Patient Rights & Responsibilities
Your Right To Admission
Tomah Memorial Hospital, as a non-profit health care provider, honors your legal right to admission for care without discrimination. A medical staff member from Tomah Memorial will arrange for you to be admitted as appropriate. Tomah Memorial Hospital does not discriminate in regards to sex, race, religion, color, creed, national origin, or ancestry, age, disability, marital status, source of income, arrest or conviction record, veteran status, military participation, physical appearance, sexual orientation, political beliefs, or newborn status.
Your Right To Privacy
You have a right to:
- Know the identity of all those who are providing care to you.
- Know the identity of anyone who may seek information from you.
- Have your privacy respected as much as your treatment and care allow.
- Be treated with respect, dignity, and courtesy at all times without abuse or harassment.
- Choose to restrict visitors, phone calls and clergy visits.
- Expect all non-emergency personnel to knock or alert you when they are about to enter your room.
- Consideration by personnel as they perform tasks to maintain a safe, clean environment for you.
- Be interviewed and examined in surroundings designed to assure reasonable visual and auditory privacy.
- Wear appropriate personal clothing and religious or other symbolic items, as long as they do not interfere with diagnostic procedures or treatment.
- Have a person of one's own sex present during a physical examination, treatment or procedure performed by a health professional of the opposite sex.
Your Right To Information
You are in charge of your life and you have the right to know about your health in terms you can understand.
From your medical provider:
- The nature, extent and prognosis (outcome) of your illness or injury.
- The proposed course of treatment, risks, benefits and alternatives of therapy.
The personnel who will be involved in that treatment.
From medical providers and technicians who give you diagnostic tests:
- The procedures involved.
- The possible risks involved.
The possible discomforts to expect.
From the health care providers caring for you:
- Patient education relevant to your care.
- An explanation of procedures involved in your care.
- The multidisciplinary plan of care.
From other personnel:
- An explanation of your bill. Financial Counselors in the business office will help you with questions regarding your bill; insurance coverage and financing your treatment costs.
- To request and receive an itemized bill.
- Support services such as pastoral support and social services.
- An explanation of medications administered to you, including the name and purpose of the medication; directions for use, potential side effects and interactions with food or other medications. An explanation of medications to be continued when you leave the facility will be provided. You can expect the hospital pharmacist will consult with your physician and other health care professionals about your drug therapy. If you are hearing impaired or have difficulty with the English language, every effort will be made to provide you with an interpreter or other translation assistance, at no extra charge.
Your Right To Choose
As a patient of Tomah Memorial you have the right to choose:
- To have a family member or representative present.
- To review your medical record. We recommend that professional staff assist your review to protect the medical record and prevent misunderstanding.
- To transfer to another hospital; after a complete explanation of the need for transfer and alternative method of treatment.
- To accept or refuse care, medications or treatment.
- Information you may want released to other individuals, such as friends, family, or media.
- You have a right as an inpatient or outpatient to leave against your physician’s advice. Should you decide to do so, you will be asked to sign a form which relieves the hospital and your physician of responsibility for harm related to your condition related to your leaving.
Your Right To Confidentiality
State and Federal laws provide for confidentiality of all medical records. These regulations and statues control the release of information contained in your medical record. These restrictions do not prevent review by authorized personnel for the purpose of assuring quality care. You have the right to access information in your own medical record and for it to be provided within a reasonable time.
Your medical record can be released to (the following but not limited to) without written consent to:
- Physicians or healthcare providers as required for your continuing care at another facility.
- Authorized legal representatives, as determined by law.
- Medical personnel in the case of a medical emergency.
- As required for third party payers, such as insurance companies, or Medicare, if requested as a court order.
- Healthcare operations.
Your Right To Develop An Advance Directive
Under Wisconsin Law, the way to make your wishes known in writing is to execute an advance medical directive. This could be in the form of a Power of Attorney for Healthcare or a Living Will.
You have the right to make known the type of medically appropriate treatment and services you would want.
You will be provided assistance in completing forms so that individuals could make medical decisions on your behalf, should you become incapacitated, terminally ill, or in a persistent vegetative state, and have practitioners and staff provide care that is consistent with these directives.
Your Responsibility To Cooperate
Your responsibilities for helping in your treatment and care include:
- Give accurate and complete information about complaints, history, hospitalization, medications and other health history.
- Cooperating with health care providers in implementing the treatment plan you have agreed upon.
- For following hospital rules and regulations affecting patient care and conduct.
- For being respectful of the property of other persons and of the hospital.
- For reporting if you clearly comprehend the course of action and what is expected of you.
- Respecting the rights and dignity of other patients and personnel.
Your Right To Appropriate Care
As a patient of Tomah Memorial Hospital you have the right to:
- Be free from both physical restraints and drugs used as a restraint. This includes that restraints will only be used when necessary and not used as a coercion, discipline, convenience or retaliation. Restraints used for behavior management can only be used in emergency situations if needed to ensure patients physical safety and less restrictive intervention have been determined to be ineffective.
- Appropriate assessment and management of pain.
You and/or your family may find it necessary to make difficult treatment choices while you are a patient. Tomah Memorial appreciates your right to make individual decisions based on your families' personal beliefs. Your caregivers will assist you by providing currently available medical information.
When difficult ethical decisions arise, such as withholding resuscitative services, forgoing or withdrawing life-sustaining treatment, a team lead by your physician will assist you.