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Patient Policies
Your Rights as a Patient
Your Responsibilities as a Patient
Notice of Privacy Practices
Patient Safety
Your Rights as a Patient
At Lakeview Medical Center, we listen to and act upon the needs of all those we serve. As part of our commitment to this philosophy, we support the following patient rights to make sure you get the best possible care and information about your care, as permitted by law.
1. You will have reasonable access to care.
2. You will not be denied appropriate hospital care because of race, creed, color, national origin, ancestry, religion, sex, sexual orientation, marital status, age, newborn status, handicap or source of payment.
3. You will receive care in a safe setting.
4. You will be free from all forms of abuse or harassment.
5. You will be free of restraint or seclusion in any form, unless medically necessary. Such measures will never be used for coercion, discipline, convenience, or retaliation by staff.
6. You will receive considerate care that respects your personal values and beliefs.
7. You will have your personal dignity and privacy respected at all times.
8. Your doctor will be notified of your admission to the hospital. If you choose, a family member or friend will also be notified.
9. You will choose who is permitted to visit you during your stay.
10. Your pain will be assessed and managed appropriately.
11. We will get a consent form from you or your legally authorized representative before any treatment is given, except in emergencies.
12. You may review your medical records and have the information explained.
13. All aspects of your care will be kept confidential such as your medical record, all computerized medical information, and any arrangements you make to pay bills and charges.
14. You may consent or decline to take part in research affecting your care.
15. We will follow your advance directives, such as a living will or durable power-of-attorney for health care. If you do not have advanced directives, we will make them available to you.
16. You are entitled to know who has overall responsibility for your care.
17. You will be told of realistic care alternatives.
18. You will be well-informed about your illness, possible treatment, and likely outcome, except in emergencies when you may not be able to make decisions for yourself or the need for treatment is urgent.
19. You will take part in decisions about your care and any ethical issues that may arise, except in emergencies.
20. You will participate in making and carrying out your plan of care, except in emergencies.
21. You can leave the hospital at any time no matter what your condition, even it it's against your doctor's advice.
22. You may ask for a different room.
23. You will not be moved to another facility without a full explanation for the move, or without plans for continuing care and acceptance by the receiving institution, except in emergencies.
24. You will be permitted to examine your hospital bill and receive an explanation of the bill, regardless of source of payment, and to receive, upon request, information relating to financial assistance available through the hospital.
25. If you wish to make a complaint or feel your patient rights have been violated, please call 715-236-6133 or write:
President Ned Wolf
Lakeview Medical Center
1100 North Main Street
Rice Lake, WI 54868
You will be informed about the hospital's policies and procedures to initiate, review, and resolve your concern.
Complaints or grievances may also be filed with the Bureau of Quality Assurance, 2917 International Lane, Suite 300, Madison, WI 53707.
OR
The Joint Commission
Division of Accreditation Operations
Office of Quality Monitoring
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
or FAX to 630-792-5636
or E-mail to: complaint@jointcommission.org
If you are a Medicare Beneficiary, you
may contact Wisconsin's Quality Improvement Organization:
MetaStar
1-800-362-2320 for:
* Complaints or grievances
* Concerns about the quality of care
* Rights to appeal premature discharge
Your Responsibilities as a Patient
For the best healthcare possible, you and your healthcare team must work together. Just as you have rights as a patient, you also have these responsibilities:
1. Be direct and honest about information and give accurate and complete medical history.
2. Follow your doctor's recommendations.
3. Tell your doctor or nurse if you cannot follow your instructions or do not understand your care.
4. Comply with safety instructions.
5. Be considerate to and respectful of your doctor, nurses, other staff, and other patients.
6. Give the hospital a copy of your written advance directive, if you have one.
7. Meet your financial obligations to the hospital.
Notice of Privacy Practices
HIPAA FORM 9
LAKEVIEW MEDICAL CENTER
1100 North Main Street
Rice Lake, WI 54868
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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.
Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your medical information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your medical information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect 4/14/2003, and will remain in effect until further requirements or recommended changes are made.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all medical information that we maintain, including medical information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request.
You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.
{Organizations Covered by this Notice}
{This notice applies to the privacy practices of the {types of} organizations listed below, with the {classes of} sites they maintain for delivery of health care products and services. These organizations are each participants in an organized health care arrangement. As such, we may share your medical information and the medical information of others we service with each other as needed for treatment, payment or health care operations relating to our organized health care arrangement.}
Lakeview Medical Center
Marshfield Clinic
Diagnostic Radiology Associates
Dr. Hager
Dr. Iwakari
Branham and Healy Orthopedic Clinic
Dr. Weber, Dr. Raether, Dr. Henkel, and Dr. Anderegg
Chippewa Valley Eye Clinic
Dr. Rieser & Dr. Thomas
Dr. Mack and Dr. Kowski (Foot and Ankle Clinic)
Uses and Disclosures of Medical Information
We may use and disclose medical information about you for treatment, payment, and health care operations. For example:
Treatment: We may use or disclose your medical information to a physician or other health care provider providing treatment to you.
Payment: We may use and disclose your medical information to obtain payment for services we provide to you.
Health Care Operations: We may use and disclose your medical information in connection with our health care operations. Health care operations include quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
To You and on Your Authorization: We must disclose your medical information to you, as described in the Individual Rights section of this notice. You may give us written authorization to use your medical information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your medical information for any reason except those described in this notice.
Facility Directory: We may use the following medical information in our facility directories: your name and location in our facility. We will disclose this information to members of the clergy and to other persons who ask for you by name. You may restrict or prohibit some or all disclosures for facility directories unless emergency circumstances prevent your opportunity to object. We may not disclose your general medical condition in our facility directories without your written permission.
Persons Involved In Your Care: With your written permission, we may disclose to a family member, friend or other person, the medical information that is directly relevant to their involvement in your care or payment for your care. We may use or disclose your name and location (and, with your written permission, general condition or death) to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person involved in your care. If you have not previously given us written permission for such uses and disclosures and are present, we will provide you with an opportunity to object to such uses or disclosures.
We may also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of medical information.
Disaster Relief: We may use or disclose your name and location to a public or private entity authorized by law or by its charter to assist in disaster relief efforts.
Marketing Health Related Services: We may use your medical information to contact you with information about health-related benefits and services or about treatment alternatives that may be of interest to you. With your written permission, we may disclose your medical information to a business associate to assist us in these activities. Unless the information is provided to you by a general newsletter or in person or is for products or services of nominal value, you may opt out of receiving further such information by telling us using the information listed at the end of this notice.
Fundraising: We may use your medical information to contact you for fundraising purposes. We will limit our use and disclosure to your demographic information and the dates of your health care. With your written permission, we may disclose this information to a foundation affiliated with us or a business associate to assist us in fundraising activities. We will provide you with any fundraising materials and a description of how you may opt out of receiving future fundraising communications.
Death; Organ Donation: We may disclose the medical information of a deceased person to a coroner, medical examiner, or organ procurement organization for certain purposes.
Required by Law: We may use or disclose your medical information when we are required to do so by law. For example, we must disclose your medical information to the U.S. Department of Health and Human Services upon request for purposes of determining whether we are in compliance with federal privacy laws. We may disclose your medical information when authorized by workers' compensation or similar laws. We may disclose your medical information to a government agency authorized to oversee the health care system or government programs or its contractors, to public health authorities for public health purposes, and to any government agency which makes a written request for a legally authorized purpose. You may be able to opt out of some of these disclosures to government agencies.
Law Enforcement: We may disclose your medical information in response to a court order and certain administrative orders, subpoenas, discovery requests, or other lawful process. We may disclose limited information to a law enforcement official concerning the medical information of a suspect, fugitive, material witness, crime victim or missing person, or when necessary to assist law enforcement officials to capture and individual who has admitted to participation in a crime or has escaped from lawful custody.
We may disclose the medical information of an inmate or other person in lawful custody to a law enforcement official or correctional institution under certain circumstances.
Abuse, Neglect or Endangerment: We may disclose your medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse or neglect. We may disclose your medical information to the extent necessary to avert a serious and imminent threat to your health or safety or the health or safety of others.
National Security: We may disclose to military authorities the medical information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials medical information required for lawful intelligence, counterintelligence, and other national security activities. You may be able to opt out of some of these disclosures to government agencies.
HIV Test Results. Your HIV test results, if any, may be disclosed as set forth in Wisconsin Statues 252.15(5)(a). A listing of the persons or circumstances set forth in that statute is available on request. Written authorization is required for release of HIV results outside of the WI statutes as listed above.
Individual Rights
Access: You have the right to look at or get copies of your medical information, with limited exceptions. {You must make a request in writing to obtain access to your medical information. You may obtain a form to request access by using the contact information listed at the end of this notice. You may also request access by sending us a letter to the address at the end of this notice. If you request copies, there will be a charge set forth by MedLegal, our release of information specialists, for staff time to locate and copy your medical information. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.}
Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your medical information for purposes, other than treatment, payment, health care operations for which we have written permission, and certain other activities, since April 14, 2003. We will provide you with the date on which we made the disclosure, the name of the person or entity to whom we disclosed your medical information, a description of the medical information we disclosed, the reason for the disclosure, and certain other information.
If you request a disclosure accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.
Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). {Any agreement we may make to a request for additional restrictions must be in writing signed by a person authorized to make such an agreement on our behalf. We will not be bound unless our agreement is so memorialized in writing.}
Confidential Communications: You have the right to request that we communicate with you about your medical information by alternative means or to alternative locations. {You must make your request in writing, and you must state that the information could endanger you if it is not communicated by the alternative means or to the alternative location you want.} We must accommodate your request if it is reasonable, specifies the alternative means or location, and provides satisfactory explanation how payments will be handled under the alternative means or location you request.
Amendment. You have the right to request that we amend your medical information. {Your request must be in writing, and it must explain why the information should be amended.} We may deny your request if we did not create the information you want amended and the originator remains available or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement to be appended to the information you wanted amended. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information.
Electronic Notice: If you receive this notice on our web site or by electronic mail (e-mail), you are entitled to receive this notice in written form. Please contact us using the information listed at the end of this notice to obtain this notice in written form.
Questions and Complaints
If you want more information about our privacy practices or have questions or concerns, please contact us using the information listed at the end of this notice.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your medical information or in response to a request you made to amend or restrict the use or disclosure of your medical information or to have us communicate with you by alternative means or at alternative locations, you may file a complaint by using the contact information listed at the end of this notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.
We support your right to the privacy of your medical information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Contact Office: Health Information Services
Telephone: 715-236-6135
Fax: 715-236-6573
E-Mail: piecuch.debra@lakeviewmedical.org
Address: 1100 N. Main Street, Rice Lake, WI 54868
Patient Safety
Lakeview Medical Center and our health care professionals are dedicated to providing the best care for our patients. When you or a family member are a patient at LMC, we want to make sure you receive the best and safest care possible. We ask you and your family to join our health care team during your stay to make sure that our care meets your needs. We encourage you to let us know if it does not.
We are committed to sharing information on quality and safety with you and your family. LMC voluntarily participates in the Wisconsin Hospital Association's "CheckPoint," a public reporting program of Quality and Error Prevention Measures (www.wicheckpoint.org) and the National Voluntary Hospital Reporting Initiative (www.cms.hhs.gov, under Quality Initiatives/National Voluntary Hospital Reporting).
Following are just some of the quality and safety practices LMC has in place:
Patient safety is central to everything we do at LMC.
Physicians and nurses at our hospital are board licensed and participate in continuing education.
We have a patient safety committee available to evaluate any safety concern brought to our attention by staff, patients or family members. The safety committee reviews each safety concern and develops a plan to make our hospital a safe place for you to receive care.
We double-check to make sure you receive the right medication, the right dose, at the right time during your stay with us. After discharge, we encourage our patients to carry current Medication Cards with them at all times that list the dose and kind of medication.
We perform a surgical "time out" before every surgical procedure to verify the site, the patient and the procedure.
We encourage you to ask questions about your care and to take notes.
We encourage patients to have a family member or friend with them during health care visits. They provide comfort, support and can also ask questions.
It is our policy to inform you of the potential results of your care, including unexpected results.
We encourage all of our patients to complete our patient satisfaction survey. We survey our patients verbally and by a written survey. We want to learn about their hospital stay experience. We review all surveys and make appropriate changes as a result of comments.
We welcome the opportunity to discuss the care you receive. If you have comments, questions, or concerns, please contact:
Sandy Harm, Risk Management Coordinator
715-236-6337
harm.sandy@lakeviewmedical.org |
