Release of Information Form
Patients Rights and Notice of Non-Discrimination
Access – You have the right to:
- Receive medically necessary treatment and the appropriate level of care regardless of age, race, ethnicity, religion, culture, color, national origin, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression, or source of payment for care.
- Other facility services for your needs such as social services (including protective services), spiritual health services, financial counseling, etc.
- View your medical and billing records within a reasonable time frame as permitted by law and access, request amendment to and obtain information on the disclosures of your medical records according to law and regulations.
- Accept or refuse medical care and be informed of the possible consequences of any such decision.
- Have a family member or representative of your choice and your own physician promptly notified of your admission to the hospital.
- Receive interpreting services and auxiliary aids and services at no cost to you.
Respect – We will:
- Listen to you and treat you with respect.
- Respect your cultural and personal values, beliefs, and preferences.
- Talk with you and answer any questions that you may have about your plan of care.
- Respect your right to confidentiality and the privacy of your medical records.
- Tell you who we are, why we have entered your room and our role as a part of your care team.
- Tell you why you are here and how we will be able to help you feel better.
- Provide you with the highest level of privacy and dignity that we can.
Safety – We will:
- Care for you in a safe and clean environment.
- Protect you from all forms of abuse, neglect, or harassment.
- Provide care that is free from restraint or seclusion, except when restraint is needed to protect your safety or the safety of our staff.
Involvement in Your Care – You have the right to:
- Receive communication in a way that is easy for you to understand.
- Be involved in treatment decisions, your care and discharge plans, make informed decisions and be informed of unanticipated outcomes.
- Have any concerns regarding care or treatment reviewed and addressed.
- Have your pain managed.
- Make end-of-life decisions and request that staff document and follow those requests.
- Designate someone to speak on your behalf if you are unable to make decisions about your care.
- Refuse to participate in research or experimental treatments and clinical trials.
Your visitors – You have the right to:
- Have visitors of your choice, including a spouse, domestic partner, same-sex domestic partner, family member or friend.
- Withdraw your consent to be visited by any visitor at any time.
If you need help filing a grievance, Barbara Zubeck is available to help you.
After regular business hours, please contact the Director of Shift Operations by calling the operator at 816-404-1000 (Hospital Hill) or 816-404-7000 (Lakewood).
You also have the option of contacting an outside organization with your concerns:
Your Responsibilities as a Patient or Visitor
- So that we can provide you with patient-centered, quality care and services, we ask that you always:
- Keep the hospital a quiet and restful place.
- Respect the rights, privacy and property of other patients and staff. Follow TMC’s rules and regulations, including the tobacco, alcohol-free and drug-free policy.
- Refrain from foul, threatening or inappropriate language.
- Refrain from hitting or threatening a family member,
- a patient or staff.
- Refrain from bringing a weapon into the facility.
- Ask questions of your healthcare team when you don’t understand something.
- Adhere to the care plan that your medical team has developed for you.
- Be on time for your medical appointments or call in advance to reschedule.
- Provide a copy of your advance directive at every visit.
- Fulfill your financial obligations for your healthcare as promptly as possible.
- Provide accurate and complete information in order for TMC to receive payment for services.
Your Personal Belongings