Patient Bill of Rights and Responsibilities

As a patient of Fairfield Medical Center (FMC), you have the following rights. These rights are intended to ensure that all patients receive respectful, safe, and high-quality care.

1. The right to have impartial access to treatment. The hospital prohibits discrimination based on race, color, national origin, age, disability, sex, sexual orientation, gender identity or expression, religion, culture, language, or socioeconomic status.
   • To report discrimination or file a grievance, contact the Human Resources Manager at 740-687-8964.
   • You may also file a civil rights complaint with the U.S. Department of Health and Human Services Office for Civil Rights at www.hhs.gov/ocr or by calling 1-800-368-1019.
2. The right to receive considerate and respectful care at all times.
3. The right to receive care in a safe environment and to be free from abuse, neglect, harassment, or exploitation.
4. The right to personal privacy and confidentially, as permitted by law, including the following:
   • To refuse to speak with or see anyone not directly involved in your care or not officially connected with FMC.
   • 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, cultural, and religious beliefs respected and to request spiritual support, including visits from personal clergy, a chaplain, or other spiritual care services.
   • To be interviewed and examined in surroundings designed to assure reasonable audio-visual privacy. Patients may request the person of their choice during certain parts of examinations, treatments, or procedures when appropriate.
   • To expect that discussions and consultations regarding your care will be conducted discreetly and that individuals not directly in your care will only be present with your permission.
   • To have your medical information accessed only by individuals involved in your care, payment, healthcare operations, or as otherwise permitted by law.
   • 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 request an amendment to your medical record.
   • To expect that communications and records related to your care, including payment information will be treated as confidential except as required or permitted by law.
   • To request a transfer to another room if another patient or visitors in your room are unreasonably disturbing.
   • To report a privacy or compliance concern without fear of retaliation.
5. The right to expect reasonable personal safety within the hospital.
6. The right to be free from restraints or seclusion that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation.
7. The right to request protective services provided hospital staff or security when appropriate.
8. The right to know the identity of the provider responsible for your care and the identities and professional status of individuals participating in your care.
9. The right to be kept informed by the attending provider of developments in your diagnosis, treatment, known prognosis, and any unanticipated outcomes of care.
10. The right to communicate with persons outside the hospital.
11. The right to receive free language and communication assistance services, including qualified interpreters and sign language interpreters, and auxiliary aids and services, when the patient’s primary language is not English or when needed for effective communication due to a hearing, vision, speech, or other communication disability. Interpreter and communication assistance services are provided at no cost to the patient.
12. 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 whether visitors are legally related to the patient. FMC will ensure that all visitors enjoy full and equal visitation privileges consistent with patient preference.
13. The right to designate a lay caregiver if the patient is an inpatient 55 years of age or older and to have discharge instructions reviewed the designated caregiver.
14. The right to give informed consent before participating in any research, investigation, or educational project that may affect your care. You have the right to refuse participation and to be informed of alternative treatments and possible risks or discomforts. Refusal to participate will not affect your access to care or treatment. Patients may withdraw from participation in research at any time without affecting their care.
15. The right to request consultation with a specialist.
16. The right to refuse treatment, as permitted by law.
17. The right to receive compassionate end-of-life care in a calm environment with appropriate pain management and the presence of loved ones when possible.
18. The right to appropriate assessment and management of pain.
19. The right to expect reasonable continuity of care, including discharge planning and follow-up information.
20. The righto be informed of the need for transfer to another facility and the alternatives to such transfer, and to receive a prompt and orderly transfer when appropriate.
21. The right to request and receive an itemized bill for services and to receive timely notice before the termination of eligibility for third-party payment or reimbursement.
22. The right to be informed of FMC’s rules and regulations that apply to your conduct as a patient.
23. The right to express a complaint or grievance regarding care and to have the complaint reviewed and resolved through FMC’s grievance process. Patients may also file complaints with state or regulatory agencies without fear of retaliation.
    • For questions or to file a complaint, contact:
      • FMC Patient Representative: 740-687-8555
      • House Supervisor: 740-687-8190
    • If concerns are not resolved through the hospital grievance process, patients may also contact the following agencies:
      • Ohio Department of Health: 1-800-342-0553
      • Joint Commission: www.jointcommission.org
      • Medicare Beneficiary Ombudsman: www.medicare.gov
24. The right to formulate advance directives and to have hospital staff comply with those directives in accordance with applicable law. The hospital will ask patients whether they have an advance directive and will document the response in the medical record.
25. The right to indicate a desire to be an organ and tissue donor in accordance with applicable law.
26. For minor patients, the right to have the patient rights exercised by a parent or legal guardian in accordance with applicable law.
27. The right to request an ethics consult. To request an ethics consult, contact the Patient Representative or House Supervisor using the numbers listed above.

As a patient of FMC, you are encouraged to participate in your care by accepting the following responsibilities:

1. Provide accurate and complete information about your past and present health and to inform your care team if you do not understand the proposed plan of care or what is expected of you.

2. Ask questions when directions, instructions, or procedures are not clearly understood.

3. Understand the possible consequences of refusing recommended treatment and to discuss concerns with your healthcare team.

4. Follow the treatment plan recommended by your provider who is responsible for your healthcare.

5. Communicate concerns about your care, including informing your provider, nurse, patient representative, or case manager if you believe you are not receiving adequate information or care.

6. Fulfill financial obligations related to your healthcare as promptly as possible.

7. Follow FMC’s rules and regulations that apply to patient conduct as described in the Patient Information Handbook.

8. Respect the rights and property of other patients, visitors, and FMC personnel, and to assist in maintaining a quiet and safe environment.

9. Designate a person who may speak on your behalf and authorize treatment in the event you are unable to make decisions for yourself.