Patient’s Rights and Responsibilities

The policy describing the rights and responsibilities of each patient admitted to a facility, except those admitted by a home health care provider, shall include, as a minimum, the following:

The patient shall be treated with consideration, respect, and full recognition of the patient’s dignity and individuality, including privacy in treatment and personal care and including being informed of the name, licensure status, and staff position of all those with whom the patient has contact, pursuant to RSA 151:3-b.
The patient shall be fully informed of a patient’s rights and responsibilities and of all procedures governing patient conduct and responsibilities. This information must be provided orally and in writing before or at admission, except for emergency admissions. Receipt of the information must be acknowledged by the patient in writing. When a patient lacks the capacity to make informed judgments the signing must be by the person legally responsible for the patient.
The patient shall be fully informed in writing in language that the patient can understand, before or at the time of admission and as necessary during the patient’s stay, of the facility’s basic per diem rate and of those services included and not included in the basic per diem rate. A statement of services that are not normally covered by medicare or Medicaid shall also be included in this disclosure.
The patient shall be fully informed by a health care provider of his or her medical condition, health care needs, and diagnostic test results, including the manner by which such results will be provided and the expected time interval between testing and receiving results, unless medically inadvisable and so documented in the medical record, and shall be given the opportunity to participate in the planning of his or her total care and medical treatment, to refuse treatment, and to be involved in experimental research upon the patient’s written consent only. For the purposes of this paragraph “health care provider’ means any person, corporation, facility, or institution either licensed by this state or otherwise lawfully providing health care services, including, but not limited to, a physician, hospital or other health care facility, dentist, nurse, optometrist, podiatrist, physical therapist, or psychologist, and any officer, employee, or agent of such provider acting in the course and scope of employment or agency related to or supportive of health care services.
The patient shall be transferred or discharged after appropriate discharge planning only for medical reasons, for the patient’s welfare or that of other patients, if the facility ceases to operate, or for nonpayment for the patient’s stay, except as prohibited by Title XVIII or XIX of the Social Security Act. No patient shall be involuntarily discharged from a facility because the patient becomes eligible for Medicaid as a source of payment.
The patient shall be encouraged and assisted throughout the patient’s stay to exercise the patient’s rights as a patient and citizen. The patient may voice grievances and recommend changes in policies and services to facility staff or outside representatives free from restraint, interference, coercion, discrimination, or reprisal.
The patient shall be permitted to manage the patient’s personal financial affairs. If the patient authorizes the facility in writing to assist in this management and the facility so consents, the assistance shall be carried out in accordance with the patient’s rights under this subdivision and in conformance with state law and rules.
The patient shall be free from emotional, psychological, sexual and physical abuse and from exploitation, neglect, corporal punishment and involuntary seclusion.
The patient shall be free from chemical and physical restraints except when they are authorized in writing by a physician for a specific and limited time necessary to protect the patient or others from injury. In an emergency, restraints may be authorized by the designated professional staff member in order to protect the patient or others from injury. The staff member must promptly report such action to the physician and document same in the medical records.
The patient shall be ensured confidential treatment of all information contained in the patient’s personal and clinical record, including that stored in an automatic data bank, and the patient’s written consent shall be required for the release of information to anyone not otherwise authorized by law to receive it. Medical information contained in the medical records at any facility licensed under this chapter shall be deemed to be the property of the patient. The patient shall be entitled to a copy of such records upon request. The charge for the copying of a patient’s medical records shall not exceed $15 for the first 30 pages or $.50 per page, whichever is greater; provided, that copies of filmed records such as radiograms, x-rays, and sonograms shall be copied at a reasonable cost.
The patient shall not be required to perform services for the facility. Where appropriate for therapeutic or diversional purposes and agreed to by the patient, such services may be included in a plan of care and treatment.
The patient shall be free to communicate with, associate with, and meet privately with anyone, including family and resident groups, unless to do so would infringe upon the rights of other patients. The patient may send and receive unopened personal mail. The patient has the right to have regular access to the unmonitored use of a telephone.
The patient shall be free to participate in activities of any social, religious, and community groups, unless to do so would infringe upon the rights of other patients.
The patient shall be free to retain and use personal clothing and possessions as space permits, provided it does not infringe on the rights of other patients.
The patient shall be entitled to privacy for visits and, if married, to share a room with his or her spouse if both are patients in the same facility and where both patients consent, unless it is medically contraindicated and so documented by a physician. The patient has the right to reside and receive services in the facility with reasonable accommodation of individual needs and preferences, including choice of room and roommate, except when the health and safety of the individual or other patients would be endangered.
The patient shall not be denied appropriate care on the basis of race, religion, color, national origin, sex, age, disability, marital status, or source of payment, nor shall any such care be denied on account of the patient’s sexual orientation.
The patient shall be entitled to be treated by the patient’s physician of choice, subject to reasonable rules and regulations of the facility regarding the facility’s credentialing process.
The patient shall be entitled to have the patient’s parents, if a minor, or spouse, or next of kin, or a personal representative, if an adult, visit the facility, without restriction, if the patient is considered terminally ill by the physician responsible for the patient’s care.
The patient shall be entitled to receive representatives of approved organizations as provided in RSA151:28.
The patient shall not be denied admission to the facility based on Medicaid as a source of payment when there is an available space in the facility.
Subject to the terms and conditions of the patient’s insurance plan, the patient shall have access to any provider in his or her insurance plan network and referral to a provider or facility within such network shall not be unreasonably withheld pursuant to RSA 420-J:8, XIV.

Source. 1981, 453:1. 1989, 43:1. 1990, 18:1-6; 140:2, XI. 1991, 365:10. 1992, 78:1. 1997, 108:6; 331:3-8. 1998, 199:2; 388:5, 6. 2001, 85:1, eff. Aug. 18, 2001. 2009, 252:1, eff. Sept. 14, 2009. 2013, 265:3, eff. Jan. 1, 2014.

RIGHTS OF THE PATIENT:

Every patient has the right to receive from his/her physician enough information so that he/she may understand the procedure or treatment being received in order to sign informed consent. In addition, the patient can exercise these rights without being subjected to discrimination or reprisal.
Every patient has the right to courtesy, respect, dignity, privacy, responsiveness, and timely attention to his/her needs.
Every patient has the right to a safe environment.
Every patient has the right to every consideration of his privacy and individuality as it relates to his social religious and psychological well being.
Every patient has the right to confidentiality. Has the right to approve or refuse the release of medical information to any individual outside the facility, except in the case of transfer to another health facility or as required by law or third party payment contract.
Every patient has the right to continuity of health care. The physician may not discontinue treatment of a patient as long as further treatment is medically indicated, without giving the patient sufficient opportunity to make alternative arrangements.
Every patient is provided complete information regarding diagnosis, treatment and prognosis, as well as alternative treatments or procedures and possible risks and side effects associated with treatment. If medically inadvisable to disclose to patient such information, the information is given to a person designated by patient or to a legally authorized individual.
Every patient has the right to make decisions regarding the health care that is recommended by the physician. Accordingly, the patient may accept or refuse any recommended medical treatment.
Every patient has the right to change health care providers at any time.
Every patient has the right to be informed of any research or experimental projects and to refuse participation without compromise to the patients usual care.
Every patient has the right to appropriate treatment and care to include the assessment managements of pain.
If a patient is adjudged incompetent under applicable state laws by a court or proper jurisdiction, the rights of the patient are exercised by the person appointed under State law to act on the patient’s behalf.
If a state court has not adjudged a patient incompetent, any legal representative or surrogate designated by the patient in accordance with State law my exercise the patient’s rights to the extent allowed by the State law.
Every patient has the right to understand facility charges. You have the right to an explanation of all facility charges related to your health care.
Every patient has the right to all resuscitative measures; therefore we will not honor Advance Directives.
Every patient has the right to be free of all forms of abuse and harassment.
Every patient has the right to know methods for expressing grievances and suggestions to the surgery center. In addition, every patient has the right to a fair process for resolving differences with their health plan, healthcare providers, and the institution that serves them.

RESPONSIBILITIES OF THE PATIENT:

Patients are responsible to be honest and direct about matters that relate to them, including answering questions honestly and completely.
Patients are responsible to provide accurate past and present medical history, present complaints, past illnesses, hospitalizations, surgeries, existence of advanced directive, medication and other pertinent data.
Patients agree to accept all caregivers without regard to race, color, religion, sex, age, gender preference or handicap, or national origin.
Patients are responsible for assuring that the financial obligations for health care rendered are paid in a timely manner.
Patients are responsible to sign required consents and releases as needed.
Patients are responsible for their actions if they should refuse a treatment or procedure, or if they do not follow or understand the instructions given them by the physician or Northridge Surgical Suites employees.
Patients are responsible for keeping their procedure appointment. If they anticipate a delay or must cancel, they will notify Northridge Surgical Suites as soon as possible.
Patients are responsible for the disposition of their valuables, as Northridge Surgical Suites does not assume the responsibility.
Patients are responsible to be respectful of others, or other people’s property and the property of Northridge Surgical Suites.
Patients are to observe safety and no smoking regulations.

PATIENT COMPLAINT OR GRIEVANCE

To report a complaint or grievance you may contact the facility Administrator by phone at 603.484.7710 or by mail to the center address.

Northridge Surgical Suites is accredited by The Joint Commission, complaints and grievances may also be filed through them as well as the New Hampshire Department of Health & Human Services, Health Facility Certification Unit. in writing at:

129 Pleasant Street | Concord, NH 03301
Phone: 603.271.9049
Email: https://www.dhhs.nh.gov/oos/bhfa/contact.htm Click on “Send e-mail to the Bureau of Health Facilities Administration” https://www.dhhs.nh.gov/oos/bhfa/complaint.htm

All Medicare beneficiaries may file a complaint or grievance with the Medicare Beneficiary Ombudsman Online at: http://www.medicare.gov/ claims-and-appeals/medicare-rights/get-help/ombudsman.html

603.484.7710

Driving Directions