Patient Bill of Rights

At Jamie Clausen Counseling, PLLC, we believe that you are in control of your health and the decisions about your health. We are passionately committed to supporting your decisions. We have established a Patient Bill of Rights and Responsibilities. Knowing your rights and understanding your responsibilities as a patient will help you make better decisions about your healthcare.

If you feel your rights are not being protected, we want you to know that we maintain formal concern, complaint, and grievance procedures. This procedure is delineated within the following Patient Bill of Rights.

This Bill of Rights and Responsibilities also describes your responsibilities as a patient. Patients who choose to disregard their rights and responsibilities agree to accept the consequences which could jeopardize our goal of providing you a superior patient experience and could impact your quality of care.

Patient Rights

Jamie Clausen Counseling, PLLC support the rights of all patients across the lifespan - including geriatric, adult, adolescent, pediatric, infant, and neonatal populations. These rights may be exercised through the patient individually or through their authorized surrogate decision maker (legal representative).

You have the right to:

Be informed of your rights in advance of receiving or discontinuing care when possible.
- You, your family, and/or authorized surrogate decision-maker (legal representative) will receive a written copy of the Patient Rights and Responsibilities upon registration or in advance of receiving care when possible.
- If you, your family, and/or authorized surrogate decision-maker do not understand the written word, you will receive your rights verbally in a manner you can understand.
- No one will be denied access to treatment or visitation because of disability, national origin, culture, age, color, race, religion, gender identity, or sexual orientation. No one will be denied examination or treatment for an emergency medical condition because of their source of payment. Care is provided in response to your requests and needs, so long as that care is medically appropriate and is within the facility’s capacity, its stated mission and philosophy, and relevant laws and regulations.
Receive, care, treatment, and visitation regardless of disability, national origin, culture, age, color, race, religion, gender identity, sexual orientation. No one is denied examination or treatment of an emergency medical condition because of their source of payment.
Give informed consent for all treatments, procedures, and/or production of recordings, films or other images when used for other than identification, diagnosis, or treatment.
- Informed consent will be explained in words you can understand to include:
  - Recommended treatment or procedure;
  - Risks and benefits of the treatment or procedure;
  - Likelihood of success, serious side effects, and risks including death;
  - Alternatives and consequences if treatment is declined;
  - Whether nurses or qualified medical providers other than the responsible practitioner will be performing important parts of a procedure.
Be informed of your health status/prognosis, including unanticipated outcomes of care and your treatment and services related to serious preventable adverse events.
- Your healthcare provider(s) and healthcare team shall disclose to you information regarding your health status/prognosis to the best of their knowledge.
- Your healthcare provider(s) and healthcare team will communicate unanticipated outcomes of care and the treatment and services related to serious preventable adverse events.
Participate in all areas of your care plan, treatment, care decisions, and discharge plan.
- You, and/or your authorized surrogate decision-maker (legal representative) have the right to be involved in decisions including but not limited to:
  - Your own care and course of treatment;
  - Withholding resuscitative services;
  - Withdrawing life-sustaining treatment; and
  - Care at the end of life.
- You, and/or your authorized surrogate decision-maker have the right to include or exclude any or all family members in participating in your care decisions.
- You, your family, and/or authorized surrogate decision-maker have the right to be informed of any continuing healthcare requirement following discharge from the facility.
- You, your family, and/or authorized surrogate decision-maker have the right to be involved in resolving dilemmas about care decisions, including the right to an ethics consultation.
Receive appropriate assessment and prompt management of your pain.
- You will be assessed for pain using tools that measure your pain intensity or pain descriptors.
- Reassessment of pain will occur after each pain intervention.
Be treated with respect and dignity.
- You will receive considerate, compassionate, and respectful care which recognizes your dignity, psychosocial needs, personal values and beliefs, and spiritual and cultural practices.
- You will be allowed and encouraged to express and observe your cultural practices and spiritual beliefs, if they do not harm or interfere with the well-being of others or your treatment and well-being.
- Concern for optimal comfort and dignity shall guide all aspects of care during the final stages of life. The framework for addressing issues related to care at the end of life includes:
  - Providing appropriate treatment for any primary and secondary symptoms; according to your wishes;
  - Managing pain aggressively and effectively;
  - Sensitively addressing issues such as autopsy and organ donation;
  - Respecting your values, religion, and philosophy;
  - Involving you, your family, and your authorized surrogate decision-maker (legal representative) in every aspect of care; and
  - Responding with empathy to the psychological, social, emotional, spiritual, and cultural concerns of you and your loved ones.
Experience personal privacy, comfort, and security to the extent possible during your stay.
- Privacy and dignity will be protected during personal hygiene activity (e.g., toileting, bathing, and dressing).
- Anyone not involved in your care will not be allowed to examine or treat you without your consent.
- Reasonable visual and auditory privacy will be offered when you are interviewed, examined, and/or treated.
- Should the actions of another patient or a visitor be unreasonably disturbing, you will be transferred to another room equally suitable when one is available.
- Upon your request, your valuables will be secured in a locked area.
Be free from restraints or seclusion imposed as a means of coercion, discipline, convenience, or retaliation by staff.
- Restraint or Seclusion will only be initiated based on patient condition or need; it will never be initiated based on request from your authorized surrogate decision maker, a spouse, domestic partner (including a same-sex domestic partner), another family member, or friend.
- Restraint or Seclusion will be initiated only after alternatives have been determined to be ineffective, unless need for restraint and/or seclusion is emergent.
- Restraint or Seclusion is also prohibited as a substitute for staffing, monitoring, assessment, or investigation of the reasons behind patient behavior (whether medical and/or psychological).
- Restraint or Seclusion will be discontinued at earliest time possible.
- You will not have the right to refuse restraint if your behavior, condition, or symptom prevents or hinders provision of care, treatment or services or has the potential to or has resulted in patient harm.
Expect confidentiality of all communication and medical records related to your care.
- You will receive a copy of our Notice of Privacy Practices to inform you how your personal medical information can be used and disclosed, and your rights related to your medical information.
- All communications (e.g., discussions about your condition, treatment, care, etc.) and records pertaining to your care, including source(s) of payment for treatment, will be treated as confidential and securely maintained.
  - Licensed Independent Practitioners involved in your care will have access to your record and may request those records.
- Discussion or consultation involving your care will not occur with individuals who are not directly involved in your care, without your permission.
- Medical records will be accessed and read only by individuals directly involved in your treatment/care or in the monitoring of its quality or by individuals authorized by law or regulation.
- Your medical records will be maintained in a secure environment, and clinical information will be reasonably protected so that no unauthorized individuals might see it.
- Although your identity is not shared, some aspects of your care may be shared for staff or medical educational purposes.
Have access to telephone calls, mail, and other communication devices.
- Any restrictions to access will be discussed with you, and you will be involved in the decision when possible or appropriate.
- Cell phones may not be safe to use when near certain critical care equipment, so use may be limited under those circumstances.
- Use of cameras and camera phones will not be permitted without your permission and permission of the facility staff. This applies to patients, visitors, and healthcare workers.
- Visitors should place cell phone or other electronic devices in a silent mode to ensure that patients are not disturbed and to avoid confusion with medical equipment alarms.
Choose a “visitor” who may visit you including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend, and you have the right to withdraw or deny such choice at any time. You also have the right to select an identified “support person” who can make visitation decisions should you become incapacitated.
- Generally, you will have the right to expect unrestricted access to visitation and/or communication.
  - Any restrictions or limitations on visitation will be fully explained to you and, when appropriate, to your support person in a language that you understand.
- All visitors chosen by you shall enjoy “full and equal” visitation privileges, consistent with your wishes, within reason.
  - To promote rest, comfort, healing, privacy, safety, and a quiet, safe, secure and orderly environment for yourself and others, there are circumstances and departments where the number of visitors may be limited.
- If a “support person” has been identified by you to make decisions regarding visitors, this “support person”, unless also designated as an authorized surrogate decision maker, will not be your legal representative and will only serve to make decisions regarding visitors if you are incapacitated. A “support person” designation does not supersede that of an authorized surrogate decision maker.
- If you are incapacitated and there is a clear dispute between two or more people over whether a particular person should be allowed to visit you, proof of prior existing relationship will be required.
  - The following forms of proof are suggested: An Advance Directive naming the individual support person, approved visitor, or authorized surrogate decision maker; shared residence; shared ownership of a property or business; financial interdependence; marital/relationship status; existence of a legal relationship recognized in any jurisdiction; and acknowledgment of a committed relationship (i.e. an affidavit). This list of proof and documentation is not intended to be exhaustive of all potential sources of information regarding proof of a relationship to allow patient visitation or support person preferences.
- If you request “confidential/silent patient status” this option will be explained to you and maintained throughout your stay.
If hospitalized, designate at least one post-discharge caregiver who will assist you with basic tasks following your discharge and, along with you or your authorized surrogate decision maker, provide consultation on your discharge plan.
- Designating a post-discharge caregiver does not mean the person you have designated is obligated to care for you.
- This designation should occur no later than 24 hours after admission and prior to discharge from the hospital or non-emergent transfer to another facility.
- If you become incapacitated, this designation may be performed by your authorized surrogate decision-maker; the decision may also be made as soon as practicable after your own recovery of consciousness and capacity.
- Your designated post discharge caregiver will be notified of your discharge as soon as practicable.
  - If the healthcare facility is unable to contact the caregiver you have designated, your discharge will not be delayed or interfered with.
- Your designated post discharge caregiver will be provided with instruction on aftercare tasks.
Be communicated with in a manner you can understand which considers your age, language, understanding and ability including, but not limited to, access to interpreter services and communication aides, at no cost. Such communication will include communication with your companion as defined below.
- The facility will take reasonable, usual, and customary steps to assist in effective communications for those with Limited English Proficiency (LEP) and/or those who speak a language other than English.
  - All interpreters or translation aids and services will be provided without cost to the person being served and/or his or her companions.
  - Interpreters will be provided, when necessary, for LEP speaking individuals.
  - Assistive devices will be made available for any other identified communication barrier (such as: hearing impaired, visually impaired, speech impaired or manually impaired).
- A Companion is a person who assists you with a communication impairment (blind, deaf, hard of hearing, etc.), and is one of the following:
  - A person whom you indicate should communicate with facility providers or staff about you, participate in any treatment decision, play a role in communicating your needs, condition, history, or symptoms to personnel or help you act on the information, advice, or instructions provided by facility staff or providers; or
  - Your authorized surrogate decision maker (legal representative); or
  - Such other person with whom facility staff or providers would ordinarily and regularly communicate your medical condition.
Have access to pastoral/spiritual care.
- You, your family, and/or authorized surrogate decision-maker may request pastoral/spiritual care from clergy or spiritual leaders of your choice and/or from the facility’s chaplains.
- Access to chaplains may be arranged through the Spiritual Care Department at each facility or through the facility operator.
Receive care in a safe setting.
- Staff will follow current standards of practice for your environmental safety, infection control and security.
- The healthcare team will consider your emotional health when assessing the safety your setting.
- The facility will comply with all applicable regulatory Life Safety standards.
- Protective privacy shall be provided for you should you and/or your healthcare provider determine it is necessary for your personal safety.
Be free from all forms of abuse, neglect, mistreatment, or exploitation.
- This right applies to all patients and visitors.
- Staff will not willfully inflict injury, unreasonable confinement, intimidation, or punishment upon you.
- Staff will not willfully cause physical harm, pain, or mental anguish in the form of
  - Staff neglect, (failure to provide adequate food, clothing, shelter, psychological care, physical care, medical care, or supervision for the patient in a timely manner and with the degree of care that a reasonable person in the same situation would exercise);
  - Indifference to infliction of injury; or
  - Intimidation of you by another.
Have access to protective services (e.g., guardianship, advocacy services, conservatorship, and child/adult protective services).
- You have the right to assistance from a designated healthcare team member or appropriate independent individual when accessing protective services. You, (and when appropriate, your family, and/or authorized surrogate decision-maker will be provided the following information in writing, as requested:
  - A list of names, addresses, and telephone numbers of pertinent local, regional, and state client advocacy groups maintained by the facility;
  - Contact information for the State survey and certification agency, the state licensure office, the state ombudsman program, the protections and advocacy network, and the Medicaid fraud control unit; and
  - Information regarding your right to file a complaint with the state survey and certification agency if you have a concern about alleged abuse, neglect, or about misappropriation of property in our facility.
Request medically necessary and appropriate care and treatment.
- You have the right to:
  - Consult a specialist (at your expense and if available);
  - Change healthcare provider(s) and/or any member of the healthcare team, if the facility can accommodate your request; and.
  - Transfer to another hospital or care facility. If at a hospital and if the hospital has the capacity to take care of you, this will be at your expense and only if the other hospital accepts you.
- You or your authorized surrogate decision-maker’s right to make decisions about care is not equivalent to a right to demand treatment or services that are deemed medically inappropriate or unnecessary.
Refuse any drug, test, procedure, or treatment and be informed of the medical consequences of such a decision.
- Your refusal of any drug, test, procedure, or treatment will not compromise your access to care.
- Should you refuse care; consequences of such refusal will be explained and documented.
- Should you refuse treatment or are non-compliant with instructions, you must accept the consequences of your decision(s).
Consent or refuse to participate in teaching programs, research, experimental programs, and/or clinical trials.
- The facility will protect your and respect your rights during research, investigation, and clinical trials involving human subjects by:
  - Giving you information to make a fully informed decision prior to any proposed participation;
  - Describing for you the purpose, duration, expected benefits, and risks any proposed participation;
  - Describing for you the potential benefits of the proposed participation;
  - Explaining to you procedures to be followed in the proposed participation and identifying for you those procedures which are experimental in nature;
  - Explaining to that your proposed participation is completely voluntary;
  - Explaining to you your right to refuse to participate, and that your refusal will not compromise your access to the services;
  - Explaining to you whom to contact for answers to pertinent questions regarding the proposed participation and any possible research-related injury.
- The facility will maintain the privacy and confidentiality of patients who are research subjects.
Receive information about Advance Directives. Set up or provide Advance Directives and have them followed. Designate an authorized surrogate decision-maker (legal representative) as permitted by law and as needed.
- Not having an Advance Directive will not compromise your access to care.
- If you have an Advance Directive, you should notify facility staff immediately when you enter the facility and provide staff with a copy which can be placed in your medical record. Once facility staff are notified, they will inform appropriate staff and providers of the directive(s) so that the directive(s) may be honored, so long as the directive(s) comply with the law and are consistent with the organization’s mission, philosophy, and capabilities.
- Designated staff shall provide assistance if you do not have an Advance Directive but wish to formulate one.
Participate in decision-making regarding ethical issues, personal values, or beliefs.
- When issues arise, staff will inform you, your family and/or authorized surrogate decision-maker of your right to access the facility’s Ethics Committee and/or other appropriate resources for resolving ethical issues.
  - The facility will facilitate the process for resolution of ethical issues according to policy and procedure.
If hospitalized, have a family member or representative of your choice and your healthcare provider promptly notified of your admission to the hospital upon your request.
- Staff will make this notification as soon as is practical.
Know the names, professional status and experience of your caregivers.
- Staff and volunteers will wear a name badge while on duty.
- Upon your request, you will be given information regarding a provider or staff member’s experience.
- Upon your request, you, and/or your authorized surrogate decision-maker (legal representative) will be given the following information:
  - The name of the provider who has primary responsibility for your care;
  - The identity and professional status of individuals responsible for authorizing and performing your procedures and/or treatment;
  - Any professional relationship to another healthcare provider, vendor or institution that might suggest a conflict of interest;
  - Any professional relationship to educational institutions for providers and staff involved in your care; or
  - Any business relationships between providers and staff involved in your care or between the hospital and any other healthcare service, or educational institutions involved in your care.
Have access to your medical records within a reasonable timeframe.
- You may inspect your medical records upon reasonable notice (in accordance with Colorado Law) and have a clinician explain any parts that you do not understood.
- You may have your medical records made available to you or your authorized surrogate decision-maker, through the Health Information Management Department, in accordance with regulations of the Colorado Department of Public Health and Environment. You will be provided copies of your medical records (at a reasonable expense to you).
- Other individuals who are not healthcare providers may have access to your medical records upon your written authorization or that of your authorized surrogate decision-maker.
Be examined, treated, and if necessary, transferred to another facility if you present to an Emergency Department or hospital campus with an emergency medical condition or are in labor, regardless of your ability to pay.
- Hospital staff and providers will comply with the hospital Emergency Medical Treatment and Active Labor Act (EMTALA) Policy and Procedure, which is based on federal regulation.
Request and receive, prior to the initiation of non-emergent care or treatment, the charges (or estimate of charges) for routine, usual, and customary services and any co-payment, deductible, or non-covered charges, as well as the facility’s general billing procedures, including receipt and explanation of an itemized bill. This right will be honored regardless of the source(s) of payment.
- Based upon insurance information provided by you, your family or authorized surrogate decision-maker (legal representative), the facility shall provide assistance estimating co-payment, co-insurance, deductible or other charges that must be paid.
- You have the right to question or appeal decisions made by payers (i.e., insurance, Medicare, Medicaid, HMOs, etc.) regarding limitations of the amount paid and/or types of treatment covered. The concerns/issues may be referred to the facility’s billing department, and if needed, staff members there will make the appropriate referrals. Call the facility’s operator or main number and ask for the billing department.
Be informed of the complaint and grievance procedure and whom to contact to file a concern, complaint, or grievance.
- Our priority is for you to have a positive patient experience. If you have concerns, please notify your immediate care giver, their department manager, or administrative staff. If hospitalized and if your concerns are not being resolved by those you have been in contact with, please call the Patient Care Representative/Advocate.
- If your care was received in a hospital, urgent care, emergency department, hospice, or home care, you may also contact The Washington State Department of Health.
- If you received care in a hospital, emergency department, home care or hospice and if after speaking with one of their representatives your complaint remains unresolved, you may contact The Joint Commission:

The Joint Commission
Division of Accreditation Office of Quality and Patient Safety
One Renaissance Boulevard
Oakbrook Terrace, IL 60181

Phone: 800-994-6610
This email address is being protected from spambots. You need JavaScript enabled to view it.
Fax: 630-792-5636
Website

You also have the right to file a complaint with the appropriate oversight boards including the Colorado Medical Board, the Colorado Dental and Podiatry Boards and the Colorado Department of Regulatory Agencies. Contact information will be provided by a facility representative upon request.

Neonatal, Infant, Pediatric and Adolescent Rights

Neonates, child, and adolescent patients possess the same rights and responsibilities as adult patients. It is, however, the responsibility of the parent/guardian to exercise these rights and responsibilities on their behalf.
It is the responsibility of Jamie Clausen Counseling, PLLC to involve the appropriate parents, family members, or guardians throughout the patient’s treatment and communicate to them issues regarding the care of the patient including, but not limited to: perceptions of the patient’s needs; information concerning the patient’s condition, treatment and progress; involvement of other persons in the patient’s treatment, as appropriate; and discharge planning.
Neonatal, pediatric, and adolescent patients that are admitted to a hospital or an inpatient hospice will be provided a physical and social environment that is conducive to their care. Age appropriate normalizing activities and resources, such as play and recreation, will be provided for and encouraged.
Neonatal, pediatric, and adolescent patients that are admitted to a hospital or an inpatient hospice will be provided a physical and social environment that allows for normalizing experiences in self-care (when appropriate) and in fulfillment of age appropriate responsibilities. The facility will coordinate these experiences through community resources such as tutors.
To receive hospital or inpatient hospice care in an environment provided with appropriate security and safety measures.

Patient Responsibilities

You have the responsibility to:

Ask questions and promptly voice concerns to facility staff and providers.
- You, your family, and/or authorized surrogate decision-maker should ask questions when you do not understand what has been told to you about your care or what is expected of you.
Give full and accurate information as it relates to your health, including prescription and non-prescription medication.
- You, your family, and/or authorized surrogate decision-maker should provide, to the best of your knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, Advance Directives, and other matters relating to your health.
Report changes in your condition or symptoms, including pain, and request assistance of a member of the healthcare team.
- The facility staff will encourage you and your visitors to ask for help when they think your condition is getting worse.
Educate yourself. Learn about medical tests that are being performed and understand your treatment plan.
Follow your recommended treatment plan.
- You, your family, and/or authorized surrogate decision-maker should express their concerns regarding their ability and willingness to follow the proposed course of treatment. Healthcare providers and staff will make every reasonable effort to adapt the treatment plan to your specific needs and limitations. If you refuse treatment or do not follow instructions, you must accept the consequences of your decision.
You, your family, and/or authorized surrogate decision-maker are responsible for keeping appointments. If you are unable to keep an appointment, you should notify Jamie Clausen Counseling, PLLC.
Be considerate of other patients and staff.
- You, your family, and/or authorized surrogate decision-maker should be considerate of the rights of other patients and staff, including assisting in the control of noise, smoking, observing visitation policies and visiting hours, following security procedures, and/or following other facility policies.
- In providing care, healthcare facilities have the right to expect behavior on the part of patients, their relatives, and friends, which is reasonable and responsible considering the nature of the patient’s illness and the needs of other patients and staff.
Secure your valuables.
- The facility is not responsible for any valuables or belongings kept in your possession.
- We encourage you to send your valuables and/or belongings home with your family.
Follow facility rules and regulations.
- To promote health, Jamie Clausen Counseling, PLLC facilities are non-smoking and entirely smoke-free. Patients, providers, staff, and visitors will be asked to comply with the “Non-Smoking” policy.
- All rules and regulations apply, but are not limited to, visitation hours and visitors.
Respect property that belongs to the facility or others.
- Keep all areas of the facility free of paper, food, drinks, trash, etc.
- Refrain from the destruction or removal of facility property.
- Take appropriate measures to theft.
Understand and honor financial obligations related to your care, including understanding your insurance coverage.
- For assistance, contact Jamie Clausen Counseling, PLLC at 360-399-9263.