Your personal dignity will always be of primary importance. Crossing Rivers Health recognizes your dignity as a human being. We want you to clearly understand your rights and responsibilities as a patient.
All individuals—regardless of age, race, language, creed, sex, national origin, cultural variances, sexual orientation, arrest or conviction record, physical and mental challenges, or sources of payment for care, shall be accorded impartial access to treatment or accommodations that are available and medically indicated.
You have the right to receive personal privacy and respectful care that is consistent with your personal values and beliefs.
You have the right to be treated in an environment that preserves dignity and contributes to a positive image.
Crossing Rivers Health Medical Center emphasizes the dying patient’s right to die with dignity and comfort. Dying patients and their families have the right to receive physical, psychosocial, spiritual and cultural support.
You have the right to be assessed and effectively treated for pain.
Crossing Rivers Health health care professionals respect your voice or the voice of your designated decision maker when ethical issues arise during your care. Through the ethics committee, you or your designated decision maker will be included in discussions of ethical issues surrounding your care.
You have the right to receive care in a setting free from mental, physical, sexual, and verbal abuse, neglect, and exploitation. You have the right to be treated in a safe and tobacco-free environment.
Information given to you will be communicated in terms you can reasonably be expected to understand. You have the right to request an interpreter. Alternate communication techniques or aids are used to address the needs of those with vision, speech, hearing and cognitive impairments.
You have the right to access people outside the hospital, including visitors through verbal and written communication. You have the right to participate as a citizen in civic affairs. This includes the right to vote by absentee ballot in all elections when you are in the hospital. You have the right to designate visitors and people involved in your care.
You have the right to access, request amendment to, and obtain information on disclosures of your health information, in accordance with the law and regulations.
You will be involved in making decisions about your care, treatment, and services, including the right to have your physician promptly notified of your admission.
You have the right to know the name and professional status of all individuals who are treating you. This includes your right to know of the existence of any professional relationships among individuals who are treating you, as well as their relationship to any other healthcare or educational institutions involved in your care. Participation by patients in clinical training programs is voluntary.
At your request and expense, you have the right to consult with a specialist. You have the right to request visitation by the spiritual/religious leader of your choice.
You have the right to be given, by the physician responsible for coordinating your care, complete and current information concerning your diagnosis or condition to the degree known; the proposed treatment or procedures; alternative treatments or procedures; and the potential benefits, unanticipated drawbacks or risks of each. You will also be informed of problems related to recuperation and the likelihood of success of proposed treatments and procedures.
You will be informed if the hospital proposes to engage in or perform human experimentation or other research/educational projects affecting your care or treatment. You have the right to refuse to participate in any such activity.
If you are incapable of understanding a proposed treatment or procedure or it is not medically advisable to give such information to you, the information will be made available to your decision maker.
You have the right to reasonable, informed participation in decisions involving your healthcare. You will not be subjected to any procedure without your voluntary and competent consent or the consent of your decision-maker except in an emergency. Consent will be obtained and documented prior to producing recordings, films, or other images of patients.
You will be free from chemical and/or physical restraints unless needed to ensure your safety or the safety of others.
Crossing Rivers Health Medical Center does promote a practice of open visitation for all inpatients and outpatients, unless there is a justified clinical restriction.
Crossing Rivers Health encourages everyone over the age of 18 to designate a health care decision maker. If you were to become incapacitated and unable to make your own decisions, it is important to identify someone you trust to make decisions for you. This can only be done with a Power of Attorney for Health Care (POA-HC) or a court ordered guardianship. Wisconsin is not a “kinship” state; this means that no one, including spouse, child or sibling, can automatically make decisions for you. Even your spouse must be appointed. If decisions need to be made and you do not have a Power of Attorney for Health Care, it may be necessary to pursue a Guardianship through the Court system which can be expensive and time consuming. The POA-HC allows families to avoid court involvement. It is your responsibility to ensure that Crossing Rivers Health has a copy
of your Power of Attorney.
The Power of Attorney for Health Care is not a difficult form to complete but does require thoughtful planning. Staff are available Monday through Friday, 8:30-4:30 (excluding holidays) to provide information regarding POA-HC documents as well as to answer your questions and to assist you in completing this document.
Your advance medical directive (AMD) will be honored by the hospital in the provision of care. The AMD must be on file at the hospital and be within the extent of the law. Whenever possible, the hospital will honor your wishes regarding organ and tissue donation.
You have the right to refuse care, treatment and services to the extent permitted by law. When refusal of treatment by you or your legal decision maker prevents the provision of appropriate care in accordance with professional standards, the relationship with you may be terminated upon reasonable notice.
Effective conflict resolution steps can include clinical consultation in the case of disagreement about a medical condition or course of treatment, consultation with pastoral or patient/family services staff, or an ethics committee consult. You, your health care agent, a family member and/or a health care provider may request services to assist in conflict resolution. You have the right to switch health care providers.
You have the right to expect reasonable continuity of care when appropriate and be informed by your physician and other caregivers of available and realistic patient care options. You or your decision maker have the right to be informed by the practitioner responsible for your care of any continuing health care requirements following discharge from the hospital.
Upon request regarding protective services and/or advocacy, you will be provided with a list of pertinent state agencies.
Regardless of the source of payment for your care, you have the right to request and receive an itemized and detailed explanation of the total bill for services rendered by Crossing Rivers Health. You have the right to timely notice prior to termination of your eligibility for reimbursement by any third-party payor or for the cost of your care. If you are referred to another organization or service, you will be informed of any financial benefit to the medical center. You are responsible for assuring that the financial obligations of your health care are fulfilled as promptly as possible.
You and your parents, guardians, or responsible persons have the right to be included in the decision-making process regarding your needs, condition, and treatment. They will be informed of progress, rights, responsibilities, and their resolution of complaints.
You have the right to be informed of Crossing Rivers Health rules and regulations applicable to your conduct as a patient. You are entitled to information about our mechanism for the initiation, review, and resolution of patient complaints.
Crossing Rivers Health respects the needs of all their patients for confidentiality, privacy and security. You have the right, within the law, to personal and informational privacy:
- To refuse to talk to or see anyone not officially connected with the hospital.
- To receive a copy of Crossing Rivers Health’s Notice of Privacy Practices.
- To wear appropriate personal clothing and religious or other culturally symbolic items, as long as they do not interfere with diagnostic procedures or treatment.
- To be interviewed and examined in surroundings designed to ensure reasonable visual and auditory privacy.
- To expect that any discussion or consultation involving your case will be conducted discreetly with respect for your privacy rights.
- Have your medical record, including all computerized medical information read only by individuals directly involved in your treatment or in the monitoring and evaluation of your care or charges, unless otherwise requested by you. Other individuals may have access only with written authorization.
- To request that your name not be included in the patient directory or census and that your status be listed as confidential.
Questions and Concerns
If you would like more information about Crossing Rivers Health’s privacy practices, have any questions or concerns, or if you believe that your rights may have been violated, you may file a complaint with the Compliance and Privacy Officer by contacting:
Concerns may also be reported using the compliance hotline. The hotline is available 24 hours a day, 7 days a week. Reported concerns and complaints are treated confidentially and taken seriously.
You may also file a complaint with the U.S. Department of Health and Human Services by contacting:
U.S. Department of Health and Human Services
200 Independence Avenue
S.W. Room 509F HH Bldg
Washington, D.C. 20201
Resolution of Concerns
You have the right to be informed of available resources for
resolving concerns and conflicts. If you have concerns, please do any of the following:
- Speak directly to the person providing your care or ask to speak to
the director of that department.
- Complete a Compliments Concern Form. The form may be found in
this booklet or obtained from any Crossing Rivers Health
- Contact the Patient Family Services Department at 608-357-2000.
Office hours are 8 a.m. to 4:30 p.m. Monday through Friday. If after
4:30 p.m., or on holidays or weekends, ask the charge nurse to
contact Crossing Rivers Health Administration.
While we desire to have any concerns handled by our staff and/or Administration on a one-on-one basis, if you feel your concerns were not addressed properly, you may contact the following licensing agencies:
Division of Accreditation Operations
Office of Quality Monitoring
Joint Commission on Accreditation of Healthcare Organizations
One Renaissance Blvd.
Oakbrook Terrace, IL 60181
State of Wisconsin, Department of Health & Family Services
Division of Quality Compliance
Madison, WI 53701
U.S. Department of Health & Human Services
200 Independence Ave.
S.W. Room 509F HH Bldg.
Washington, DC 20201