alternative treatments and associated discomforts. Should you refuse to participate in research or experimentation, you are entitled to the most effective care FMC can otherwise provide.

• The right to consult a specialist.

• The right to refuse treatment, as permitted by law.

• The right to die with dignity in a calm, quiet environment with significant others present and pain relieved insofar as possible.

• The right to effective pain management.

• The right to request and receive assistance with communication without cost to the patient.

• The right to expect reasonable continuity of care, including discharge planning, with specific follow-up information.

• The right, before being transferred to another facility, to be informed of the need for and alternatives to such a transfer, which includes having a prompt and orderly transfer to a facility that is more appropriately suited to meet your need for services.

• The right to expect that, within its capacity, FMC will make a reasonable response to the request of the patient for services.

• The right to request and receive an itemized bill of charges of FMC services, and timely notice before the termination of your eligibility for third-party pay or reimbursement.

• The right to be informed of FMC’s rules and regulations that apply to your conduct as a patient.