Legal Legal Wyckoff Heights Medical Center is committed to providing information to its patients about concerns about their care as well as their rights and responsibilities with regard to advocacy and privacy issues. Concerns About Your Care Speak Up. Help Prevent Errors in Your Care. Everyone has a role in making health care safe - physicians, health care executives, nurses, and technicians. Healthcare organizations across the country are working to make healthcare safety a priority. You, as the patient, can also play a vital role in making your care safe by becoming an active, involved, and informed member of your healthcare team. If you have a concern, problem, or complaint related to any aspect of care during your hospital stay, speak to your doctor, nurse, or hospital staff member. An Institute of Medicine (IOM) report has identified the occurrence of medical errors as a serious problem in the healthcare system. The IOM recommends, among other things, that a concerted effort be made to improve the public’s awareness of the problem. The Speak Up Program™, sponsored by The Joint Commission, urges patients to get involved in their care. Such efforts to increase consumer awareness and involvement are supported by the Centers for Medicare and Medicaid Services. This initiative provides simple advice on how you, as the patient, can make your care a positive experience. Research shows that patients who take part in decisions about their healthcare are more likely to have better outcomes. Speak up if you have questions or concerns, and if you don’t understand, ask again. It’s your body and you have a right to know. Your health is too important to worry about being embarrassed if you don’t understand something that your doctor, nurse, or other health care professional tells you. Don’t be afraid to ask about safety. If you’re having surgery, for example, ask the doctor to mark the area that is to be operated upon, so that there's no confusion in the operating room. Don’t be afraid to tell the nurse or the doctor if you think you are about to receive the wrong medication. Don’t hesitate to tell the healthcare professional if you think he or she has confused you with another patient. Pay attention to the care you are receiving. Make sure you’re getting the right treatments and medications by the right healthcare professionals. Don’t assume anything. Tell your nurse or doctor if something doesn’t seem quite right. Expect healthcare workers to introduce themselves when they enter your room and look for their identification badges. A new mother, for example, should know the person to whom she is handing her baby. If you are unsure, ask. Notice whether your caregivers have washed their hands. Hand washing is the most important way to prevent the spread of infections. Don’t be afraid to gently remind a doctor or nurse to do this. Know what time of day you normally receive a medication. If it doesn’t happen, bring this to the attention of your nurse or doctor. Make sure your nurse or doctor confirms your identity, that is, checks your wristband or asks your name, before he or she administers any medication or treatment. Educate yourself about your diagnosis, the medical tests you are undergoing, and your treatment plan. Ask your doctor about the specialized training and experience that qualifies him or her to treat your illness (and be sure to ask the same questions of those physicians to whom he or she refers you). Gather information about your condition. Good sources include your doctor, your library, respected websites, and support groups. Write down important facts your doctor tells you, so that you can look for additional information later, and ask your doctor if he or she has any written information you can keep. Thoroughly read all medical forms and make sure you understand them before you sign anything. If you don’t understand something, ask your doctor or nurse to explain it. Make sure you are familiar with the operation of any equipment that is being used in your care. If you will be using oxygen at home, do not smoke or allow anyone to smoke near you while oxygen is in use. Know what medications you take and why you take them. Medication errors are the most common health care mistakes. Ask about the purpose of the medication and ask for written information about it, including its brand and generic names. Also inquire about the side effects of the medication. If you do not recognize a medication, verify that it is for you. Ask about oral medications before swallowing and read the contents of bags of intravenous (IV) fluids. If you're not well enough to do this, ask your advocate to do this. If you are given an IV, ask the nurse how long it should take for the liquid to run out. Tell the nurse if it doesn’t seem to be dripping properly (that it is too fast or too slow). Whenever you are going to receive a new medication, tell your doctors and nurses about allergies you have, or negative reactions you have had to medications in the past. If you are taking multiple medications, ask your doctor or pharmacist if it is safe to take those medications together. This holds true for vitamins, herbal supplements, and over-the-counter drugs, too. Make sure you can read the handwriting on any prescriptions written by your doctor. If you can’t read it, the pharmacist may not be able to either. Use a hospital, clinic, surgery center, or other type of healthcare organization that has undergone a rigorous on-site evaluation against established, state-of-the-art quality and safety standards, such as that provided by the Joint Commission. Ask about the healthcare organization’s experience in treating your type of illness. How frequently do they perform the procedure you need and what specialized care do they provide in helping patients get well? If you have more than one hospital or other facility to choose from, ask your doctor which one offers the best care for your condition. Before you leave the hospital or other facility, ask about follow-up care, and make sure that you understand all of the instructions. Go to Quality Check at The Joint Commission to find out whether your hospital or other healthcare organization is accredited. Participate in all decisions about your treatment. You are the center of the healthcare team. You and your doctor should agree on exactly what will be done during each step of your care. Know who will be taking care of you, how long the treatment will last, and how you should feel. Understand that more tests or medications may not always be better. Ask your doctor what a new test or medication is likely to achieve. Keep copies of your medical records from previous hospitalizations and share them with your healthcare team. This will give them a more complete picture of your health history. Don't be afraid to seek a second opinion. If you are unsure about the nature of your illness and the best treatment, consult with one or two additional specialists. The more information you have about the options available to you, the more confident you will be in the decisions made. Ask to speak with others who have undergone the procedure you are considering. These individuals can help you prepare for the days and weeks ahead. They also can tell you what to expect and what worked best for them as they recovered. Ask a trusted family member or friend to be your advocate. Your advocate can ask questions that you may not think of while you are under stress. Ask this person to stay with you, even overnight, when you are hospitalized. You will be able to rest more comfortably, and your advocate can help to make sure you get the right medications and treatments. Your advocate can also help remember answers to questions you have asked and speak up for you if you cannot. Make sure this person understands your preferences for care and your wishes concerning resuscitation and life support. Review consents for treatment with your advocate before you sign them and make sure you both understand exactly what you are agreeing to. Make sure your advocate understands the type of care you will need when you get home. Your advocate should know what to look for if your condition is getting worse and whom to call for help. Resources The Joint Commission Quality Check Department InfoPatient Advocate 718-963-7189 HOURS Mon-Fri, 9 AM-5 PM Patricia Meade, RN WHMC Patient Safety Officer email@example.com 718-963-4681 HIPAA Notice of Privacy PracticesThis Health Insurance Portability and Accountability Act (HIPAA) Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Wyckoff Heights Medical Center is required by law to protect the privacy of your health information, and to provide you with a copy of this Notice. This Notice consists of two parts: (1) a summary of how we handle your health information, and (2) detailed information about our privacy practices and procedures. Who Will Follow this Notice? This Notice describes the health information privacy practices of Wyckoff Heights Medical Center (WHMC), its medical staff, and affiliated health care providers that jointly provide health care services with our hospital. The privacy practices described in this Notice will be followed by: (1) any health care professional who treats you at any of our locations, including our Ambulatory Care Services; (2) any employee, student, trainee or volunteer, at any of our locations, including our Ambulatory Care Services; (3) any employee, medical staff, trainee, student or volunteer at WHMC Pharmacy ; and (4) any business associates of our hospital or of WHMC Pharmacy (which are described further below). Please note your private physician may have different privacy practices regarding the use and disclosure of your health information related to care provided at his/her office. Important Summary Information Requirement For Written Authorization. We will generally obtain your written authorization before using your health information or sharing it with others outside the hospital. You may also request transfer of your records to another person by completing a written authorization form. If you provide us with written authorization, you may revoke that written authorization at any time, except to the extent that we have already relied upon it. To revoke a written authorization, please write to our Health Information Services Department. Exceptions To Written Authorization Requirement. There are some situations when we do not need your written authorization before using your health information or sharing it with others. They are: Treatment, Payment, And Business Operations. We may use and disclose your health information to treat your condition, collect payment for that treatment, or run our business operations. Patient Directory and Disclosure to Family and Friends Involved in Your Care. We may include information about you in our Patient Directory or share your health information with family and friends involved in your care, if you do not object to the use or disclosure of your health information in this way. Public Need. We may use or disclose your health information in certain situations to comply with the law or to meet important public needs. If Information Is Completely or Partially De-Identified. How To Access Your Health Information. You generally have the right to inspect and copy your health information. How To Correct Your Health Information. You have the right to request that we amend your health information if you believe it is inaccurate or incomplete. How To Identify Others Who Have Received Your Health Information. You have the right to receive an accounting of disclosures, which identifies certain persons or organizations to whom we have disclosed your health information. How To Request Additional Privacy Protections. You have the right to request further restrictions on the way we use your health information or share it with others. How To Request More Confidential Communications. You have the right to request that we contact you in a way that is more confidential for you, such as at home instead of at work. How Someone May Act on Your Behalf. You have the right to name a personal representative who may act on your behalf to control the privacy of your health information. How To Learn About Special Protections For HIV-Related Information and Mental Health Information. Special privacy protections apply to HIV-related information and mental health information. To request copies of special notices concerning these types of information, please contact the Patient Relations Department at 718-963-7356. How To Obtain a Copy of This Notice. You have the right to a paper copy of this Notice and may request a paper copy of this Notice (or any current version of this Notice) at any time. To do so, please call our admitting department at 718-963-7311. If you have any questions about this Notice or would like further information, please contact our Privacy Officer at 718-963-7272. A copy of our current Notice will always be posted in designated reception areas. We may change our privacy practices from time to time. If we do, we will revise this Notice so you will have an accurate summary of our practices. The revised notice will apply to all your health information, including any information created or received prior to issuing the new notice. We are required to abide by the terms of the Notice that is currently in effect. How To File a Complaint. Patients or family members who are concerned that their HIPAA privacy rights may have been violated should immediately contact the Privacy/Compliance hotline by phone at 833-WYCKOFF (833-992-5633) or by email at Compliance@Wyckoffhospital.org No one will retaliate or take action against you for filing a complaint. What Health Information is Protected We are committed to protecting the privacy of information we gather about you while providing health-related services. Some examples of protected health information are: information indicating that you are a patient at the hospital or receiving treatment or other health-related services from our hospital; information about your health condition (such as a disease you may have); information about health care products or services you have received or may receive in the future (such as an operation); or information about your health care benefits under an insurance plan (such as whether a prescription is covered); when combined with: demographic information (such as your name, address, or insurance status); unique numbers that may identify you (such as your social security number, your phone number, or your driver's license number); and other types of information that may identify who you are. How We May Use and Disclose Your Health Information Without Your Written Authorization For your information, we have included below a more detailed explanation of how we may use and disclose your health information without your written authorization. 1. Treatment, Payment, and Business Operations We may use your health information or share it with others in order to treat your condition, obtain payment for that treatment, and run our business operations. In some cases, we may also disclose your health information for payment activities and certain business operations of another health care provider or payor. The Medical Center, its medical staff and other health care providers affiliated with the Medical Center, participate in an organized health care arrangement as permitted by HIPAA, which allows them to share information among themselves solely for purposes of treatment, payment, and health care operations. Below are further examples of how your information may be used and disclosed for these purposes. Treatment. We may share your health information with doctors or nurses or other health care providers at the hospital who are involved in taking care of you, and they may in turn use that information to diagnose or treat you. A doctor at our hospital may share your health information with another doctor inside our hospital, or with a doctor at another hospital, to determine how to diagnose or treat you. Your doctor may also share your health information with another doctor to whom you have been referred for further health care. Our different departments and health care practitioners may share your health information in order to provide and coordinate services such as prescriptions, lab work and x-rays. Our faculty, students, volunteers, and trainees will have access to your health information for training and treatment purposes as they participate in continuing education training, internships, and residency programs. Payment. We may use your health information or share it with others so that we may obtain payment for your health care services. For example, we may share information about you with your health insurance company in order to obtain reimbursement after we have treated you, or to determine whether it will cover your treatment. We might also need to inform your health insurance company about your health condition in order to obtain pre-approval for your treatment, such as admitting you to the hospital for a particular type of surgery. Finally, we may share your information with other providers and payors for their payment activities, such as an ambulance company. Business Operations. We may use your health information or share it with others in order to conduct our business operations which include internal administration, planning, and various activities that improve the quality and cost-effectiveness of the care that we deliver to you, such as performance improvement, utilization review, internal auditing, accreditation, certification, licensing, educational and credentialing activities. For example, we may use your health information to conduct patient satisfaction surveys, to evaluate the performance of our staff in caring for you, or to educate our staff on how to improve the care they provide for you. We may disclose your health information to our patient representatives in order to resolve any complaints you may have and ensure that you have a comfortable visit with us. Finally, we may share your health information with other health care providers and payors for certain of their business operations if the information is related to a relationship the provider or payor currently has or previously had with you, and if the provider or payor is required by federal law to protect the privacy of your health information. Appointment Reminders, Treatment Alternatives, Benefits and Services. In the course of providing treatment to you, we may use your health information to contact you with a reminder that you have an appointment for treatment or services. We may also use your health information in order to recommend possible treatment alternatives or health-related benefits and services that may be of interest to you. Fundraising. To support our business operations, we may use demographic information about you, including information about your age and gender, where you live or work, and the dates that you received treatment, in order to contact you to raise money to help us operate. We may also share this information with a charitable foundation that will contact you to raise money on our behalf. If you do not want us to contact you for fundraising efforts, you may contact the Development Office at 718-963-7677. Business Associates. We may disclose your health information to contractors, agents and other business associates who need the information in order to assist us with obtaining payment or carrying out our business operations. For example, we may share your health information with a billing company that helps us to obtain payment from your insurance company. We may share your health information with medical transcriptionists and copy services which assist us with copying your medical records. Other examples are that we may share your health information with an accounting firm or law firm that provides professional advice to us about how to improve our health care services and comply with the law, or with an insurance company or risk management organization in order to obtain professional advice about how to manage risk and legal liability, including insurance or legal claims. If we do disclose your health information to a business associate, we will have a written contract to ensure that our business associate also protects the privacy of your health information. 2. Patient Directory/Family and Friends We may use your health information in, and disclose it from, our Patient Directory, or share it with family and friends involved in your care. We will always give you an opportunity to object unless there is insufficient time because of a medical emergency (in which case you will be able to express your preferences as soon as the emergency is over). We will follow your wishes unless we are required by law to do otherwise. Patient Directory. If you do not object, we will include your name, your location in our facility, your general condition (e.g., fair, stable, critical, etc.) and your religious affiliation in our Patient Directory while you are a patient in the hospital or at any of our facilities. This directory information, except for your religious affiliation, may be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if he or she doesn't ask for you by name. Family and Friends Involved in Your Care. If you do not object, we may share your health information with a family member, relative, or close personal friend who is involved in your care or payment for that care. We may also notify a family member, personal representative, or another person responsible for your care about your location and general condition here at the hospital, or about the unfortunate event of your death. In some cases, we may need to share your information with a disaster relief organization that will help us notify these persons. 3. Public Need We may use your health information, and share it with others, to comply with the law or to meet important public needs that are described below. As Required by Law. We may use or disclose your health information if we are required by law to do so. We also will notify you of these uses and disclosures if notice is required by law. Public Health Activities. We may disclose your health information to authorized public health officials (or a foreign government agency collaborating with such officials) so they may carry out their public health activities. For example, we may share your health information with government officials that are responsible for controlling disease, injury, or disability. We may also disclose your health information to a person who may have been exposed to a communicable disease or be at risk for contracting or spreading the disease if a law permits us to do so. Finally, we may release some health information about you to your employer if your employer hires us to provide you with a physical exam and we discover that you have a work-related injury or disease that your employer must know about in order to comply with employment laws. Victims Of Abuse, Neglect or Domestic Violence. We may release your health information to a public health authority that is authorized to receive reports of abuse, neglect, or domestic violence. For example, we may report your information to government officials if we reasonably believe that you have been a victim of such abuse, neglect, or domestic violence. We will make every effort to obtain your permission before releasing this information, but in some cases, we may be required or authorized to act without your permission. Health Oversight Activities. We may release your health information to government agencies authorized to conduct audits, investigations, and inspections of our facilities. These government agencies monitor the operation of the health care system, government benefit programs such as Medicare and Medicaid, and compliance with government regulatory programs and civil rights laws. Product Monitoring, Repair and Recall. We may disclose your health information to a person or company that is regulated by the Food and Drug Administration for the purpose of reporting about problems with products. Lawsuits And Disputes. We may disclose your health information if we are ordered to do so by a court or administrative tribunal that is handling a lawsuit or other dispute. Law Enforcement. We may disclose your health information to law enforcement officials for the following reasons: To comply with court orders or laws that we are required to follow; To assist law enforcement officers with identifying or locating a suspect, fugitive, witness, or missing person; If you have been the victim of a crime and we determine that: (1) we have been unable to obtain your agreement because of an emergency or your incapacity; (2) law enforcement officials need this information immediately to carry out their law enforcement duties; and (3) in our professional judgment disclosure to these officers is in your best interests; If we suspect that your death resulted from criminal conduct; If necessary to report a crime that occurred on our property; or If necessary to report a crime discovered during an offsite medical emergency (for example, by emergency medical technicians at the scene of a crime). To avert a serious and imminent threat to health or safety. We may use your health information or share it with others when necessary to prevent a serious and imminent threat to your health or safety, or the health or safety of another person or the public. In such cases, we will only share your information with someone able to help prevent the threat. We may also disclose your health information to law enforcement officers if you tell us that you participated in a violent crime that may have caused serious physical harm to another person (unless you admitted that fact while in counseling), or if we determine that you escaped from lawful custody (such as a prison or mental health institution). National Security and Intelligence Activities or Protective Services. We may disclose your health information to authorized federal officials who are conducting national security and intelligence activities or providing protective services to the President or other important officials. Military And Veterans. If you are in the Armed Forces, we may disclose health information about you to appropriate military command authorities for activities they deem necessary to carry out their military mission. We may also release health information about foreign military personnel to the appropriate foreign military authority. Inmates And Correctional Institutions. If you are an inmate or you are detained by a law enforcement officer, we may disclose your health information to the prison officers or law enforcement officers if necessary to provide you with health care, or to maintain safety, security, and good order at the place where you are confined. This includes sharing information that is necessary to protect the health and safety of other inmates or persons involved in supervising or transporting inmates. Workers’ Compensation. We may disclose your health information for workers’ compensation or similar programs that provide benefits for work-related injuries. Coroners, Medical Examiners and Funeral Directors. In the unfortunate event of your death, we may disclose your health information to a coroner or medical examiner. This may be necessary, for example, to determine the cause of death. We may also release this information to funeral directors as necessary to carry out their duties. Organ And Tissue Donation. In the unfortunate event of your death, we may disclose your health information to organizations that procure or store organs, eyes, or other tissues so that these organizations may investigate whether donation or transplantation is possible under applicable laws. Please note that organ and tissue donations still require consent. Research. In most cases, we will ask for your written authorization before using your health information or sharing it with others in order to conduct research. However, under some circumstances, we may use and disclose your health information without your written authorization if we obtain approval through a special process to ensure that research without your written authorization poses minimal risk to your privacy. Under no circumstances, however, would we allow researchers to use your name or identity publicly. We may also release your health information without your written authorization to people who are preparing a future research project, so long as any information identifying you does not leave our facility. In the unfortunate event of your death, we may share your health information with people who are conducting research using the information of deceased persons, as long as they agree not to remove from our facility any information that identifies you. 4. Completely De-identified Or Partially De-Identified Information We may use and disclose your health information if we have removed any information that has the potential to identify you so that the health information is completely de-identified. We may also use and disclose partially de-identified health information about you if the person who will receive the information signs an agreement to protect the privacy of the information as required by federal and state law. Partially de-identified health information will not contain any information that would directly identify you (such as your name, street address, social security number, phone number, fax number, electronic mail address, website address, or license number). 5. Incidental Disclosures While we will take reasonable steps to safeguard the privacy of your health information, certain disclosures of your health information may occur during or as an unavoidable result of our otherwise permissible uses or disclosures of your health information. For example, during the course of a treatment session, other patients in the treatment area may see, or overhear discussion of, your health information. Your Rights to Access and Control Your Health Information You have the following rights to access and control your health information (These rights are important because they will help you make sure that the health information we have about you is accurate. They may also help you control the way we use your information and share it with others, or the way we communicate with you about your medical matters): Right to Inspect and Copy Records You have the right to inspect and obtain a copy of any of your health information that may be used to make decisions about you and your treatment for as long as we maintain this information in our records. This includes medical and billing records. To inspect or obtain a copy of your health information, please submit your request in writing to the Health Information Services Department. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies we use to fulfill your request. The standard fee is $0.75 per page and must generally be paid before or at the time we give the copies to you. We will respond to your request for inspection of records within 10 days. We ordinarily will respond to requests for copies within 30 days if the information is located in our facility, and within 60 days if it is located off-site at another facility. If we need additional time to respond to a request for copies, we will notify you in writing within the time frame above to explain the reason for the delay and when you can expect to have a final answer to your request.Under certain very limited circumstances, we may deny your request to inspect or obtain a copy of your information. If we do, we will provide you with a summary of the information instead. We will also provide a written notice that explains our reasons for providing only a summary, and a complete description of your rights to have that decision reviewed and how you can exercise those rights. The notice will also include information on how to file a complaint about these issues with us or with the Secretary of the Department of Health and Human Services. If we have reason to deny only part of your request, we will provide complete access to the remaining parts after excluding the information we cannot let you inspect or copy. Right to Amend Records If you believe that the health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept in our records. To request an amendment, please write to our Health Information Services Department. Your request should include the reasons why you think we should make the amendment. Ordinarily we will respond to your request within 60 days. If we need additional time to respond, we will notify you in writing within 60 days to explain the reason for the delay and when you can expect to have a final answer to your request.If we deny part or all of your request, we will provide a written notice that explains our reasons for doing so. You will have the right to have certain information related to your requested amendment included in your records. For example, if you disagree with our decision, you will have an opportunity to submit a statement explaining your disagreement, which we will include in your records. We will also include information on how to file a complaint with us or with the Secretary of the Department of Health and Human Services. These procedures will be explained in more detail in any written denial notice we send you. Right to An Accounting of Disclosures You have a right to request an accounting of disclosures (as defined below) which identifies certain other persons or organizations to whom we have disclosed your health information in accordance with applicable law and the protections afforded in this Notice of Privacy Practices. An accounting of disclosures does not describe the ways that your health information has been shared within and between the hospital and the facilities and individuals listed at the beginning of this Notice, as long as all other protections described in this Notice of Privacy Practices have been followed. If a request for an accounting of disclosures is made to Wyckoff Heights Medical Center, our response will ordinarily be limited to disclosures made by the hospital (including our clinics) and will not usually include disclosures made by the other entities or individuals listed at the beginning of this Notice such as disclosures by individual physicians from their private offices.An accounting of disclosures also will not include information about the following disclosures: Disclosures we made to you or your personal representative; Disclosures we made pursuant to your written authorization; Disclosures we made for treatment, payment, or business operations; Disclosures made from the patient directory; Disclosures made to your friends and family involved in your care or payment for your care; Disclosures that were incidental to permissible uses and disclosures of your health information (for example, when information is overheard by another patient passing by); Disclosures for purposes of research, public health, or our business operations of limited portions of your health information that do not directly identify you; Disclosures made to federal officials for national security and intelligence activities; Disclosures about inmates to correctional institutions or law enforcement officers; Disclosures made before April 14, 2003. To request an accounting of disclosures, please write to the Health Information Services Department. Your request must state a time period within the past six years (but after April 14, 2003) for the disclosures you want us to include. For example, you may request a list of the disclosures that we made between January 1, 2004 and January 1, 2005. You have a right to receive one accounting within every 12-month period for free. However, we may charge you for the cost of providing any additional accounting in that same 12-month period. We will always notify you of any cost involved so that you may choose to withdraw or modify your request before any costs are incurred.Ordinarily we will respond to your request for an accounting within 60 days. If we need additional time to prepare the accounting you have requested, we will notify you in writing about the reason for the delay and the date when you can expect to receive the accounting. In rare cases, we may have to delay providing you with the accounting without notifying you because a law enforcement official or government agency has asked us to do so. Right to Request Additional Privacy Protections You have the right to request that we further restrict the way we use and disclose your health information to treat your condition, collect payment for that treatment, or run our business operations. You may also request that we limit how we disclose information about you to family or friends involved in your care. For example, you could request that we not disclose information about a surgery you had. To request restrictions, please write to the Privacy Officer. Your request should include (1) what information you want to limit; (2) whether you want to limit how we use the information, how we share it with others, or both; and (3) to whom you want the limits to apply. We will send you a written response.We are not required to agree to your request for a restriction, and in some cases the restriction you request may not be permitted under law. However, if we do agree, we will be bound by our agreement unless the information is needed to provide you with emergency treatment or comply with the law. Once we have agreed to a restriction, you have the right to revoke the restriction at any time. Under some circumstances, we will also have the right to revoke the restriction as long as we notify you before doing so; in other cases, we will need your permission before we can revoke the restriction. Right to Request Confidential Communications You have the right to request that we communicate with you about your medical matters in a more confidential way by requesting that we communicate with you by alternative means or at alternative locations. For example, you may ask that we contact you at home instead of at work. To request more confidential communications, please write to our Patient Relations Department. We will not ask you the reason for your request, and we will try to accommodate all reasonable requests. Please specify in your written request how or where you wish to be contacted, and how payment for your health care will be handled if we communicate with you through this alternative method or location. Additional Information How Someone May Act on Your Behalf You have the right to name a personal representative who may act on your behalf to control the privacy of your health information. Please note, however, that naming someone to act on your behalf to control the privacy of your health information does not in itself give that person the right to make treatment decisions on your behalf. Parents and guardians will generally have the right to control the privacy of health information about minors unless the minors are permitted by law to act on their own behalf. Special Protections For HIV-Related Information and Mental Health Information Special privacy protections apply to HIV-related information and mental health information. Some parts of this general Notice of Privacy Practices may not apply to these types of information. If you would like a written explanation of how the information will be protected, please contact our Patient Relations Department at 718-963-7190. Health Care ProxyWho Will Speak for You? In New York State, there exists a law called the New York Health Care Proxy law. This law allows you to appoint someone you trust, such as a family member or a close friend, to decide about medical treatment if you lose the ability to decide for yourself. Why is a Health Care Proxy Important? If you ever become unable to communicate with the doctors or any other medical staff involved in your care, without a health care proxy, neither a family member nor a close friend will be allowed to make decisions about your treatment, even if they know what you would choose. Completing a health care proxy empowers a trusted individual to carry out your wishes regarding your medical treatment. Where Can I Obtain a New York State Health Care Proxy Form? Once you decide who you wish to be your health care proxy (agent), you will be able to complete the New York Health Care Proxy form. The form, including instructions, is available in the following languages: English, Spanish, Chinese, Korean, and Russian. If you need assistance in completing the form, please contact one of our Patient Advocates at 718-963-7189 or click here for more information. Forms Health Care Proxy – Chinese Health Care Proxy – English Health Care Proxy – Korean Health Care Proxy – Russian Health Care Proxy – Spanish Patients’ Bill of RightsAs a patient in a hospital in New York State, you have the right, consistent with law, to: (1) Understand and use these rights. If for any reason you do not understand or you need help, the hospital MUST provide assistance, including an interpreter. (2) Receive treatment without discrimination as to race, color, religion, sex, gender identity, national origin, disability, sexual orientation, age, or source of payment. (3) Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints. (4) Receive emergency care if you need it. (5) Be informed of the name and position of the doctor who will be in charge of your care in the hospital. (6) Know the names, positions and functions of any hospital staff involved in your care and refuse their treatment, examination, or observation. (7) Identify a caregiver who will be included in your discharge planning and sharing of post-discharge care information or instruction. (8) Receive complete information about your diagnosis, treatment, and prognosis. (9) Receive all the information that you need to give informed consent for any proposed procedure or treatment. This information shall include the possible risks and benefits of the procedure or treatment. (10) Receive all the information you need to give informed consent for an order not to resuscitate. You also have the right to designate an individual to give this consent for you if you are too ill to do so. If you would like additional information, please ask for a copy of the pamphlet, "Deciding About Health Care — A Guide for Patients and Families." (11) Refuse treatment and be told what effect this may have on your health. (12) Refuse to take part in research. In deciding whether or not to participate, you have the right to a full explanation. (13) Privacy while in the hospital and confidentiality of all information and records regarding your care. (14) Participate in all decisions about your treatment and discharge from the hospital. The hospital must provide you with a written discharge plan and written description of how you can appeal your discharge. (15) Review your medical record without charge and, obtain a copy of your medical record for which the hospital can charge a reasonable fee. You cannot be denied a copy solely because you cannot afford to pay. (16) Receive an itemized bill and explanation of all charges. (17) View a list of the hospital’s standard charges for items and services and the health plans the hospital participates with. (18) Challenge an unexpected bill through the Independent Dispute Resolution process. (19) Complain without fear of reprisals about the care and services you are receiving and to have the hospital respond to you and if you request it, a written response. If you are not satisfied with the hospital’s response, you can complain to the New York State Health Department. The hospital must provide you with the State Health Department telephone number. (20) Authorize those family members and other adults who will be given priority to visit consistent with your ability to receive visitors. (21) Make known your wishes in regard to anatomical gifts. Persons sixteen years of age or older may document their consent to donate their organs, eyes and/or tissues, upon their death, by enrolling in the NYS Donate Life Registry or by documenting their authorization for organ and/or tissue donation in writing in a number of ways (such as a health care proxy, will, donor card, or other signed paper). The health care proxy is available from the hospital. Public Health Law (PHL) 2803 (1)(g) Patient’s Rights, 10NYCRR, 405.7, 405.7(a)(1), 405.7(c) - 2/2019 Click here for more information. Resources New York State Patients’ Bill of Rights Arabic Chinese Creole English Italian Korean Polish Russian Spanish New York State Parents’ Bill of Rights Chinese Creole English Korean Russian Spanish Patient Responsibilities A patient has the responsibility to provide, to the best of his/her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to the patient’s health. A patient has the responsibility to report unexpected changes in a condition to the responsible practitioner, for making it known whether a contemplated course of action and any subsequent expectation are clearly comprehended. Compliance with Instructions A patient is responsible for following the treatment plan recommended by the practitioner primarily responsible for the patient’s care. This may include following the instructions of nurse and allied health care personnel as they carry out the coordinated plan of care and implement the responsible practitioner's orders, and as they enforce the applicable medical center rules and regulations. The patient is responsible for keeping appointments and, when unable to do so for any reason, notifying the responsible practitioner or the medical center. Refusal of Treatment The patient is responsible for his/her actions if (s) he refuses treatment or does not follow the practitioner's instructions. Medical Center Charges The patient is responsible for assuring that the financial obligations of his/her healthcare are fulfilled as promptly as possible. Medical Center Rules and Regulations The patient is responsible for following hospital rules and regulations affecting patient care and conduct. Respect and Consideration The patient is responsible for being considerate of the rights of other patients and medical center personnel and for assisting in the control of noise, smoking, and the number of visitors. The patient is responsible for being respectful of the property of other persons and of the medical center. Smoking Wyckoff Heights Medical Center is a smoke-free facility. Smoking is prohibited anywhere in the hospital by order of the New York City Fire Department, and local and state laws. For health and safety reasons, we require your compliance with this rule. For your information: Smoking will trigger the smoke alarm system, setting off the hospital fire alarm system and a response from the New York City Fire Department. Alcohol and Controlled Substances The use of alcoholic beverages and/or other controlled substances is absolutely forbidden. This prohibition applies both to patients and visitors to the medical center.