Hmong | Spanish
As a Gundersen Health System patient, you have the right to make informed choices about your healthcare. You and your family are key members of your healthcare team. We urge you to be fully involved in plans and goals for your present and future health.
We respect the dignity, beliefs and values of each patient. We use proven best practice to care for patients without regard to:
- Nation of birth
- Economic status
- Physical abilities
- Sexual orientation
- Source of payment
We devote our resources and skills to:
- Help prevent illness.
- Restore and maintain health.
- Support patients and families.
- Manage pain.
- Inform and teach patients.
- Offer comfort when death seems certain.
|High quality care.
|You may know the names and roles of all staff members involved in your care.
||Ask staff to give their names and state their roles in your care if you are unsure.
|You may ask to be cared for by a Gundersen staff member other than the one who cares for you now.
||Be willing and able to explain in private to a third party why you wish to make this change.
|You may request a second opinion from another member of our medical staff or a doctor in any other health system.
||Tell your doctor or nurse if you want a second opinion. You or your insurance will be charged for office visits and tests required by the second doctor.
|Gundersen is a teaching facility. This improves the care we provide. Your care team includes resident doctors, and medical, nursing and other health profession students. They are directly supervised by staff doctors and nurses.
||If you wish to limit the degree to which residents and students are involved in your care, talk to your staff doctor or nurse. To the extent we can, we will honor your request if doing so will not affect the care you receive.
|A clean, safe, comfortable environment.
|No one will abuse, harass or neglect you.
||Be courteous and considerate to all who give and receive care in our clinics and hospital.
|You will receive care in safe places by staff trained in safe practices. Rooms and hallways are lit and arranged to reduce your risk of falls.
||Leave chairs and equipment where they are placed. Moving things around may keep staff from safely and quickly caring for you.
|Be safe and achieve the best health you can with our help.
||Follow instructions given by our staff.
|If a patient or visitor disturbs you more than you can stand, you may ask to move to some other room.
||Be respectful to others. Keep noise levels low. Turn off cell phones in all patient care areas.
|You will be free of seclusion or restraints unless you could harm yourself or others.
||Know that we may seclude or restrain you to ensure your safety or the safety of others.
|If you have a disability, we will listen when you ask for changes in policies, programs, services and space. We will do what we can to provide equal access to care for all patients.
||Accept our efforts to meet your special needs. We will respond to questions about our policies, programs, service and space.
|We will inform you of policies and practices that relate to your care, treatment and responsibilities. These are meant to protect you, our staff and facilities.
||Follow clinic and hospital policies.
|Faith, culture and other factors affect how you perceive illness or injury. We provide access to pastoral care, religious and spiritual support and counsel.
||Tell us if you want us to advise your faith community that you are in the hospital. Make it clear if you prefer to have no contact with our pastoral care staff.
|Involvement in your care.
|We will base your plan of care on:
• Facts you give us about yourself.
• Results of tests and exams we think are required for your health.
|Give full and honest details about your helath and lifestyle at all times. Tell us about:
• Medicines you take.
• Allergies, past illness, surgery and other care.
|We will inform you of and explain all treatment options we can offer. Tell our staff if you need more information about treatment choices.
||Be fully involved in the care we plan with and foryou. Ask questions to learn about your health status and your role in treatment.
|You can consent (agree) to treatment. Or, to the extent allowed by law, you can refuse treatment.
||Let us explain what could happen if you refuse. You may be asked to sign a form whether you consent (agree) to or refuse treatment.
|You may accept or limit treatment after you are told about its effects on your health.
||If you refuse what we think is the best practice in your case, we will:
• Offer other care within Gundersen.
• Help you transfer to some other facility.
|You can choose to follow a certain lifestyle and diet.
||Accept the results of choices you make that affectyour health.
|We will provide the help you need to talk with staff members at no cost to you if:
• You have trouble seeing, speaking, hearing, or reading.
• You do not speak English.
|Tell us when you need to have something explained in a different way. We will use plain language and do our best to help you understand.
|Staff will explain how you can be fully involved in your own care.
||If you cannot follow a treatment plan for any reason, tell a staff member.
|Your pain will be assessed and managed in our clinics and hospital.
||Accept the limits that may affect our efforts to relieve your pain. These include laws, safety issues and ethics codes.
|You can consent (agree) to or refuse to enroll in research related to your care after risks and benefits are explained to you.
||Listen to treatment options offered by staff when they think your health is more likely to improve if you enroll in a research project.
|You can have a written plan for end of life care (advance directive). Caregivers can access it and will honor and fulfill all terms that do not:
• Ask staff to do something that is against the law.
• Violate personal or professional ethics of treating staff or accepted practice standards.
|If you do not have an advance directive, think about putting one in your medical record. We have staff who can guide you through the process.
|Provide your consent (agree) before treatment begins unless you need emergency care.
||Accept the care we give you in emergencies
|Protection of your privacy.
|Decide who is told when you are in our hospital. You may ask to limit visitors.
||Tell staff who can be told you are in the hospital. Let staff know if you wish to limit visitors.
|At your request, we will ask any person(s) you do not want to hear about or be involved in your care to leave the room.
||Tell your doctor or nurse when you do not want any other person (family or visitor) to hear about your past or present health and treatment.
|We store and protect your medical records. These are kept private unless you make a written request for us to share your records with others.
||Know that we may be required by law to release your records. If we release them, we will tell you to whom they were released and why.
|You can review your records and have them explained in words you understand. You may have a copy of your record.
||Know what is in your medical records. Pay for copies if a fee is charged. For secure internet access to your record, use MyCare.
|Help with your bill.
|You will receive a copy of your bill. When needed, we will explain the charges and help you understand.
||If you have insurance coverage, let us release bills and facts about your care to private and government carriers.
|How you pay your bill does not affect the quality of your care. If financial assistance is needed, we can advise you of places to apply.
||Know what your insurance covers and where you are supposed to receive care. Tell us if your insurance changes in any way. Pay your statement balance within our stated time limit. If you cannot, let us know why.
|Help getting ready to go home.
|Before you are discharged from the hospital, we will teach you how to care for yourself as you recover. We will explain what medicine to take, why it is needed and when to take it. We will help you find follow up care if:
• You cannot care for yourself.
• Family and friends cannot assist you.
|Allow us to explain what help is available. We can find and arrange for:
• Skilled care in your home.
• Alternative care such as a nursing home or assisted living.
|Transfer of care if needed.
|We will not transfer you to another hospital unit or facility before:
• We explain why you must be moved.
• We tell you what care is arranged for you.
|Accept that in an emergency transfer there may be little time for staff to explain or get your consent.
Share your concerns about your care.
Your concerns will be:
- Received with respect.
- Answered and resolved in a timely manner.
If you have concerns, you may:
If you are not satisfied with how we resolve your concern
- Talk with your nurse or doctor.
- Talk with the unit/department charge nurse, nursing supervisor or manager.
- Fill out a "We value your opinion" comment form. These are displayed in patient rooms and waiting areas. Give it to a staff member or mail it.
- Speak with a patient representative. From 8 a.m. to 5 p.m. weekdays, call (608) 775-7676 or (800) 362-9567, ext. 57676.
- After 5 p.m., weekends and holidays, call (608) 782-7300 or (800) 362-9567. Ask for the hospital operations manager.
- Email CRFeedback@gundersenhealth.org
As a clinic patient, you may contact: Wisconsin Department of Health Services.
Call (800) 642-6552
As a hospital patient, you may contact: The Joint Commission.
Call (800) 994-6610, 8:30 a.m.-5 p.m. Central Time. Email email@example.com
You have a right to see Gundersen’s Notice of Privacy Practices. Spanish and Hmong versions are available at the top of this page. Interpreters are available for other languages.
Wisconsin Statutes and Administrative Code
Joint Commission Standards
CMS Conditions of Participation
American Hospital Association’s Patient Care Partnership