Florida Patient’s Bill of Rights and Responsibilities

Please direct any questions regarding your rights and responsibilities to any Hospice Team member. Should questions arise after hours, please call your Hospice Team telephone number. You will reach a staff member in our call center who can address your concerns, or they will leave a message for your team members to get back to you.

Florida Law requires that your health provider or healthcare facility recognize your rights while you are receiving medical care, and that you respect the healthcare provider’s or healthcare facility’s right to expect certain behavior on the part of the patient. You may request a copy of the full text of this law from your healthcare provider or healthcare facility. A summary of your rights and responsibilities, as developed by Florida statute, and integrated with those of the National Hospice

Organization, is as follows:

Report any concerns to our Hotline at: 1 (800) 765-7408

AS A PATIENT YOU HAVE THE RIGHT TO:

Quality services: Be cared for by a team of professionals who will provide quality comprehensive hospice services as needed and appropriate for you and your family (including extended and alternative family).

Clearly understand services: Have a clear understanding of the availability of, and access to, hospice services and hospice staff who visit regularly and are on call 24 hours a day, 7 days a week. You have the right to have an interpreter available if you do not speak English.

Access to Care: Impartial access to appropriate and compassionate care or

accommodations, regardless of diagnosis, race, national origin, age, gender, religion, creed, disability, sexual orientation, place of residence within the area served by the hospice, source of payment or the ability to pay for the services rendered.

Response to questions: A prompt and reasonable response to questions and requests.

Know who is providing service: Know who is providing medical services, who is responsible for your care, and how much services will cost.

Be informed regarding your health: Be appropriately informed regarding your health status, diagnosis, planned course of treatment, alternatives, risks and prognosis in order to participate in the planning of your care. The hospice professional team will assist you and your family in identifying which service and treatments will help you attain your goals.

Be informed regarding medical treatments: Be appropriately informed regarding the potential benefits and risks of all medical treatments or services suggested by the hospice, and to accept or refuse those treatments and/or services as appropriate to your personal wishes, except as otherwise provided by law. The hospice professional team will provide you with information pursuant to the Patient Self-Determination Act about ways to make your wishes known to those caring for you.

Consent to/refuse research participation: Know if medical treatment is for purposes of experimental research, and to give your consent or refusal to participate in such experimental research. Know you have the right to refuse treatment and to have your unique ethical, spiritual and philosophical life goals honored.

Be treated respectfully: Be treated with courtesy and respect, with appreciation of dignity for your person, family, caregivers and property, as well as protection for your need for individual privacy and confidentiality.

Have caregivers educated: Have your family or other caregivers, if available, educated in effective ways of caring for you.

Emergency medical treatment: Treatment for any emergency medical condition that will deteriorate from failure to provide treatment.

Be free from physical abuse: State Hotline 800-96-ABUSE (1.800.962.2873). Open 24 hours, 7 days a week.

Confidentiality: Confidentiality with regard to information concerning your health status, as well as social and/or financial circumstances. Patient information or records will be released only on your agent’s written consent, or as required by law.

Voice grievances: Voice grievances concerning patient care, treatments, violations of rights as stated in Florida law, and/or respect for person or privacy without being subject to discrimination or reprisal and have any such complaints investigated by the hospice in accordance with its grievance procedure.

Use of ethics services: There is an Ethics Committee to resolve clinical ethical concerns. To use this service, please contact your primary nurse and request an ethics consultation.

Be informed of fees/charges: Be informed of any fees or charges in advance of services for which you may be responsible. Prior to treatment, you have the right to be given, upon request, full information and necessary counseling on the availability of known financial resources for your care. You have the right to use any insurance or entitlement program for which you may be eligible.

Receive an understandable bill for charges: Upon request, receive a copy of a clear and understandable, itemized bill, and have the charges explained.

Know that Hospice is certified: If eligible for Medicare/Medicaid, to know whether the hospice is certified for Medicare/Medicaid reimbursement, and to be fully informed concerning the hospice Medicare/Medicaid benefit.

AS A PATIENT YOU/YOUR CAREGIVER HAVE THE RESPONSIBILITY TO/FOR:

Participate in the plan of care: Participate in developing your Plan of Care, and updating it as your condition or needs change.

Follow the treatment plan: Follow the treatment plan recommended by your physician, hospice and any other healthcare provider, as mutually agreed.

Report any condition changes: Report to the hospice any unexpected changes in your condition.

Report whether or not you understand: Report to the hospice whether or not you understand a proposed course of action, and what is expected of you.

Keep appointments: Keep appointments and, when unable to do so for any reason, notify the appropriate healthcare provider and hospice.

Your actions if you refuse treatment: Your actions if you refuse treatment or do not follow the healthcare provider’s instructions.

Provide accurate health information: Provide, to the best of your knowledge, the hospice with accurate and complete health information about present complaints, past illnesses, hospitalizations, medications and other matters relating to your health.

Remain under a physician’s care: Remain under a physician’s care while receiving hospice services.

Maintain a safe environment: Assist the hospice staff in developing and maintaining a safe environment in which your care can be provided.

Assure your financial obligation, if applicable: Assure that the financial obligation of your healthcare is fulfilled as promptly as possible, if applicable.

Follow Hospice rules: Follow hospice rules and regulations affecting patient care and conduct.

Organ or tissue donation: You have the right to make an organ or tissue donation. Please discuss your plans for organ or tissue donation with your nurse.

Medical Privacy Under the Health Insurance Portability and Accountability Act (HIPAA)

TrustBridge protects your medical information and your rights regarding your own medical records. We are dedicated to protecting your right to privacy of your medical information, while providing the highest quality medical care. We want you to be aware of regulations that affect how we use and disclose your medical information, and the rights you have regarding your medical records. Privacy rules adopted as part of the federal Health Insurance Portability and Accountability Act (HIPAA) establish standards for the release of medical information that personally identifies you.

Our Privacy Practices

We must provide you access to a Privacy Notice that explains how we may use or disclose your medical information. We will ask you to acknowledge that you have received and understand our privacy notice when you are first admitted.

Your Permission

Once we have informed you about our privacy practices, you may designate to whom you want your medical information released. We may release information about you for purposes of your treatment, billing for services, or for hospice operations such as quality assurance without further permission from you. You may revoke your permission to use and disclose your medical information at any time.

Authorization

You may be asked to sign an authorization form allowing release of information for other purposes not related to your treatment, billing for services or hospice operations. However, you are not required to sign an authorization form. We will not deny treatment if you elect not to sign the authorization form.

Facility Directory

Facilities typically include your name, location in the facility, and your condition in the facility directory. You may tell the facility not to include your information in the directory.

The facility may release information, including the fact that you are in the facility, where you are located, and your general condition to inquiring family and friends, and in some circumstances to the media. You may restrict this disclosure by telling the facility you do not want that information released.

Your Rights Regarding Medical Records

Federal privacy regulations give you many rights regarding your medical records including:

The right to an accounting of certain disclosures of your medical information. Medical records are retained for six years.

The right to inspect and obtain a copy of your medical information.

The right to receive confidential communications of your medical information by an alternative means or at an alternative location.

The right to request an amendment to your medical record.

The right to submit a complaint about how your medical information is used or disclosed.

If you have any questions about how we will use or disclose your medical information, please contact Health Information Management at (561) 227-5215.

For questions regarding your rights, or HIPAA, call our Compliance Hotline at (800) 765-7408.