Bill of Rights

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BILL OF RIGHTS AND RESPONSIBILITIES

The patient has the right – To receive information about services covered under hospice

To receive information about scope of services hospice will provide as well as limitations

To have his or her property and person treated with respect

To choose his or her attending MD

To refuse care or treatment

To exercise his or her rights as a patient of the hospice

To voice grievances regarding treatment of care that is (or fails to be) furnished and the lack of respect for property by anyone who is furnishing services on behalf of the hospice

To not be subjected to discrimination or reprisal for exercising his or her rights.

Hospice has the responsibility -

To inform and distribute written information to patient concerning its policy and procedure on advance directives

To maintain confidentiality of clinical records

To receive effective pain management and symptom control from the hospice for
conditions related to the terminal illness

_________________________________          ____________
PATIENT SIGNATURE                                                                             DATE

_____________________________                    _____________
PATIENT’S LEGAL REPRESENTATIVE                    DATE
SIGNATURE

______________________________           ____________
WITNESS SIGNATURE                                                   DATE

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