Penn Presbyterian Infusion Services Patient Bill of Rights and Responsibilities, Cherry Hill

As a healthcare facility within the University of Pennsylvania Health System (UPHS) and Penn Medicine, we are committed to delivering quality medical care to you, our patients, and to make sure your visit is as pleasant as possible. The following, “Statement of Patient’s Rights,” endorsed by the administration and staff of this facility, applies to all patients. If you are not able to exercise these rights on your behalf, then these rights apply to your designated legally authorized representative. As it is our goal to provide medical care that is effective and considerate within our capacity, mission, philosophy, and applicable laws and regulations, we submit these to you as a statement of our policy.

View the Statement of Patient Responsibilities

Statement of Patient’s Rights

You have the right to:

• be informed of your patient rights, as evidenced by the patient’s written acknowledgment or by documentation by staff in the medical record, that the patient was offered a copy of these rights and given a written or verbal explanation of these rights, in terms you could understand.
• be informed of services available in the facility, of the names and professional status of the personnel providing and/or responsible for the patient's care, and of fees and related charges, including the payment, fee, deposit, and refund policy of the facility and any charges for services not covered by sources of third-party payment or not covered by the facility's basic rate.
• be informed if the facility has authorized other health care and educational institutions to participate in your treatment. You shall also have a right to know the identity and function of these institutions, and to refuse to allow their participation in your treatment.
• receive from your physician(s) or clinical practitioner(s), in terms you understand, an explanation of your complete medical/health condition or diagnosis, prognosis, recommended treatment, treatment options including the option of no treatment, risk(s) of treatment/risk(s) of no treatment, possible complications, and expected result(s). If this information would be detrimental to your health, or if you are not capable of understanding the information, the explanation shall be provided to your designated/legally authorized representative (a guardian, health care agent or a health care representative) or next of kin. The release of information to the designated/legally authorized representative or next of kin, along with the reasons for not informing the patient directly, shall be documented in the patient’s medical record.
• participate in the planning of your care and treatment, and to accept or refuse any medications and treatments offered by the facility, to the extent permitted by the law. A physician shall inform you or your designated/legally authorized representative of the medical consequences of such refusal which shall be documented in the patient’s medical record.
• be included in experimental research only when you are informed, and provide written consent to such participation, or when a designated/legal authorized representative gives such consent for an incompetent/incapacitated patient in accordance with law, rule, and regulation. You or your designated/legally authorized representative may, at any time, refuse to participate or continue in any experimental research or program, including the investigation of new drugs and medical devices, to which informed consent has previously been given.
• voice complaints/grievances, to include quality of care concerns or coverage decisions, or recommend changes in policies and services to facility personnel, the governing authority, and/or outside representatives of your choice, either individually or as a group, and free from restraint, interference, coercion, discrimination, retaliation, recrimination, or reprisal. You have a right to have those complaints/grievances reviewed, and when possible, resolved.
• receive care in a safe setting, and be free from all forms of neglect, harassment, exploitation, and abuse to include verbal, mental, physical, and sexual abuse, and to have access to protective services.
• be free from exploitation and free from the use of restraint or seclusion not medically necessary or used as a means of coercion, discipline, convenience, or retaliation by staff. This intervention would not be used unless authorized by a physician for a limited period of time to protect you or others from injury. Drugs and other medications shall not be used for discipline of patients or for convenience of facility personnel.
• have all information, including records, pertaining to your medical care, treated as confidential except as otherwise protected by law or third-party contractual agreement.
• not have information in the patient’s medical record released to anyone outside the facility without you or your designated/legally authorized representative’s approval, unless another health care facility to which you are transferred requires the information, or unless the release of the information is required or permitted by law, a third-party payment contract, or a peer review, or unless the information is needed by the Department for statutorily authorized purposes. The facility may release data about the patient for studies containing aggregated statistics when the patient’s identity is masked.
• be treated with courtesy, consideration, respect, and recognition of your dignity, individuality, and right to privacy, including, but not limited to, auditory and visual privacy. The patient’s privacy shall also be respected when facility personnel are discussing your care.
• not be required to work for the facility unless the work is part of your treatment and is performed voluntarily by you. Such work shall be in accordance with local, state, and federal laws and rules.
• exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices, or any attendance at religious services, shall be imposed upon you.
• medical and nursing services without discrimination based upon age, sex, race, color, ethnicity, religion, gender, disability, ancestry, national origin, marital status, familial status, genetic information, sexual preference, gender identity or expression, sexual orientation, culture, language, socioeconomic status, domestic or sexual violence status, victim status, source of income or source of payment, or deprived of any constitutional, civil, and/or legal rights solely because of receiving services from the facility.
• expect and receive appropriate assessment, management, and treatment of pain as an integral component of your care in accordance with N.J.A.C. 8:43E-6.
• respectful care provided by competent personnel which reflects consideration of your personal value and belief systems and optimizes patient comfort and dignity.
• examine and receive a detailed explanation of your bill, as well as complete information and counseling on the availability of known financial resources for your care.
• make decisions regarding the withholding of resuscitative services or the foregoing of or the withdrawal of life sustaining treatments within the limits of the law and policies of the facility.
• make decisions involving your health care in collaboration with your providers. This right applies to the family and/or guardian of any minors. Except in the case of an emergency, the provider must obtain your informed consent prior to the start of any procedure or treatment or both. The provider must fully inform you or your designated/legally authorized representative of the risks including risks of no treatment, benefits, and expected outcome of a procedure.
• participate in your care and treatment to the fullest extent possible. There are circumstances under which you may be unable to do so. In these situations (for example, if you have been adjudicated incompetent per the law, or are found by the physician to be medically incapable of understanding the proposed treatment or procedure, or unable to communicate your wishes regarding treatment, or are an emancipated minor) the patient’s rights are to be exercised, to the extent permitted by law, by the designated representative or other legally authorized person.
• assistance in obtaining consultation with another physician at your request or expense.
• participate in considering the ethical issues surrounding care within the framework established by this organization to consider such matters.
• formulate an advance directive or appoint a health care agent to make health care decisions on your behalf. These decisions will be honored by the facility and its professionals within the limits of the law and our mission, values, and philosophy. If applicable, you are responsible in providing a copy of your advance directive to the facility.
• not be required to have or complete an advance directive to receive care and treatment in this facility.
• have your medical record read only by individuals directly involved in your care, by individuals monitoring the quality of care, or by individuals authorized by law or regulation. Upon request, the facility shall provide you or your designated/legally authorized representative access to all information contained in the medical record unless access is specifically restricted by the attending practitioner for medical reasons.
• expect good management techniques to be implemented within the facility considering effective use of time and avoidance of personal discomfort.
• receive a Patient Privacy Notice which provides an explanation of how your protected health information is used and who may be given access to it.
• if requested, to have someone present while physical examinations, treatments, or procedures are being performed, if they do not interfere with care.
• be communicated in a clear, concise, and understandable manner. If you do not speak English, you should have access, where possible, free of charge to language interpretation and translation services. Information is provided in a manner tailored to your age (if applicable), language, and ability to understand. This includes helping you in a way that meets your needs if you have vision, speech, hearing, or cognitive impairments.
• quality care and high professional standards that are continually maintained and reviewed.
• expect emergency procedures to be implemented without unnecessary delay. If an emergency occurs and you are transferred to another facility, the designated/legally authorized representative shall be notified. The institution to which you are to be transferred shall be notified before your transfer.
• information on after-hours and emergency care.
• receive care at another facility when medically permissible if this facility cannot meet the request or need for care because of a conflict with our mission or philosophy or incapacity to meet your needs or request. Such a transfer of care should be made only after you or your designated/legally authorized representative have received complete information and an explanation concerning the needs for, and alternatives to, such a transfer of care. The transfer of care must be acceptable to the other provider.
• expect the facility to provide a mechanism whereby you are informed of continuing health care requirements and the means for meeting them upon discharge.
• written disclosure of physician financial interests or ownership, all of which must be provided in advance of the date of service.
• designate a family member, friend, or other individual as a support person during your ambulatory care treatment.
• designate those persons who may stay with you. These individuals do not need to be legally related to you. They could be, for example, a spouse, a domestic partner (including a same-sex partner), another family member, or a friend. The facility will not restrict, limit, or deny any visitor based on age, race, color, national origin, religion, sex, handicap, disability, gender, ancestry, marital status, familial status, gender identity or expression, sexual orientation, culture, language, socioeconomic status or domestic or sexual violence victim status. The facility may need to limit or restrict visitors to care for you or other patients. You have the right to be informed of any such clinical restrictions or limitations.
• give or withhold informed consent to produce or use recordings, films, or other images of you for purposes other than your own care, treatment, or patient identification.
• know the facility’s expectations and responsibilities for patient and visitor conduct.
• not to be denied the right of access to an individual or agency who is authorized to act on his/her behalf to assert or protect the rights set out in above.

For more information, questions, or concerns

If you have questions or problems concerning your healthcare, please speak with your physician, nurse, or other hospital or ambulatory practice representative before you leave the clinical site.  

Questions about the Patient Bill of Rights and Responsibilities

If you have question about the Patient Bill of Rights and Responsibilities or a patient complaint or grievance, contact the following:

Penn Presbyterian Infusion Services (PPIS)
1865 Route 70 East Cherry Hill, NJ 08003
Phone: 856-427-2933
Fax: 856-281-9667
or the Penn Presbyterian Medical Center Guest Relations Office: Penn Presbyterian Medical Center
185 Wright Saunders 39th and Market Streets Philadelphia, PA 19104
Phone: 215-662-9100

HIPAA questions and concerns

You may direct questions or concerns regarding the Health Insurance Portability and Accountability Act (HIPAA) and privacy-related matters to:

UPHS Privacy Office
Email:privacy@uphs.upenn.edu
Phone: 215-573-4492

If you have questions or concerns about possible violations of policies or legal requirements, you may contact the 215-P-COMPLY Confidential Reporting and Help Line by calling 215-726-6759 or logging onto upenn.edu/215pcomply.

Unresolved complaints or grievances

You may direct questions or concerns regarding accessibility or accommodations to the University of Pennsylvania Health System Disability Access Officer at 215-615-4317.

If you or a family member thinks that a complaint or grievance remains unresolved through the hospital resolution process, or regardless of whether you have used the hospital's grievance process, you have the right to contact the following organizations about your concerns without worry of retaliation.

The Centers for Medicare and Medicaid Services (CMS)
Quality and Appeals 866-815-5440
You may complete a Medicare Quality Complaint Form
found at https://www.livantaqio.cms.gov/en

New Jersey Department of Health and Senior Services Division of Health Facilities Evaluation and Licensing Assessment and Survey Program / Complaint Unit
PO Box 367 Trenton, NJ 08625-0367
Hotline: 1-800-792-9770
Consumer Resident/Patient Complaint Report Form (AAS-60)
File electronically with Department of Health | Health Facilities | Complaints and Hotlines (nj.gov)

State Long-Term Care Ombudsman
NJ Long-Term Care Ombudsman
P.O. Box 852
Trenton, NJ 08625-0852
Hotline: 1-877-582-6995
Fax: 1-609-943-3479
ombudsman@ltco.nj.gov
File electronically with New Jersey Long-Term Care Ombudsman - Complaint Form (nj.gov)

The Joint Commission

The Joint Commission provides a patient information Line on how to report a concern or complaint about an accredited or certified healthcare organization at 1-800-994-6610

The preferred method for submitting a new or updated previously submitted concern or complaint is through The Joint Commission’s online submission form. You may locate the online submission form with detailed instructions at The Joint Commission’s website at jointcommission.org.

Locate the “Connect with Us” area, click “Report a Safety Concern,” and follow the instructions.

You may also contact The Joint Commission through US Mail:

• Office of Quality and Patient Safety
  The Joint Commission
  One Renaissance Boulevard
  Oakbrook Terrace, Illinois 60181
  Note: there is no ability to submit complaints or concerns by fax or email.

For concerns related to discrimination or any civil rights concerns

The U.S. Department of Health and Human Services, Office for Civil Rights:

Online complaint resource available at Filing a Complaint | HHS.gov
Civil Rights concerns, complaints, and allegations may be filed in writing by mail, fax, e-mail, or via the Complaint Portal Assistance at OCR Complaint Portal.

If you have any questions or need help filing a civil rights, conscience or religious freedom, or health information privacy complaint, you may email OCR at OCRMail@hhs.gov or call the U.S. Department of Health and Human Services, Office for Civil Rights toll-free at: 1-800-368-1019, TDD: 1-800-537-7697.

Email complaints: OCRComplaint@hhs.gov
Open and fill out the Civil Rights Discrimination Complaint Form Package.

For concerns related to disability accessibility or accommodations

The United States Department of Justice
950 Pennsylvania Avenue, NW
Civil Rights Division, Disability Rights Section–1425 NYAV
Washington, D.C., 20530
Telephone: 1-800-514-0301
Facsimile: 202-307-1197
Online complaint forms are available at: ada.gov/complaint/

Statement of Patient Responsibilities

To help patients receive safe, quality care we request that patients and their designated legally authorized representatives act in accordance with University of Pennsylvania Health System (UPHS) and the facility policies and rules.

Please assume responsibility for the following:

• Providing accurate and complete information about present complaints, conditions your provider should know when caring for you (e.g., allergies), past illnesses, hospitalizations, medications, advance directives, and other matters relating to your health history or care for you to receive effective medical treatment.
• Following instructions and medical orders to the best of your ability and cooperate with facility staff and ask questions if directions and/or procedures are unclear.
• Reporting whether you understand the planned course of action and self-care expectations.
• To the extent possible, members of your family or designated caregivers/ legally authorized representative should be available to UPHS personnel for review of your treatment if you cannot communicate with your health caregivers properly.
• Arranging for a responsible person to escort you home to ensure your safety for same day procedures.
• Being responsible for your actions if you refuse care or do not follow care instructions.
• Being considerate of other patients and health care staff, to assist in the control of noise, visitors, and crowds in the facility.
• Being respectful of the property of other persons and the property of UPHS. Threats, violence, disruption of patient care or harassment of other patients, visitors or staff will not be tolerated.
• Refraining from any illegal activity on UPHS property. If such activity occurs, UPHS may report it to law enforcement.
• Not taking any medications or drugs which have not been prescribed by your provider and administered by appropriate staff; these actions put you at risk of complicating or endangering your healing process.
• Not consuming alcoholic beverages or toxic substances during your visit to the facility.
• Not bringing firearms and/or weapons into the facility.
• Not photographing and/or recording anyone without permission.
• Not making offensive, disrespectful, or discriminatory comments about others' race, accent, religion, gender, gender identity, sexual orientation, or other personal traits.
• Not bringing any valuables with you to the facility. If you must bring valuables, please give any valuables you may have brought to your family/caregiver/escort for their security.
• Observing the non-smoking policy of the facility.
• Adhering to the Penn Medicine Patient, Visitor and Staff Code of Conduct.
• Assuming the financial responsibility of paying for all services rendered either through third-party payers (your insurance company) or being personally responsible for payment for any services which are not covered by your insurance policies.

Our entire Penn Medicine team thanks you for choosing to receive your care here. It is our pleasure to serve and care for you.