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Patient Information -
Patient Rights and Responsibilities
1. Considerate and respectful care, and to be
made comfortable. You have the right to respect
for your cultural, psychosocial, spiritual,
and personal values, beliefs and preferences.
2. Have a family member (or other representative
of your choosing) and your own physician
notified promptly of your admission to the
3. Know the name of the physician who has
primary responsibility for coordinating your
care and the names and professional relationships
of other physicians and non-physicians
who will see you.
4. Receive information about your health status,
diagnosis, prognosis, course of treatment,
prospects for recovery and outcomes of care
(including unanticipated outcomes) in terms
you can understand. You have the right to effective
communications and to participate in
the development and implementation of your
plan of care. You have the right to participate
in ethical questions that arise in the course of
your care, including issues of conflict resolution,
withholding resuscitative services, and forgoing
or withdrawing life-sustaining treatment.
5. Make decisions regarding medical care and
receive as much information about any proposed
treatment or procedure as you may need
in order to give informed consent or to refuse a
course of treatment. Except in emergencies, this
information shall include a description of the
procedure or treatment, the medically significant
risks involved, alternate courses of treatment
or non-treatment and the risks involved
in each, and the name of the person who will
carry out the procedure or treatment.
6. Request or refuse treatment, to the extent
permitted by law. However, you do not have
the right to demand inappropriate or medically
unnecessary treatment or services. You have
the right to leave the hospital even against the
advice of physicians, to the extent permitted by
7. Be advised if the hospital or personal physician
proposes to engage in or perform human
experimentation affecting your care or treatment.
You have the right to refuse to participate
in such research projects.
8. Reasonable responses to any reasonable
requests made for service.
9. Appropriate assessment and management
of your pain, information about pain, pain
relief measures and to participate in pain
management decisions. You may request or
reject the use of any or all modalities to relieve
the pain, including opiate medications, if you
suffer from severe chronic intractable pain.
The doctor may refuse to prescribe opiate
medication, but, if so, must inform you that
there are physicians who specialize in the
treatment of severe chronic pain with methods
that include the use of opiates.
10. Formulate Advance Directives. This includes
designating a decision maker if you become
incapable of understanding a proposed treatment
or become unable to communicate your
wishes regarding care. Hospital staff and practitioners
who provide care in the hospital shall
comply with these directives. All patient rights
apply to the person who has legal responsibility
to make decisions regarding medical care on
11. Have personal privacy respected. Case discussions,
consultation, examinations and treatment
are confidential and should be conducted
discreetly. You have the right to be told the
reason for the presence of any individual. You
have the right to have visitors leave prior to an
examination and when treatment issues are
being discussed. Privacy curtains will be used in
12. Confidential treatment of all communications
and records pertaining to your care and
stay in the hospital. You will receive a separate
“Notice of Privacy Practices” that explains your
privacy rights in detail and how we may use
and disclose your protected health information.
13. Receive care in a safe setting, free from
mental, physical, sexual or verbal abuse and
neglect, exploitation or harassment. You have
the right to access protective and advocacy
services, including notifying government agencies
of neglect or abuse.
14. Be free from restraints and seclusion in any
form used as a means of coercion, discipline,
convenience or retaliation by staff.
15. Reasonable continuity of care and to know
in advance the time and location of appointments,
as well as the identity of the persons
providing the care.
16. Be informed by the physician, or a delegate
of the physician, of continuing healthcare
requirements and options following discharge
from the hospital. You have the right to be
involved in the development and implementation
of your discharge plan. Upon your request,
a friend or family member may be provided
with this information also.
17. Know which hospital rules and policies
apply to your conduct while a patient.
18. Designate visitors of your choosing, if you
have decision-making capacity, whether or
not the visitor is related by blood or marriage,
- No visitors are allowed.
- The facility reasonably determines that the
presence of a particular visitor would endanger
the health or safety of a patient, a
member of the health facility staff or other
visitor to the health facility, or would significantly
disrupt the operations of the facility.
- You have told the health facility that you
no longer want a particular person to visit.
However, a health facility may establish reasonable
restrictions upon visitation, including the
restrictions upon the hours of visitation and
number of visitors.
19. Have your wishes considered, if you lack
decision-making capacity, for the purposes
of determining who may visit. The method of
that consideration will be disclosed in the
hospital policy on visitation. At a minimum,
the hospital shall include any persons living in
20. Examine and receive an explanation of
the hospital’s bill regardless of the source
21. Exercise these rights without regard to sex,
economic status, educational background, race,
color, religion, ancestry, national origin, disability,
sexual orientation, marital status or the
source of payment for care.
22. File a grievance. If you want to file a grievance
with this hospital, you may do so by writing
147 North Brent Street
Ventura, CA 93003-2854
23. File a complaint with the State Department
of Health Services regardless of whether you
use the hospital’s grievance process. The State
Department of Health Service’s phone number
and address are:
Department of Health Services
1889 North Rice Avenue, Suite 200
Oxnard, CA 93030
24. Contact the Joint Commission on Accreditation
of Healthcare Organizations if you have
any unresolved patient safety or quality of care
concerns by writing or calling:
Hospital Complaint DNV Healthcare Inc.
400 Techne Center Drive, Suite 350
Millford, OH 45150
or toll free 866/523-6842
These Patient Rights combine Title 22 and other
California laws. Joint Commission and Medicare
Conditions of Participation requirements. (4/05)
At Community Memorial Health System, we
believe patients and families are partners in
ensuring that the best possible care is provided
in a healthful, safe environment. You can
participate in your healthcare by following
these Patient Responsibilities:
1. Provide, to the best of your knowledge,
accurate and complete information about
present complaints, past illness, hospitalization,
medications, and other matters relating to your
condition to the responsible practitioner.
2. Provide upon admission a copy of your
healthcare proxy or any other advance
directives or power of attorney forms, if you
3. Report any perceived risks in your care
and unexpected changes in your condition to
your doctor, nurse or other member of the
4. Follow the treatment plan that you and your
healthcare team have developed. This includes
following the instructions of healthcare staff
who are involved in your care.
5. Develop a pain management plan with your
doctor, nurse and healthcare team including:
- asking for pain relief when pain first begins,
- helping your doctor and nurse assess
- tell your doctor or nurse if your pain is
- tell your doctor or nurse about any worries
you have about taking pain medication.
6. Tell your nurse or doctor if you do not clearly
understand the proposed plan of care and what
is expected of you. Ask questions when you
7. Keep appointments. When you are unable to
do so for any reason, notify the office appointment
center in advance.
8. You are responsible for your actions if you
refuse treatment or do not follow the practitioner’s
instructions as to your provision of care.
9. Provide insurance information for processing
bills and assure that financial obligations are
fulfilled as promptly as possible.
10. Treat other patients and staff with consideration
11. Be respectful of other patients’ right to privacy.
Respect a roommate’s and other patients’
rights to privacy and quiet, including the control
of noise from use of radio, TV, and number
12. Be respectful of the property of other persons
and of the hospital.
13. You are responsible for following hospital
rules and regulations affecting patient care
Thank you for your cooperation, and we trust
that your stay with Community Memorial
Hospital will be as pleasant as possible.