Patient & Visitor Information

Transcription

1 Patient & Visitor Information Mission Maricopa Integrated Health System (MIHS) is Maricopa County s only public teaching hospital and health care system. We are committed to providing safe, comprehensive, high-quality physical and behavioral health care in a patient-centric environment to the communities we serve; and expanding the community s available pool of physicians and other health care professionals by offering excellent academic programs. Vision MIHS will be recognized locally and nationally as an effective, efficient, and fiscally responsible organization that maintains an integrated, high-quality, patient-centric health care delivery system and an excellent academic medical center. Values Respect, Compassion, Collaboration, Excellence, Stewardship, Leadership, Integrity, Education, Innovation, Accountability.

2 Patient Information: Name: Unit: Room & Bed #: Unit / Station Ph #: My bedside phone #:

3 As President & CEO, I would like to take this opportunity to welcome you to Maricopa Integrated Health System (MIHS). MIHS is the only public hospital in Arizona and it touches nearly all residents of Maricopa County in one way or another. That includes the Level One Trauma Center and the nationally recognized Arizona Burn Center. The care provided to the residents of Maricopa County could include hospitalization or wellness and preventative services in our clinics. We understand that it can take time to adjust to unfamiliar surroundings such as a hospital room so we prepared this guide to help make your stay with us as comfortable as possible. It contains useful information and helpful tips on how you can help us ensure that you receive the excellent care you deserve. On behalf of our doctors, employees and volunteers, thank you for choosing MIHS. Sincerely, Stephen A. Purves President & CEO Maricopa Health System On behalf of the staff and employees of Maricopa Integrated Health System (MIHS), welcome and thank you for choosing Maricopa Medical Center for your care. We understand that no one enjoys spending time in the hospital, so we are going to do our best to make your stay with us as comfortable as possible. At MIHS we are committed to offering comprehensive and safe care to all of those who live in Maricopa County. If you have any needs that would better help us deliver on our mission during your stay, please tell any member of our health care team. Again thank you for choosing MIHS to serve your health care needs. We hope that you have a positive experience with us and will recommend us to your family and friends. This is your hospital, and we are working hard to ensure it is everything you need it to be. Sincerely, Bill Vanaskie Chief Operating Officer 3 MIHS Patient and Visitor Information

4 Welcome to Maricopa Integrated Health System As Arizona s only public health care system, Maricopa Integrated Health System (MIHS) is committed to offering comprehensive care for all those who live in Maricopa County and beyond. Through a continuum of care and collaboration, MIHS is dedicated to keeping our community healthy by offering medical care in a top-notch, serviceoriented setting. MIHS includes Maricopa Medical Center, home to our highly-respected Adult Level-1 and Pediatric Level II Trauma Centers and the top-ranked Arizona Burn Center. We also offer eleven family health centers located throughout the Valley, a comprehensive specialty health center (CHC), Arizona Children s Center, two behavioral health centers, Walk-in clinic and Integrated Health Home clinics. Maricopa Medical Center is a premier training center for the nation s physicians. Our medicine, surgery, pediatrics and obstetric and gynecology (OB/GYN) programs, in particular, contribute to the body of knowledge of patient care. Maricopa Medical Center ensures that health care is available to all area residents giving them access to top quality medical care. District Medical Group (DMG), partners with MIHS to provide a full spectrum of professional services. As leaders in patient care and medical education, DMG physicians have a tradition of professional excellence and service to the community. YOUR Satisfaction. We Encourage Your Feedback to Improve Care Your health care is our priority. To determine where improvements are needed, you may be receiving a patient satisfaction survey in the mail after your hospital stay. The survey measures your satisfaction with the quality of care you received while a patient at MIHS. Please take the time to fill out the survey; your feedback is valuable! Phone Directory: Main Number Patient Registration Patient Billing Patient Advocate Interpreter Office Volunteer Services Chaplain Gift Shop Security For more information about MIHS, go to mihs.org

5 During Your Stay We have policies and procedures in place to help you and your family work with our doctors, nurses and staff to get the most from your hospital stay. Please take a few minutes to review these guidelines with your loved ones. Visitor Guidelines: We encourage visitors for emotional support and recovery. To provide a restful and safe environment, we ask that all visitors comply with the following guidelines. Be considerate of other patients by keeping noise to a minimum. Refrain from visiting if you have a cold, sore throat or any contagious disease. Observe No Visiting and precaution signs before entering the room. Parking: Visitor parking is located in various areas of our campus. Visitor parking spaces are color coded white. Security: Safety and security of our patients and employees are paramount concerns of the hospital. Security officers are on patrol at the hospital at all times. If you have security concerns, please tell any member of our staff or you may contact security directly at Interpreters: In our diverse culture, many of our patients speak languages from around the world and we are pleased to offer several services to assist patients with language translation and interpretation. Please tell any member of our staff if you need assistance. Interpretation services are free of charge. Sign language interpretation is also available to our patient s and family members at no cost. If you are visually impaired please tell any member of our staff so we can make arrangement to communicate the contents of critical hospital documents. Telephone: Telephones are provided in all patient rooms. To place a local call dial 9 then the phone number. Valuables and Personal Belongings: Please help us protect your valuables and personal belongings while you are here by taking these precautions: Leave valuables at home as well as billfolds or pocketbooks containing large amounts of money. If unable to send valuables or money home, ask your nurse to complete the valuables information form and place the small valuable items in the hospital safe. MIHS cannot be responsible for your valuable belongings left unsecure. However, if you do have property lost or stolen during your stay, please ask a member of our staff to contact security to submit a report, or, if you wish, you may contact the security department directly. Personal belonging bags for your clothing are available from your nurse. Please do not wrap dentures or hearing aids in tissue and place them on your food tray, bedside table or night stand. They are easily mistaken for trash. Tobacco-Free Campus: Tobacco use is not permitted anywhere in the hospital or on hospital grounds. Talk to your doctor or nurse if you have questions or concerns. TV: Televisions are provided free of charge in each patient room. Please be considerate of others and keep the TV volume down and turn off your TV at bedtime. Channel listings are located on page 7. All televisions have closed captioning available for the hearing impaired. ATM: For your convenience, an automated teller machine (ATM) is located in the lower level of the hospital in the cafeteria. Cafeteria (Twisted Fork): The cafeteria is located on the lower level of the hospital. The cafeteria provides a wide selection of hot meals, snacks and beverages. The cafeteria is open weekdays for breakfast 6-10 am, lunch 10:30-2 pm, snacks and beverages 2-4:30 pm, dinner 5-6:45 pm and late hours are 12am 2 am. On weekends and holidays the cafeteria is open for breakfast 6-9 am, lunch 10:30 1:30 pm, snacks and beverages 2-4:30 pm, dinner 5-6:45pm and late hours 12am -2am. Coffee Cart: Coffee cart offers hot and cold coffee drinks and is located on the first floor in the main lobby. Hours of operation are Monday Friday 5am to 4:30pm; Weekends 5am to 1pm. Gift Shop: The gift shop is located on the first floor in the main lobby. The proceeds from the gift shop are donated back to the hospital through Maricopa Health Foundation to assist the needs of our patients. Cash and all major credit cards are accepted. Hours of operation are Monday Friday 7am to 6pm; Weekends 10am 4pm. Spiritual Care: The hospital chapel is on the first floor in the hospital s main lobby and is open 24 hours a day, seven days a week. Chaplains are available for your spiritual needs please ask your caregiver or call MIHS Patient and Visitor Information

6 SPEAK UP! Take charge of your care: During your stay, the doctors, nurses and staff of MIHS will treat you and your family as partners in your own care. One important way that you can be involved is to speak up. Ask questions, voice your concerns, and don t be afraid to raise any issues relating not only to your care and treatment, but also to overall hospital services. Patient Identification: Any time staff enters your room to administer medications, transport you or perform procedures and treatments, they must check your birth date and name before they proceed. At times, you may be asked the same questions repeatedly. We are aware that this may be annoying. Please understand however, that this verification process is a critical component in our patient safety program in order for all of our patients to receive the correct medications and treatments. Fighting Infections: The single most important thing you can do to help prevent infections is to wash your hands and make sure that everyone who touches you including your doctors and nurses- wash their hands, too. You, your family and friends should wash hands: 1. After touching objects or surfaces in the hospital room 2. Before eating 3. After using the restroom It is also important that your healthcare providers wash their hands with both soap and water or with an alcoholbased hand cleaner every time, both before and after they touch you. Health providers know to practice hand hygiene, but sometimes they forget. You and your family should not be afraid or embarrassed to speak up and ask them to wash their hands. Do you have PAIN? You are the expert about how you are feeling. Be sure to tell your doctor or nurse when you have any kind of pain. To help describe your pain, be sure to report. When the pain began Where you feel the pain How the pain feels - sharp, dull, throbbing, burning, tingling If the pain is constant or if it comes and goes What, if anything, makes the pain feel better What, if anything, makes the pain feel worse How much, if any, pain your medicine is taking away If your medicine helps with the pain, how many hours of relief do you get? PREVENTING Falls Hospital patients often fall because they are weak or unsteady due to illness or medical procedures, their medications make them dizzy, or because they ve been sitting or lying down for too long. MIHS cares about our patients safety. PLEASE HELP US KEEP YOU SAFE BY FOLLOWING THESE GUIDELINES DURING YOUR HOSPITAL STAY: Do not get out of bed by yourself. Your hospital bed is probably higher and narrower than your bed at home and you can easily fall while trying to get in or out of it. Please use your nurse call button and ask for assistance. Keep often used items - call button, tissues, water, eyeglasses, telephone, TV remote - within easy reach. Do not walk in bare feet. Wear non-skid socks or slippers. Make sure your robe or pajamas don t drag on the floor; they can cause you to trip. Use the handrails in your bathroom and throughout the hospital at all times. Ask your nurse to show you how to properly walk with your IV pole, drainage bags or any other equipment. Rapid Response Team: Rapid Response Team (RRT) is a team of trained health care professionals who will come to your bedside to help assist your nurse when there is a concerning change in your condition. When should someone call RRT? Sudden or severe pain Difficulty breathing Unable to wake up Sudden confusion, problems thinking clearly, or restlessness Concern about the patient s condition Chest pain Any other urgent situation If you or your representative notice any signs of decline in your health, notify your nurse right away and ask that the rapid response team be called. If you feel your urgent needs are not being met, ask to speak to the manager or director of the area. 6 For more information about MIHS, go to mihs.org

7 Television Channels available here at MIHS 3-3TV 19 Hallmark 34 Univision 4 TV Land 20 Headline News 35 Nickelodeon 5 - CBS 21 Fox News 36 Baby First TV 6 MTV TR Weather Channel 37 Disney 7 Patient Channel 23 - National Geographic 38 Disney XD 8 PBS 24 - Discovery 39 Fox Soccer 10 - Fox 25 TLC 40 MLB Network 11 - My45 26 USA 41 NBA Network 12 - NBC 27 TBS 42 NFL Network 13 - Spanish 28 TNT 43 NickToons 14 Lifetime Movies 29 Speed 44 Nick Jr. 15 ABC 30 FX 45 TeenNick 16 ion 31 Cartoon Network 46 PBS Kids Sprout 17 Bloomberg TV 32 TBN Religion 18 CNN 33 TeleMundo Patient Rights and Responsibilities Patient Rights Your right to considerate and respectful care You or your representative have the right to: Be informed of your rights prior to receiving care or before your care is discontinued. Be treated with consideration, respect and dignity. The number of patients in a room is based on the patients ages, developmental levels, clinical conditions, and diagnosis needs, and MIHS goals if the setting provides long term care of greater than 30 days. MIHS allows the patient to keep and use personal clothing and possessions, unless this infringes on others rights or is medically or therapeutically contraindicated, based on the setting or service. Have your cultural, personal values, beliefs, and preferences respected. Have your religious and other spiritual services accommodated as much as is reasonably possible. Have access to a telephone. Request and receive an itemized and detailed explanation of your total bill for services rendered in the hospital, regardless of the source of payment. Obtain a copy of hospital rates and charges. Consent to receive visitors that you have designated either orally or in writing. Not be discriminated against based on race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis. Receive treatment that supports and respects your individuality, choices, strengths, and abilities. Your right to information and participation in care You or your representative have the right to: Except in emergency, alternatives to a proposed psychotropic medication or surgical procedure and associated risks and possible complications of the proposed psychotropic medication or surgical procedure. Be informed of your health status. Request or refuse treatment, as permitted by law, throughout your hospital stay. 7 MIHS Patient and Visitor Information

8 Refuse examination or withdraw consent for treatment before treatment is started, as permitted by law. Participate in the development and implementation of your inpatient treatment/care plan, outpatient treatment/care plan. Participate in the development and implementation of your discharge plan. Participate in the development and implementation of your pain management plan and transition planning. Except in an emergency, either consents to or refuses treatment. Receive assistance from a family member, representative, or other individual in understanding, protecting or exercising the patients rights. Have access to interpreting and translation services, or other reasonable means of communication in order to communicate effectively with the healthcare providers. Have a family member or representative of your choice and your own physician notified promptly of your admission to the hospital. Access information contained in your medical record within a reasonable time frame, except when restricted by law. Know the names and roles of the staff treating you while in the hospital. Receive a referral to another health care institution if our hospital is unable to provide physical health services or behavioral health services for the patient. Your right to privacy and confidentiality You or your representative have the right to: Receive privacy in treatment and activities of daily living, as much as is reasonably possible. Refuse to see anyone not officially connected with the hospital, including visitors or persons officially connected with the hospital but not directly involved in your care. Request to have a person of your own sex be present during certain parts of an examination, procedure or treatment being performed by a health professional of the opposite sex. Expect your medical record information be disclosed only with the written consent by you or your representative, as permitted by law. Expect that your medical information will only be available to those persons involved in your care and to those authorized in the Conditions of Admission. Access, request amendment to, and/or obtain information on who has reviewed your medical record, in accordance with law and regulation. Your right to ethical decisions You or your representative have the right to: Consent or refuse recordings, films, or other images of yourself for purposes other than your care. Create an advance directive, such as a Living Will or a Healthcare Power of Attorney, and have our healthcare providers comply with these directives. Designate a decision maker in the event you are unable to understand a proposed treatment or procedure or are unable to communicate your wishes regarding care. Know you will not be discriminated against or your treatment limited based upon whether or not you decide to prepare a Living Will or Healthcare Power of Attorney. Access the Ethics Committee when you or your family have conflicts with your treatment or personal values. Consent and/or refuse to participate in any research or experimental treatment. Except in an emergency, is provided a description of the health care directives policies and procedures: (i) If an inpatient, at the time of admission; or (ii) If an outpatient: (1) Before any invasive procedure, except phlebotomy for obtaining blood for diagnostic purposes; or (2) If the hospital services include a planned series of treatments, at the start of each series; Consents to photographs before photographed except that a patient may be photographed when admitted to a hospital for identification and administrative purposes. Your right to safety and security You or your representative have the right to: Expect reasonable safety and security in the hospital practices and environment. Be free from restraint and seclusion, of any form, used as a means of coercion, discipline, convenience, or retaliation by staff. Be free from all forms of abuse, neglect, harassment, exploitation, manipulation, sexual assault and corporal punishment. a. MIHS will immediately evaluate all allegations, observations, and suspected cases of neglect, exploitation, and abuse that occur within the system. b. MIHS will report allegations, observations, and suspected cases of neglect, exploitation, and abuse to authorities based upon its evaluation of the suspected events or as required by law. Protective and advocacy services Not be subjected to misappropriation of personal and private property by a hospital s medical staff, personnel members, employees, volunteers, or students. 8 For more information about MIHS, go to mihs.org

9 Your right to submit a grievance You or your representative have the right to: Submit a grievance, complaint, or concern without fear of retaliation. Submit a complaint concerning Advance Directive requirements. MIHS Patient Advocates are available to patients and families to assure your questions and concerns are answered or addressed timely. The Patient Advocates work with patients and hospital staff to facilitate resolution of issues with the goal of maximizing patient satisfaction. If for some reason your provider, nurse or unit manager are unable to meet your expectations, please contact the Patient Advocate at An important Patient Advocate goal is to improve communication between the patient, family, physicians and staff. However, patients or their representatives have a right to submit a written grievance or complaint to Maricopa Integrated Health System, Patient Advocate, 2601 E. Roosevelt Street, Phoenix, AZ You may also contact the following regulatory agencies to report your concerns: Arizona Department of Health Services (ADHS) 150 North 18th Avenue Phoenix, AZ Phone: Det Norske Veritas Healthcare, Inc (DNV GL) 400 Techne Center Drive Suite 100 Milford, OH Phone: Patient Responsibilities Your responsibility for information and participation in care You are responsible for: Providing needed information to the healthcare providers and to be honest about your health. Communicating concerns regarding care, treatment, or services. Participating in care, treatment, and services and to ask questions if you do not understand. Following the instructions of the healthcare providers who are providing your care. Not taking medications or herbs from home while in the hospital. Wearing an identification band while in the hospital and to refuse to take medication or treatment from anyone not wearing a hospital issued name badge. Paying for services provided as soon as possible, or work with the hospital to set up a payment plan, or to ask for assistance when needed. Treating hospital staff and other patients with respect and consideration. Acknowledging when you do not understand the treatment course or care decision. Bringing a copy of your Living Will or Healthcare Power of Attorney to be placed in your medical record at the time of each admission. Notice of Privacy Practices (This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.) We are committed to protecting the confidentiality of your medical information, and are required by law to do so. This notice describes how we may use your medical information within Maricopa Integrated Health System (MIHS) and how we may disclose it to others outside MIHS. This notice also describes the rights you have concerning your own medical information. Please review it carefully and let us know if you have questions. Please note that incarcerated patients do not have the right to notice under this section. This Notice of Privacy Practices applies to all at MIHS (including Maricopa Medical Center, the Behavioral Health Annex, Desert Vista, the Family Health Centers, and the Comprehensive HealthCareCenter), District Medical Group (DMG), and all MIHS personnel, volunteers, students, and trainees. The Notice also applies to MIHS physicians, physician assistants, therapists, emergency service providers, medical transportation companies, medical equipment suppliers, and other health care providers not employed by MIHS, unless these other health care providers give you their own notice that describes how they will protect your medical information. MIHS may share your medical information with these other health care providers for their treatment, payment, and health care operations. This arrangement is only for sharing information and not for any other purpose. 9 MIHS Patient and Visitor Information

10 How we use and disclose your medical information: Treatment: We may use your medical information to provide you with medical services and supplies. We may also disclose your medical information to others who need that information to treat you, such as doctors, physician assistants, nurses, medical and nursing students, technicians, therapists, emergency service and medical transportation providers, medical equipment providers, and other health care facilities involved in your care. For example, we will allow your physician to have access to your Hospital or Clinic medical record to assist in your treatment at the Hospital and for follow-up care. We also may use and disclose your medical information to contact you to remind you of an upcoming appointment, to inform you about possible treatment options or alternatives, or to tell you about health-related services available to you. Payment: We may use and disclose your medical information to get paid for the medical services and supplies we provide to you. For example, your health plan or health insurance company may ask to see parts of your medical record before they will pay us for your treatment. Hospital Operations: We may use and disclose your medical information if it is necessary to improve the quality of care we provide to patients or to run the hospital. We may use your medical information to conduct quality improvement activities, to obtain audit, accounting or legal services, or to conduct business management and planning. For example, we may look at your medical record to evaluate whether MIHS personnel, your doctors, or other health care professionals did a good job. Fundraising: We may contact you to ask for your help with different fund raising campaigns. Please notify us if you do not wish to be contacted during fund raising campaigns. If you advise us in writing (at the physical address listed at the bottom of this Notice) that you do not wish to receive such communications, we will not use or disclose your information for these purposes. Family Members and Others Involved in Your Care: We may disclose your medical information to a family member or friend who is involved in your medical care, or to someone who helps to pay for your care. We also may disclose your medical information to disaster relief organizations to help locate a family member or friend in a disaster. If you do not want MIHS to disclose your medical information to family members or others who will visit you, please inform the registration staff and mark the appropriate box on the form provided during registration. Patient Directory: In order to assist family members and other visitors in locating you while you are an inpatient, we maintain a patient directory. This directory includes your name, room number, your general condition (such as fair, stable, or critical). We will disclose this information to someone who asks for you by name. The patient directory also includes your religious affiliation (if any). We will disclose this information only to clergy members. MIHS behavioral health facilities do not maintain a patient directory. If you do not want to be included in the patient directory, or your religious affiliation information given to the clergy, please inform the registration staff and mark the appropriate box on the form provided during registration. Research: We may use or disclose your medical information for research projects, such as studying the effectiveness of a treatment you received. These research projects must go through a special process that protects the confidentiality of your medical information. Required by Law: Federal, state, or local laws sometimes require us to disclose patients medical information. For instance, we are required to report child abuse or neglect and vulnerable adults and must provide certain information to law enforcement officials in domestic violence cases. We also are required to give information to Worker s Compensation Programs for work- related injuries. Public Health: We also may report certain medical information for public health purposes. For instance, we are required to report births, deaths, and communicable diseases to the State of Arizona. We also may need to report patient problems with medications or medical products to the FDA, or may notify patients of recalls of products they are using. Public Safety: We may disclose medical information for public safety purposes in limited circumstances. We may disclose medical information to law enforcement officials in response to a search warrant or a grand jury subpoena. We also may disclose medical information to assist law enforcement officials in identifying or locating a person, to prosecute a crime of violence, to report deaths that may have resulted from criminal conduct, and to report criminal conduct within MIHS. We also may disclose your medical information to law enforcement officials and others to prevent a serious threat of health or safety. 10 For more information about MIHS, go to mihs.org

11 Health Oversight Activities: We may disclose medical information to a government agency that oversees MIHS or its personnel, such as the Arizona Department of Health Services, the federal and state agencies that oversee Medicare and Medicaid, the Board of Medical Examiners or the Board of Nursing. These agencies need medical information to monitor MIHS compliance with state and federal laws. Coroners, Medical Examiners, and Funeral Directors: We may disclose information concerning deceased patients to coroners, medical examiners, and funeral directors to assist them in carrying out their duties. Organ and Tissue Donation: We may disclose medical information to organizations that handle organ, eye or tissue donation or transplantation. Military, Veterans, National Security and Other Government Purposes: If you are a member of the armed forces, we may release your medical information as required by military command authorities or to the Department of Veterans Affairs. MIHS may also disclose medical information to federal officials for intelligence and national security purposes or for Presidential Protective Services. Marketing: We will not use or disclose your health information for marketing purposes without your authorization. Additionally, if we were to receive remuneration from a third party in connection with our promotion of its product or service to you, then we will obtain your written authorization before we can use or disclose your health information. We are not required to obtain your authorization to discuss our health-related products or services that are available for your health care treatment, case management or care coordination, or to direct or recommend alternative treatments, therapies, providers, or settings of care, providing face to face discussions and offering samples or promotional gifts of nominal value. Psychotherapy Notes: Psychotherapy notes are notes that are written by a mental health professional that document the conversations during a private counseling session or in group or joint therapy. Many uses and disclosures of psychotherapy notes require your authorization Sale of PHI: We will obtain your authorization for any disclosure of your information which we directly or indirectly receive remuneration in exchange for the information. Judicial Proceedings: MIHS may disclose medical information if ordered to do so by a court or if a subpoena or search warrant is served. You will receive advance notice about this disclosure in most situations so that you will have a chance to object to sharing your medical information. Information with Additional Protection: Certain types of medical information have additional protection under state and federal law. For instance, medical information about communicable disease and HIV/ AIDS, drug and alcohol abuse treatment, genetic testing, and evaluation and treatment for a serious mental illness is treated differently than other types of medical information. For those types of information, MIHS is required to get your permission before disclosing that information to others in many circumstances. Other Uses and Disclosures: If MIHS wishes to use or disclose your medical information for a purpose that is not discussed in this Notice, MIHS will seek your permission. If you give your permission to MIHS, you may take back that permission any time, unless we have already relied on your permission to use or disclose information. If you would ever like to revoke your permission, please notify the Medical Records Department in writing. We will obtain your written authorization to use and disclose your health information for these specific purposes: 11 MIHS Patient and Visitor Information

12 What Are Your Rights? Right to Request Your Medical Information: You have the right to look at your own medical information and to get a copy of that information. Please note that exceptions may apply as provided by law. (The law requires us to keep the original record.) This includes your medical record, your billing record, and other records we use to make decisions about your care. To request your medical information, call or write to the Medical Records Department (contact information at the end of this notice). You can request an electronic copy or a paper copy of your records. If you request a copy of your information, we will charge you for our costs to copy the information. We will tell you in advance what this copying will cost. You can look at your record at no cost. Right to Request Amendment of Medical Information You believe is incorrect or incomplete: If you examine your medical information and believe that some of the information is wrong or incomplete, you may ask us to amend your record. To ask us to amend your medical information, submit a written request to the Medical Records Department. Right to Get a List of Certain Disclosures of Your Medical Information: You have the right to request a list of many of the disclosures we make of your medical information. If you would like to receive such a list, submit a written request to the Medical Records Department. We will provide the first list to you free, but we may charge you for any additional lists you request during the same year. We will tell you in advance what this list will cost. Right to Request Restrictions on how MIHS will use or Disclose your Medical Information for Treatment, Payment, or Health Care Operations: You have the right to ask us NOT to make uses or disclosures of your medical information to treat you, to seek payment for care, or to operate the System. We are not required to agree to your request, but if we do agree, we will comply with that agreement. We are required to comply with your request to restrict your information to a health plan for payment or health care operations, but the full cost of the service to which the information relates must be paid by you. If you want to request a restriction, write to the Health Information Management (HIM) Department and describe your request in detail. Right to Request Confidential Communications: You have the right to ask us to communicate with you in a way that you feel is more confidential. For example, you can ask us not to call your home, but to communicate only by mail. To do this, please discuss this with our care giver, or submit a written request to the Chief Compliance/Privacy Officer. You can also ask to speak with your health care providers in private outside the presence of other patients - just ask them! Right to Receive Notice of a Privacy Breach: You have the right and will be notified if we discover a breach of unsecured protected health information involving your information. Changes To This Notice From time to time, we may change our practices concerning how we use or disclose patient medical information, or how we will implement patient rights concerning their information. We reserve the right to change this Notice and to make the provisions in our new notice effective for all medical information we maintain. If we change these practices, we will publish a revised Notice of Privacy Practices. You can get a copy of our current Notice of Privacy Practices upon request at any MIHS facility or by requesting one from the Chief Compliance / Privacy Officer. Do you have concerns or complaints? Please tell us about any problems or concerns you have with your Privacy Rights or how MIHS uses or discloses your medical information. If you have a concern, please contact the Chief Compliance / Privacy Officer at If for some reason MIHS cannot resolve your concern, you may also file a complaint with the Federal Government. Office for Civil Rights U.S. Department of Health and Human Services 90 7th Street, Suite 4100 San Francisco, CA Voice Phone (415) Fax (415) TDD (415) We will not penalize you or retaliate against you in any way for filing a complaint with the Federal government. Do you have questions? MIHS is required by law to give you this Notice and to follow the terms of the Notice that is currently in effect. If you have any questions about this Notice, or have further questions about how MIHS may use and disclose your medical information, please contact the Chief Compliance/ Privacy Officer. Address for the Compliance / Privacy Officer: Maricopa Integrated Health System (MIHS) C/O Compliance 2601 East Roosevelt St. Phoenix, AZ Address for the Medical Records Department: Maricopa Integrated Health System (MIHS) C/O Medical Records Department 2601 E. Roosevelt Phoenix, AZ Phone for the Medical Records Department: (602) For more information about MIHS, go to mihs.org

13 Advance Directives: The following information is being provided to you as a result of a Federal law, the Patient Self-Determination Act of 1990, enacted in December The information is to inform you about your right to make health care decisions and about our written policies concerning this right. We hope this information will be helpful to you in making your health-care decisions. You are encouraged to talk with your family, your doctors, and anyone else whose advice and support you value in these matters. You are not required to have an Advance (Health Care) Directive in order to receive care at any Maricopa Integrated Health System facility. The nature and quality of care you receive will not differ if you do not have an advance directive. All Maricopa Integrated Health System facilities have DNR (Do Not Resuscitate) policies. If you desire further information on those policies you can contact the facility for more information. Who has the right to make your health care decisions? You do, if you are able to make and communicate your health care decisions. Your doctors should tell you about the treatment they recommend, other reasonable alternatives, and important medical risks and benefits of that treatment and the alternatives. You have the right to decide what health care, if any, you will or will not accept. We, at Maricopa Integrated Health System, honor your right to accept or refuse medical treatment and to participate in decisions regarding your health care or treatment. What if you become unable to make or communicate your health care decisions? You can still have some control over these decisions if you have planned ahead. One way to plan ahead is by making an Advance (Health Care) Directive which names someone to make decisions for you or help guide or control these decisions. If you have not named someone in an Advance (Health Care) Directive, your doctors must seek a person authorized by law to make these decisions. A person who makes health care decisions for you is called a surrogate. Maricopa Integrated Health System is required to ask you if you have an ADVANCE DIRECTIVE (HEALTH CARE) and indicate your answer in your medical record. What is a Advance (Health Care) Directive? It is a written statement about how you want your health care decisions made. Under Arizona law, there are four common types of Advance (Health Care) Directives. They are: A HEALTH CARE POWER OF ATTORNEY is a written statement in which you name an adult to make health care decisions for you. That person will make health care decisions for you only when you cannot make or communicate such decisions. A MENTAL HEALTH CARE POWER OF ATTORNEY is a written statement in which you name another adult to make decisions to admit you to a mental health care facility if needed and decisions of treatment options. That person will make decisions for you only when you cannot make or communicate those decisions. A LIVING WILL is a written statement about the health care you want to receive or do not want to receive if you cannot make your own health care decisions. For example, a living will can state whether you would want to be fed through a tube if you were unconscious and unlikely to recover. It can also specify whether you want to receive artificially administered fluid, to be hospitalized, or whether or not you wish to be resuscitated. A PRE-HOSPITAL MEDICAL CARE DIRECTIVE is a directive refusing certain lifesaving emergency care given outside a hospital or in a hospital emergency room. To make one, you must complete a special orange form. These directives used separately or together, can help you say yes to treatment you want and no to treatment you don t want. Must your Advance (Health Care) Directives be followed? Yes. Both health care providers and surrogates must follow valid Advance (Health Care) Directives. Can you be required to make an Advance (Health Care) Directive? No. Whether you make an Advance (Health Care) Directive is entirely up to you. A health care provider cannot refuse to provide you care based on whether or not you have an Advance (Health Care) Directive. Must a lawyer prepare your Advance (Health Care) Directive? No. There are local and national organizations that may provide you with information on Advance (Health Care) Directives, including forms. Be sure that any Advance (Health Care) Directive that you use is valid under Arizona law. Who can legally make health care decisions for you if you are unable to make your own decisions and if you have not made a Health Care Power of Attorney? A court may appoint a legal guardian to make health care decisions for you. Otherwise, your health care provider must go down the following list to find a surrogate to make health care decisions for you: 1. Your spouse (unless legally separated). 2. Your adult child. If you have more than one adult child, your physician and hospital staff will seek the consent of the majority of your adult children who are reasonably available. 3. A parent. 4. Your domestic partner (if you are unmarried). 5. Your adult brother or sister. 6. A close friend (someone who shows special concern for you and is familiar with your health care views.) 13 MIHS Patient and Visitor Information

14 If your health care provider cannot find an available and willing surrogate to make health care decisions for you, then your doctor can decide with the advice of an ethics committee, or if this is not possible, with the approval of another doctor. You can keep anyone from becoming your surrogate by stating, preferably in writing, that you do not want that person to make health care decisions for you. A surrogate will not have the right to withdraw the use of tubes to give you food or fluids unless: You have appointed a surrogate to make health care decisions for you in a health care power of attorney; or, A court has appointed that surrogate as your guardian to make health care decisions for you; or, You have stated in an Advance (Health Care) Directive that you do not want this specific treatment. Will Maricopa Integrated Health System facilities assist you in completing an Advance (Health Care) Directive? Maricopa Integrated Health System facilities have forms for a living will, a durable health care power of attorney, a mental health care power of attorney and a pre-hospital directive available. Our Case Management Department or the Staff of the Family Health Centers can assist you in filling out the form, but they cannot assist you with writing your own directives or provide legal advice. You are encouraged to discuss your directives with your doctor or your family. If you have legal questions, you should seek the advice of a lawyer. Who should have a copy of your Advance (Health Care) Directives? Give a copy of your Advance (Health Care) Directive to your doctor and to any health care facility you normally utilize. If you have a durable health care power of attorney, give a copy of it to the person you have named in it. You should keep extra copies for yourself. You should provide Maricopa Integrated Health System with a copy of your Advance (Health Care) Directive. A copy should be given to the admissions person who is completing your paperwork, a social worker, a case manager, or a health care provider. The Advance (Health Care) Directive will be placed in your medical record. If you cannot get copies, copies can be made at Maricopa Integrated Health System facilities. If we do not have a copy of your living will or your durable health care power of attorney, we cannot honor it. Can you change or cancel your Advance (Health Care)Directive? Yes. If you change or cancel your Advance (Health Care) Directive, be sure to notify anyone who has a copy of your directive. Maricopa Integrated Health System prefers to have written changes or revocations in your durable health care power of attorney or living will, unless conditions are such that you are unable to write. What if you already have a living will or other Advance (Health Care) Directive? An Advance (Health Care) Directive which was valid when made anywhere in the U.S. may be valid under Arizona law. However, Arizona law changed on September 30, 1992, making new choices available to you. You should review your Advance (Health Care) Directive periodically and update them as needed. What does Arizona law require for an Advance (Health Care) Directive? A health care power of attorney must: Name a person to make health care decisions for you if you become unable to make your own decisions. You may also name an additional person or persons to make decisions for you if your first choice cannot serve. The person or persons must be at least 18 years old. Be signed or marked by you and dated. Be signed by a notary or by an adult witness or witnesses, who saw you sign or mark the document and who say that you appear to be of sound mind and free from duress. A notary or witness cannot be the person you name to make decisions and cannot be providing health care to you. If you have only one witness, that witness cannot be related to you or someone who will get any of your property from your estate if you die. A living will must: State how you want your health care decisions to be made in the future. Be signed or marked by you and dated. Be notarized or witnessed in the same manner as described above for a health care power of attorney. A pre-hospital directive must: Be exactly the form required by law. The form must be orbit orange and must be in the exact format specified by state law (ARS ). Be signed or marked by you and dated. Be signed by a licensed health care provider and a witness. A pre-hospital directive is valid until it is revoked or a new document replaces it. You should talk to your doctor about pre-hospital directives if you are thinking about signing one. If you have signed an orange pre-hospital medical care directive, you may also carry a wallet size form. A mental health care power of attorney must: Be in writing. Must state clearly that you intend to create a mental health care power of attorney. Must be dated and signed or marked by you. Must be notarized or signed by an adult witness in the same manner as described above. 14 For more information about MIHS, go to mihs.org

15 Organ and Tissue Donation: The partnership between Maricopa Integrated Health System (MIHS) and Donor Network of Arizona (DNA) is crucial to saving and enhancing lives locally and throughout the nation. To further the partnership between MIHS and DNA, donor program coordinators at DNA act as consultants to assist the hospital in complying with organ, tissue and cornea donation regulations and accreditation standards. We understand how difficult it can be to discuss these matters at the time of death, especially when the patient has not talked about his/her wishes regarding organ/tissue donation with the family ahead of time. We encourage people to discuss such matters with their family in advance so that everyone is fully informed and aware of each other s wishes. For more information, visit the website, Your account/bill: MIHS Patient Accounts customer service is here to help you with questions you may have about your account. Your bill How to make a payment Setting up a payment plan Updating your information Did your insurance get billed Financial Assistance If so please call or visit us in person at: 2601 East Roosevelt Street, 1st floor, Phoenix, Arizona The hours of operation are Monday through Friday 8am 4:30pm. Preparing for Discharge: Discharge planning begins on admission to the hospital. You will meet with your care manager upon admission to talk about your concerns and health care needs after you leave the hospital if a need is identified. Remember as a patient you have the right to request a transition plan from your care management team. This team will work with you, your family and your doctor and nurses to provide you with the assistance you will need for a safe discharge. Short stays are the norm in health care today, so early discharge planning with your care management team is very important. The team will work closely with you and/or your caregiver, your physician and your insurance company to coordinate your discharge plan. Once you have been told by your physician that you can go home our care management team will try to make your discharge as efficient and timely as possible. It is very important that you and/or your family clearly understand your discharge instructions. If you have any questions or concerns regarding your discharge instructions, it is important that your questions or concerns are answered before you leave the hospital. Please do not hesitate to ask questions. Copa Care -Financial Assistance Program At MIHS we know seeking medical care can be overwhelming. That s why we have developed a program to help you deal with the financial stress of paying for the health care you deserve. MIHS Copa Care Program is designed to give you realistic payment options. To find out more about MIHS s Copa Care Program visit or to set up an appointment to talk with our eligibility specialist call MIHS Patient and Visitor Information

16 Center for Healthcare against Family Violence (Mariposa: Wings to Safety) Domestic Violence is not a family problem. It is a crime. You have the right to be safe. NO one has the right to hit or threaten you. Children are also hurt emotionally by seeing domestic violence. If you want to talk call Family Learning Center: The Family Learning Centers (FLC) is a library for patients and their families. The FLCs provide you with reliable health information, community referrals, classes and literacy events. It contains books, pamphlets, DVDs, children s reading area and computers with internet access. If you would like more information about a health topic, please call one of the FLCs. The FLCs locations: Comprehensive Healthcare Center, 2nd Floor 2525 E Roosevelt St Phoenix, AZ Phone: Maryvale Family Health Center 4011 N. 51st Avenue Phoenix, AZ Phone: South Central Chandler Family Health Center Family Health Center 811 S. Hamilton Street 33 W. Tamarisk Chandler, AZ Phoenix, AZ Phone: Phone: Volunteers: Make a difference and become part of our dedicated team! Volunteers are an integral part of the success of MIHS and provide an indispensable service to the patients, visitors and staff of the health system by delivering care and compassion to every person, every time. They are a group of individuals who share a strong desire to help where they can and willingness to serve where they are most needed. Dedication and generosity of our volunteers are a critical part of our success. To learn more about becoming a volunteer, contact Volunteer Services at Maricopa Health Foundation: Committed to patient welfare, health education, and special programs, the Maricopa Health Foundation touches lives daily at Maricopa Integrated Health System. Whether helping young students learn about health care, providing needy patients with medical treatment, or raising funds for important projects, the Foundation stands ready to help. The Foundation generates financial support for these critical initiatives through charitable gifts, fundraising, and grants from other foundations, corporations, and federal and state agencies. The Foundation s mission is three-fold: To advance patient welfare at Maricopa Medical Center; To advance the practices of health care professionals through education and research; and To sponsor educational and scientific activities, projects, and programs that advances these objectives. For further information on how you can help, please contact the foundation at For more information about MIHS, go to mihs.org