The rights of the patient may be exercised by the patient or authorized representative, if any, without fear of retribution or retaliation. The Patient Bill of Rights includes, but is not limited to, the right to: Have one’s person and property treated with respect. Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; Live free from involuntary confinement, and to be free from physical or chemical restraints. Express complaints verbally or in writing about services or care that is or is not furnished, or about the lack of respect for the patient’s person or property by anyone who is furnishing services on behalf of the Agency and must not be subject to discrimination or reprisal for doing so. The Agency must investigate complaints made by a patient or the patient’s authorized representative, if any, regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect for the patient’s property by anyone furnishing services on behalf of the Agency and must document both the existence of the complaint and the resolution of the complaint. Be free from any discrimination or reprisal for exercising his or her rights or for voicing grievance to the HHA or an outside entity Confidentiality of all records, communications, and personal information. The Agency shall advise the patient, in writing, of the agency's policies and procedures regarding disclosure of clinical information and records. Participate in, be informed about and consent or refuse care in advance of and during treatment, where appropriate, with respect to: (i) Completion of all assessments; (ii) The care to be furnished based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. Receive all services outlined in the plan of care. Refuse treatment within the confines of the law, to be informed of the consequences of such action and to be involved in experimental research only upon the patient’s voluntary written consent. Be informed of the Agency’s policies on advance directives, including: determine the existence of advance directives educate patients and families about advance directives as well as rendering of service/care in the absence or presence of advance directives facilitate advanced directives, as may be appropriate Receive a proper written notice, in advance of a specific service being furnished, if HHA believes that the service may be non-covered care, or in advance of the HHA reducing or terminating on –going care. Choose a healthcare provider, including an attending physician. Receive appropriate care without discrimination in accordance with physician orders. Be advised orally and in writing prior to the start of services of the extent to which payment for the Agency services may be expected from Medicare, Medi-Cal, or any other Federally funded or aided program known to the Agency, insurance or other sources; the charges for services that will not be covered by Medicare, Medi-Cal, or any other Federally funded or aided program; and the extent to which payment may be required from the patient. Be advised of any changes in billing or payment procedures before implementation, in advance of the next home health visit. If an agency is implementing a scheduled rate increase to all Patients, the agency shall provide a written notice to each affected patient at least 30 days before implementation. Be informed of any financial benefits when referred to a home health agency. Be advised of the availability of the state’s toll-free Home Care Agency (HCA) hotline. The patient and/or authorized representative, has the right to use this hotline to lodge complaints regarding the Agency, including care received or not received and/or implementation of the advance directives’ requirements. The Colorado Department of Public Health and Environment State Hotline (1-800-842-8826) At any time, the patient may register a complaint about home health agency with the agency’s accrediting organization ACHC (Accreditation commission for Health Care) at 1-855-937-2242 or 919-785-1214 Be advised of the addresses, and telephone numbers of the following Federally-funded and state-funded entities that serve the area: Area Agency on Aging 1001 17th Street, Suite 700 Denver, CO 80202 Phone: 303-455-1000 Fax: 303-480-6790 E-mail: Send DRCOG an e-mail at drcog@drcog.org Center for Independent Living Atlantis Community, Inc. 201 South Cherokee Denver, CO 80223 Phone: 303- 733-9324 Fax: 303- 733-6211 www.atlantiscommunity.org Protection and Advocacy Agency for Colorado 455 Sherman Street, Suite 130 Denver, CO 80203 Phone: 303-722-0300, Toll Free 1.800.288.1376 E-mail: tlcmail@thelegalcenter.org Aging and Disability Resource Center (ADRC) 1001 17th Street, Suite 700 Denver, CO 80202 Phone: 303-480-6700 Toll Free: 1(866) 959-3017 Quality Improvement Organization Area 3 - KEPRO Phone: 844-430-9504 http://www.keproqio.com/ the patient has contact and who is supplying, staffing or supervising care or services. The patient has the right to be served by agency staff that is properly trained and competent to perform their duties. Be able to identify visiting personnel members through the agency generated photo identification. Be informed, upon request, of all individuals or other legal entities having ownership or controlling interest in the agency. Be informed of the right to access auxiliary aids and language services and how to access these services. Be informed of transfer and discharge rights as follows: The transfer or discharge is necessary for the patient's welfare because the HHA and the physician who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA must arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities; The patient or payer will no longer pay for the services provided by the HHA; The transfer or discharge is appropriate because the physician who is responsible for the home health plan of care and the HHA agree that the measurable outcomes and goals set forth in the plan of care have been achieved, and the HHA and the physician who is responsible for the home health plan of care agree that the patient no longer needs the HHA's services; The patient refuses services, or elects to be transferred or discharged; The HHA determines that the patient's (or other persons in the patient's home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the HHA to operate effectively is seriously impaired. The HHA must do the following before it discharges a patient for cause: (i)Advise the patient, representative (if any), the physician(s) issuing orders for the home health plan of care, and the patient's primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) that a discharge for cause is being considered; (ii)Make efforts to resolve the problem(s) presented by the patient's behavior, the behavior of other persons in the patient's home, or situation; (iii)Provide the patient and representative (if any), with contact information for other agencies or providers who may be able to provide care; and (iv)Document the problem(s) and efforts made to resolve the problem(s), and enter this documentation into its clinical records; The patient dies; or The HHA ceases to operate. I attest to verbal and written receipt of the aforementioned notice of rights. Patient or Legal Representative(Required)Date(Required) MM slash DD slash YYYY Patient Selected Representative, if applicableDate MM slash DD slash YYYY Agency Representative(Required)Date(Required) MM slash DD slash YYYY Δ
(i) Completion of all assessments;
(ii) The care to be furnished based on the comprehensive assessment;
(iii) Establishing and revising the plan of care;
(iv) The disciplines that will furnish the care;
(v) The frequency of visits;
(vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits;
(vii) Any factors that could impact treatment effectiveness; and
(viii) Any changes in the care to be furnished.
Receive all services outlined in the plan of care.
State Hotline (1-800-842-8826)
At any time, the patient may register a complaint about home health agency with the agency’s accrediting organization
ACHC (Accreditation commission for Health Care)
at 1-855-937-2242 or 919-785-1214
Area Agency on Aging
1001 17th Street, Suite 700
Denver, CO 80202
Phone: 303-455-1000
Fax: 303-480-6790 E-mail: Send DRCOG an e-mail at drcog@drcog.org
Center for Independent Living
Atlantis Community, Inc.
201 South Cherokee Denver, CO 80223 Phone: 303- 733-9324 Fax: 303- 733-6211
www.atlantiscommunity.org
Protection and Advocacy Agency for Colorado
455 Sherman Street, Suite 130 Denver, CO 80203 Phone: 303-722-0300, Toll Free 1.800.288.1376 E-mail: tlcmail@thelegalcenter.org
Aging and Disability Resource Center (ADRC)
Phone: 303-480-6700
Toll Free: 1(866) 959-3017
Quality Improvement Organization
Area 3 - KEPRO
Phone: 844-430-9504
http://www.keproqio.com/
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