Patient Rights & Responsibilities
A guide to how you can participate in your healthcare
Tri-County Memorial Hospital, Inc. d/b/a Gundersen Tri-County Hospital and Clinics and Gundersen Tri-County Care Center, hereinafter "Gundersen Tri-County."
Overview - Patient Rights and Responsibilities
Being a good patient at Gundersen Tri-County does not mean being a silent one. It means sharing your wishes, ideas and concerns. We are committed to creating an environment in which you and your family are comfortable explaining your:
- Safety concerns
- Unmet needs
Gundersen Tri-County recognizes your right to dignity as a human being and the right to receive culturally responsive care.
You have the right to appropriate and medically indicated care and services regardless of your race; creed; color; national origin; ancestry; religion; sex; sexual orientation; marital status; age; newborn status; disability; or source of payment.
We recognize your individuality and personal needs, including your need for privacy. We will consider your cultural, spiritual, and other needs. That includes your expectation of prompt responses. We will do this within our capacity, stated mission and applicable laws. If you would like further clarification of your rights and responsibilities, or would like more information regarding our complaint and/or grievance process, please contact Gundersen Tri-County at:
Special services to patients and families
Gundersen Tri-County offers a variety of services to patients who have limited English proficiency and patients who are deaf or hard of hearing, reading difficulties and their families. Gundersen Tri-County will take appropriate steps to ensure that persons with disabilities — including persons who are deaf, hard of hearing, or blind, or who have other sensory or manual impairments or require interpretive services — have an equal opportunity to participate in our services, activities, programs and other benefits at no cost to you.
- You may know the names and roles of all staff members involved in your care.
- You may ask to be cared for by a Gundersen Tri-County staff member other than the one who cares for you now.
- You may request a second opinion from another member of our medical staff or a doctor in any other health system.
- You have the right to be made aware of and afforded rights under Wisconsin Statutes Sec. 51.61. These provisions may apply to you if you receive services for a developmental disability, mental illness or for alcohol or drug abuse.
- Ask staff to give their names and state their roles in your care if you are unsure.
- Be willing and able to explain in private to a third party why you wish to make this change.
- 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.
- Tell your doctor, nurse or social worker if you want more information about these rights.
Protection of Your Privacy
- Decide who is told when you are in our hospital. You may ask 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.
- 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.
- Tell staff who can be told you are in one of Gundersen Tri-County facilities or if you wish to limit visitors.
- Tell your doctor or nurse when you do not want any other person(s) to hear about your health and treatment.
- 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.
- Know what is in your medical records. Pay for copies if a fee is charged. Access your records through MyCare.
- Contact your clinic, or call Registration from your room telephone at extension 2000 to request a copy.
- You can review your records and have them explained in words you understand. You may have a copy of your record.
- You have the right to review a copy of our Notice of Privacy Practices
A Clean, Safe, Comfortable Environment
- We will involve you in your plan of care. We will base your plan of care on:
- Your medical needs as determined by your doctor;
- Facts you give us about yourself;
- Results of tests and exams we think are required for your health.
- We will inform you of your total health status; your Care and treatment plan as well as explain available treatment options in a language that you can understand.
- You can consent (agree) to treatment and you can request specific treatments. Or, to the extent allowed by law, you can refuse treatment.
- You may accept or limit treatment after you are told about its effects on your health.
- You may choose to follow a certain lifestyle and diet.
- 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.
- Staff will explain how you can be fully involved in your own care.
- To the best of our ability, your pain will be assessed and managed to your satisfaction.
- You can consent (agree) to or refuse to enroll in research related to your care after risks and benefits are explained to you.
- Provide your consent (agree) before treatment begins unless you need emergency care.
- Hospitals are expected to take reasonable steps to determine the patient's wishes concerning designation of a representative. Unless prohibited by applicable state law, a family member or representative and your regular physician may be promptly notified of your admission if you so choose.
- You have the right that others, on your behalf, may exercise all the rights explained here. Others who would do this could include your guardian, next of kin or legally authorized person. You, and they, have this right under specific circumstances:
- if you have been adjudicated incompetent in accordance with the law;
- if your physician determines you are medically incapable of understanding the proposed treatment or procedure;
- if you are unable to communicate your treatment wishes;
- or you are a minor.
- Give full and honest details about your health and lifestyle at all times. Tell us about:
- Medicines you take;
- Allergies, illness, surgery and other care
- Tell our staff if you need more information about treatment choices. Be fully involved in the care we plan with and for you. Ask questions to learn about your health status and your role in 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.
- If you refuse what we think is the best practice in your case, we will:
- Offer other care within our facility;
- Help you transfer to another facility
- Accept the results of choices you make that affect your health.
- 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.
- If you cannot follow a treatment plan, tell a staff member.
- Accept the limits that may affect our efforts to relieve your pain. These include laws, safety issues and ethics codes.
- Listen to treatment options offered by staff when they think your health is more likely to improve if you enroll in a research project.
- Accept the care we give you in emergencies.
- Tell staff if you would like someone notified of your admission at Gundersen Tri-County.
- Tell staff if you have another person who exercises your rights for you.
- If you don't have a legally responsible person who does this for you, you can still elect to have a person assist you with understanding information we provide to you. Tell us who that person is.
- An advance directive describes in writing your choices about the treatments you want or do not want, or about how healthcare decisions should be made for you if you become incapacitated and cannot express your wishes.
- If you do not have an advance directive, consider putting one in your medical record. We have staff who can guide you through the process.
Transfer of Care if Needed
- When medically appropriate and legally permissible, or when you have so requested, you may be transferred to another facility.
- We will not transfer you to another hospital level of care or another facility before we explain:
- Why this is necessary;
- The risks, benefits and any alternatives;
- What care is arranged for you.
- The institution to which you are to be transferred must first have accepted you for transfer and made provisions for your continuing care.
- Accept that in an emergency transfer there may be little time for staff to explain or get your consent.
Help with Your Bill
You will receive a copy of your bill. When needed, we will explain the charges and help you understand. 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.
If you have insurance coverage, let us release bills and facts about your care to private and government carriers. 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 Gundersen Tri-County, 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.
You have the right to file a grievance without fear of retaliation. Your concerns will be:
- Received with respect;
- Answered and resolved in a timely manner.
If you have a concern, you may:
- Talk with your nurse or doctor;
- Talk with the Director of Nursing or department supervisor;
- Talk with the hospital's Social Worker
- Contact an administrative representative at Gundersen Tri-County at one of the numbers listed further up on this page.
If you are not satisfied with how we resolve your concern, we will submit a written report of your concern to the Gundersen Tri-County Compliance Officer and the Gundersen Tri-County Administrator for further review. You will receive a written report outlining the actions taken to address your concerns.
You also may file a report with the following agencies:
- Department of Health Services Department of Quality Assurance
1 West Wilson, P.O. Box 2969
Madison, WI 53701
Phone Number: (800) 642-6552
- Livanta - Wisconsin's quality improvement organization
LLC (888) 524-9900
TTY (888) 985-8775
- Office of Civil Rights, US Department of Health
and Human Services, 200 Independent Ave
SW, Washington DC, 20201, (855) 843-4776
If you speak a language other than English, language assistance services are available to you, free of charge. Gundersen Tri-County complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.
Atención: Si usted habla Español, tenemos disponible para usted servicios de asistencia de idioma gratuitos. Llame al (715) 538-4361.Gundersen Tri-County cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.
A Notice about Physician Coverage
Gundersen Tri-County Hospital and Clinics may use Certified Nurse Practitioners (NPs) or Physician Assistants (PA-Cs) to provide Urgent Care and Emergency Services with back-up coverage from a licensed physician. Arrival or maximum response time is 45 minutes; however if the response is related to Labor and Delivery, the maximum response time is 30 minutes.