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PATIENT RIGHTS & RESPONSIBILITIES  Your Patient Rights                           hospital’s capacity, its stated mission, and    11. You have the right to the
                                                                                 applicable law and regulation.                  confidentiality of your medical record

                                   You have rights and a role                    6. You have the right to considerate and        and information within legal limits.

                                   regarding your treatment                      respectful care in a dignified manner,          12. You have the right to access

                                   and care. Knowing your rights                 including the following:                        information contained in your medical
                                   and role can help you make                      a) Care that considers psychosocial,          record within a reasonable time frame
                                   better decisions about your                     spiritual, cultural, personal values,         and under conditions established by
                                   health care.                                    preferences, and other variables that         hospital policy.
                                                                                   influence the perception of illness;

                                   1. The hospital prohibits discrimination      b) Care of the dying that optimizes comfort 13. You have the right to personal privacy.
                                                                                 and dignity:
                                   to patients and visitors based on age,
                                   race, ethnicity, national origin, religion,   •	 By treating primary and secondary            14. You have the right to receive care in a
                                   culture, language, physical or mental           symptoms that respond to treatment            safe setting.
                                   disability, socioeconomic status, gender,       according to individual wishes;
                                   or sexual orientation.                                                                        15. You have the right to be free from
                                                                                 •	 By effectively managing pain; and            all forms of abuse and harassment,
                                   2. You have the right to receive              •	 By recognizing psychosocial and              including neglect, exploitation, verbal
                                   information about your rights as a                                                            abuse, mental abuse, physical abuse and
                                   patient and how to present a complaint          spiritual concerns about dying and            sexual abuse.
                                                                                   grief.

                                   or grievance, including whom to contact       7. You have the right to work together          16. You have the right to be free from
                                   with your complaint.                          with your physician to make decisions           bodily punishment, including the right to
                                                                                 about your care and treatment:                  be free from restraint or seclusion of any
                                     a) To learn more about the complaint-                                                       form that is used as a means of coercion,
                                     handling process or to file a complaint,      a) Receive information you need to make       discipline, convenience or retaliation
                                     ask your nurse or another member of the       an informed decision about care and           by the hospital workforce. Restraint or
                                     hospital workforce, or call 832-534-5838      treatment that reflects your wishes;          seclusion may only be used to ensure
                                     to speak to a hospital representative at      b) Receive information necessary to give      your immediate physical safety or the
                                     any time during your stay to report your      your informed consent before certain          safety of others, and must be ordered by
                                     concern or complaint (grievance).             procedures or treatments;                     your physician and discontinued at the
                                     b) For grievances regarding civil rights      c) Accept or refuse care, treatment, and/     earliest possible time.
                                     discrimination, please submit your            or services, to the extent permitted by law,
                                     complaint in writing with your name,          and receive information about the possible

                                   your address, a description of the alleged    effects of refusing care or treatment;          17. You have the right to be informed
                                   discriminatory action, and the resolution     d) Receive information about the outcomes       of any human experiments, research or
                                   sought to the following:                      of care or treatment that was provided,         clinical education programs that affect

                                   CHI St. Luke’s Health | Attn: Division          including any unexpected outcomes; and        your care, treatment, and/or services,
                                   Corporate Responsibility Officer | PO           e) Participate in the plan for your care,     including the respect and protection of
                                   Box 20269 | MC 3-121                            treatment, and discharge, and manage          your rights.
                                   Houston, TX 77225-0269 | 832-355-2146           your pain.
                                                                                                                                 18. Your guardian, next of kin or legally
                                   c) If you feel that your concerns have not    8. You have the right to receive                authorized person has the right to
                                   been resolved by the hospital, you may        information in a manner you understand.         exercise, to the extent permitted by law,
                                   contact one of the following:                                                                 your rights if you are unable to express
                                   •	 Texas Department of State Health           9. You have the right to participate in         your wishes about care, treatment, and/
                                                                                 addressing ethical issues related               or services.
                                     Services                                    to your care.

                                     •	 U.S. Department of Health and            10. You have the right to work together         19. You have the right to receive
                                        Human Services, Office for Civil Rights  with your physician to express your             visitors whom you designate including,
                                                                                 choices about care and/or treatment             but not limited to, a spouse, domestic
                                     •	 Centers for Medicare and Medicaid        before it is needed, such as through an         partner (including a same-sex domestic
                                        Services (CMS)                           advance directive. If you prefer, you may       partner), another family member or
                                                                                 appoint someone to make health care             a friend. You may make changes to
                                     •	 DNV Healthcare Inc.                      decisions for you.                              withdraw or deny consent to a visitor
                                                                                                                                 at any time. The hospital may need to
                                   3. If you have Medicare coverage and are        a) During admission, you will be asked        restrict visitors based on your clinical
                                   admitted to the hospital, you have the          if you have an advance directive or need      condition or to protect the rights and
                                   right to receive the Beneficiary Notice,        assistance with writing an advance            safety of others. The number of visitors,
                                   the “Important Message from Medicare.”          directive.                                    visiting hours and overnight visitors may
                                                                                   b) If you have an advance directive,          also be limited. Please check with your
                                   4. You have the right to have a family          a copy, if available, will be placed in your  nurse about the specific limitations for
                                   member or person of your choice and             medical record. As appropriate to your        your room.
                                   your physician notified when you are            care, it will be reviewed with you or your
                                   admitted to the hospital.                       decision maker.                               Still have questions about
                                                                                   c) Care, treatment and services are not       your rights or responsibilities?
                                   5. You have the right to reasonable             based on whether or not you have an           Call 832-355-2146 for answers.
                                   responses to requests and needs for care,       advance directive.
                                   treatment, and/or services, within the

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