Southern New Hampshire Medical Center (The Medical Center) promotes and supports open communication regarding safety and quality of care issues. If you have a safety or quality of care concern, we encourage you to contact The Medical Center’s Patient Relations (603) 577-2196 and/or Quality Management (603) 577-2716. You may also report a concern by calling the Compliance Hotline (888) 414-2743. Should you feel your concerns have not been addressed, you have the right to report these concerns to the DNV GL for the Accreditation of Healthcare Organizations by calling (866) 496-9647. The Medical Center respects the rights of the patient and recognizes that each patient is an individual with unique health care needs. Recognizing the importance of respecting each patient's personal dignity, The Medical Center provides considerate, respectful care focused upon consideration of the psychosocial, spiritual, and cultural variables that influence the perceptions of illness. The Medical Center will respond to reasonable patient requests and needs for treatment or service within The Medical Center's capacity, its mission, and applicable laws and regulations. The Medical Center affirms the patient's right to make decisions regarding the patient’s medical care, including the decision to discontinue treatment, to the extent permitted by law. The Medical Center assists the patient in the exercise of the patient’s rights and informs the patient of any responsibilities incumbent upon the patient in the exercise of those rights regardless of age, race, color, ethnicity, national origin, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression. Based on the New Hampshire State Statute RSA 151:21, Patients’ Bill of Rights as well as, 42 CFR Part 482 Hospital Conditions of Participation: Patients’ Rights, The Medical Center adopts the Patient's Bill of Rights. The patient shall be treated with consideration, respect, and full recognition of the patient's dignity and individuality, including privacy in treatment and personal care and including being informed of the name, licensure status, and staff position of all those with whom the patient has contact, pursuant to RSA 151:3-b. The patient shall be fully informed of a patient's rights and responsibilities and of all procedures governing patient conduct and responsibilities. This information must be provided orally and in writing before or at admission, except for emergency admissions. Receipt of the information must be acknowledged by the patient in writing. When a patient lacks the capacity to make informed judgments the signing must be by the person legally responsible for the patient. The patient shall be fully informed in writing in language that the patient can understand, before or at the time of admission and as necessary during the patient's stay, of the facility's basic per diem rate and of those services included and not included in the basic per diem rate. A statement of services that are not normally covered by Medicare or Medicaid shall also be included in this disclosure. The patient shall be fully informed by a health care provider of his or her medical condition, health care needs, and diagnostic test results, including the manner by which such results will be provided and the expected time interval between testing and receiving results, unless medically inadvisable and so documented in the medical record, and shall be given the opportunity to participate in the planning of his or her total care and medical treatment, to refuse treatment, and to be involved in experimental research upon the patient's written consent only. For the purposes of this paragraph "health care provider" means any person, corporation, facility, or institution either licensed by this state or otherwise lawfully providing health care services, including, but not limited to, a physician, hospital or other health care facility, dentist, nurse, optometrist, podiatrist, physical therapist, or psychologist, and any officer, employee, or agent of such provider acting in the course and scope of employment or agency related to or supportive of health care services. The patient shall be transferred or discharged after appropriate discharge planning only for medical reasons, for the patient's welfare or that of other patients, if the facility ceases to operate, or for nonpayment for the patient's stay, except as prohibited by Title XVIII or XIX of the Social Security Act. No patient shall be involuntarily discharged from a facility because the patient becomes eligible for Medicaid as a source of payment. The patient shall be encouraged and assisted throughout the patient's stay to exercise the patient's rights as a patient and citizen. The patient may voice grievances and recommend changes in policies and services to facility staff or outside representatives free from restraint, interference, coercion, discrimination, or reprisal. The patient shall be permitted to manage the patient's personal financial affairs. If the patient authorizes the facility in writing to assist in this management and the facility so consents, the assistance shall be carried out in accordance with the patient's rights under this subdivision and in conformance with state law and rules. The patient shall be free from emotional, psychological, sexual and physical abuse and from exploitation, harassment, neglect, corporal punishment and involuntary seclusion. The patient shall be free from chemical and physical restraints except when they are authorized in writing by a physician for a specific and limited time necessary to protect the patient or others from injury. In an emergency, restraints may be authorized by the designated professional staff member in order to protect the patient or others from injury. The staff member must promptly report such action to the physician and document same in the medical records. All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff. The patient shall be ensured confidential treatment of all information contained in the patient's personal and clinical record, including that stored in an automatic data bank, and the patient's written consent shall be required for the release of information to anyone not otherwise authorized by law to receive it. Medical information contained in the medical records at any facility licensed under this chapter shall be deemed to be the property of the patient. The patient shall be entitled to a copy of such records upon request. The charge for the copying of a patient's medical records shall not exceed $15 for the first 30 pages or $.50 per page, whichever is greater; provided, that copies of filmed records such as radiograms, x-rays, and sonograms shall be copied at a reasonable cost. The patient shall not be required to perform services for the facility. Where appropriate for therapeutic or diversional purposes and agreed to by the patient, such services may be included in a plan of care and treatment. The patient shall be free to communicate with, associate with, and meet privately with anyone, including family and resident groups, unless to do so would infringe upon the rights of other patients. The patient may send and receive unopened personal mail. The patient has the right to have regular access to the unmonitored use of a telephone. The patient shall be free to participate in activities of any social, religious, and community groups, unless to do so would infringe upon the rights of other patients. The patient shall be free to retain and use personal clothing and possessions as space permits, provided it does not infringe on the rights of other patients. The patient shall be entitled to privacy for visits and, if married, to share a room with his or her spouse if both are patients in the same facility and where both patients consent, unless it is medically contraindicated and so documented by a physician. The patient has the right to reside and receive services in the facility with reasonable accommodation of individual needs and preferences, including choice of room and roommate, except when the health and safety of the individual or other patients would be endangered. The patient shall not be denied appropriate care on the basis of age, sex, gender identity, sexual orientation, race, color, marital status, familial status, disability, religion, national origin, source of income, source of payment, or profession. The patient shall be entitled to be treated by the patient's physician of choice, subject to reasonable rules and regulations of the facility regarding the facility's credentialing process. The patient shall be entitled to have the patient's parents, if a minor, or spouse, or next of kin, unmarried partner, or a personal representative chosen by the patient, if an adult, visit the facility, without restriction, if the patient is considered terminally ill by the physician responsible for the patient's care. The patient shall be entitled to receive representatives of approved organizations as provided in RSA 151:28. The patient shall not be denied admission to the facility based on Medicaid as a source of payment when there is an available space in the facility. Subject to the terms and conditions of the patient's insurance plan, the patient shall have access to any provider in his or her insurance plan network and referral to a provider or facility within such network shall not be unreasonably withheld pursuant to RSA 420-J:8, XIV. The patient shall not be denied admission, care, or services based solely on the patient's vaccination status. In addition to the rights specified in paragraph XVIII, the patient shall be entitled to designate a spouse, family member, or caregiver who may visit the facility while the patient is receiving care. A patient who is a minor may have a parent, guardian, or person standing in loco parentis visit the facility while the minor patient is receiving care. The patient has a right to have a family member or representative of the patient’s choice and patient’s own physician notified promptly of patient’s admission to the hospital. The patient has the right to formulate Advance Directives and appoint a surrogate to make health care decisions on patient’s behalf to the extent permitted by law. The patient has the right to participate in the development and implementation of his or her plan of care. The patient or patient’s representative (as allowed under State Law) has the right to participate in and make informed decisions regarding the patient’s plan of care. The patient’s rights include being informed of their health status, being involved in care planning and treatment, and being able to request or refuse treatment. The right shall not be construed as a mechanism to demand the provision of treatment or services deemed medically unnecessary or inappropriate. The patient has a right to receive care in a safe setting. The patient has a right to appropriate assessment and management of patient’s pain/discomfort. The patient has the right to receive visitors of their choice subject to their consent including but not limited to the following: a spouse, a domestic partner (including a same-sex domestic partner), any other family member, or friend. The patient has the right to revoke their consent to visitors at any time during their stay. Patients have the right to access their medical records, including current medical records, upon an oral or written request, in the form and format requested by the individual, if it is readily producible in such form and format (including in an electronic form or format when such medical records are maintained electronically); or, if not, in a readable hard copy form or such other form and format as agreed to by the facility and the individual, and within a reasonable time frame. The hospital must not frustrate the legitimate efforts of individuals to gain access to their own medical records and must actively seek to meet these requests as quickly as its record keeping system permits. Patients also have the right to lodge complaints with a State Agency or CMS by contacting the State of New Hampshire Department of Health and Human Services, Office of Program Support, Bureau of Health Facilities Administration, 129 Pleasant Street, Concord NH 03301- 3857. Telephone (603) 271-9499 or NH Toll Free (800) 852-3345. Patients of Southern New Hampshire Medical Center Have the Following Responsibilities: In order to provide our patients with a higher level of care, the Medical Center asks that our patients and families accept certain responsibilities. These may include: Providing Information: Patients or their families are responsible for providing, to the best of their knowledge, accurate and complete information about present conditions, past illnesses, hospitalizations, medications and other health-related matters. Patients are asked to report unexpected medical changes to the appropriate caregiver. We value your feedback, so please let us know how you are feeling about your hospital stay. Asking Questions: Patients and their families should ask questions if they do not understand their care, treatment or service or if they have any concerns relating to safety. Following Instructions: Patients or their families are responsible for following the care and treatment plan that is developed. If patients or their families have any concerns about a planned course of treatment, we will make every effort to adapt the treatment plan to address these concerns. If we are unable to, we will advise them about the possible consequences of alternative treatments and the risks of not following the prescribed plan. Understanding Consequences: If patients or their families do not follow the provider’s instructions, the responsibility for the outcome rests with them. Rules and Regulations: Rules and regulations at The Medical Center are designed to facilitate care for all of our patients. Therefore, all patients and their families are responsible for following the standards affecting patient care and conduct. Respect and Consideration: In the close environment of a hospital, being respectful of the rights of others is necessary, especially with regard to smoke, noise and other distractions as well as showing consideration of the personal property of others, including hospital property. Financial Commitment: The Medical Center is prepared to work with patients and families to help them meet their financial obligations to the organization. Payment plans are available by calling the hospital billing office at (603) 577-7800. Advance Directives: Patients are responsible for providing The Medical Center with a copy of their Advance Directives, if formulated, and notifying their caregivers and The Medical Center of any changes or revocation of these documents. Personal Property: The Medical Center can only be responsible for items placed in the direct care of the Medical Center Staff. These include items placed in the Medical Center safe or under the direct control of Medical Center staff. Patients are advised to leave valuables, money, or unnecessary personal items at home. Items retained at the bedside or under the control of a patient with appropriate mental capacity are the responsibility of the patient. Individual safes are provided in some patient rooms to facilitate independent storage of belongings. The Medical Center does not assume responsibility for belongings stored in this manner. Feedback from our patients is very important to us. When you get home, you may receive a survey in the mail or by email, phone, or text asking you what we've done well and what we could be doing better. We'd appreciate it if you would take a few minutes to complete it. Updated 7/2022