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As a patient of UMass Memorial Health – HealthAlliance-Clinton Hospital, you have the right:
1. To obtain, upon request, the name and specialty of the physician or others responsible for your care or coordination of care.
2. To freedom of selection of a physician and facility except for emergency medical treatment, provided that the physician is able to accommodate the patient.
3. To participate in the development and implementation of the plan of care.
4. To the confidentiality of all records and communication as provided by law.
5. To have visitors of your choosing (or a support person where appropriate) in accordance with hospital policies. Visitation rights cannot be denied on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability.
6. To have all reasonable requests responded to promptly and adequately within the capabilities of this facility.
7. Upon request, obtain an explanation as to the relationship, if any, of this facility to any other health care facility or educational institution as it relates to your care or treatment.
8. Upon request, to receive any information which this facility has available relative to financial assistance and free care as well as any rules that apply to your conduct as a patient at this facility.
9. To receive information about your responsibilities while receiving care, treatment, and services.
10. Upon request, to inspect, request an amendment to, or receive a copy of your medical records for a fee determined by the current rate of copying expenses.
11. To receive a copy of your medical records, free of charge, if you show that your request is to support a claim or appeal under any provisions of the Social Security Act or federal or state financial needs-based benefit program.
12. To refuse to be examined, observed, or treated by students or any other staff member without jeopardizing access to physiological, psychological, or other medical care and attention.
13. To refuse to serve as a research subject and to refuse any care or examination when the primary purpose is educational or informational rather than therapeutic.
14. To be notified in advance of providing or discontinuing care whenever possible.
15. To privacy and personal dignity during medical treatment or care within the capacity of the facility.
16. To have your cultural, psychosocial, spiritual, and personal values, beliefs and preferences, sexual orientation, gender identity, or gender expression respected.
17. To request pastoral and other spiritual services.
18. To lifesaving treatment in an emergency without discrimination because of the source of payment or delay due to discussions of the source of payment.
19. If refused treatment because of lack of a source of payment, to a prompt and safe transfer to a facility that agrees to receive and provide treatment.
20. If you are a rape victim of childbearing age who may become pregnant, to receive medically and factually accurate written information prepared by the Massachusetts Commissioner of Public Health about emergency contraception, to be promptly offered emergency contraception, and to be provided with emergency contraception, upon request.
21. To informed consent to the extent provided by law, including the right to accept or refuse medical treatment, including foregoing or withdrawing life-sustaining treatment or withholding resuscitative services.
22. If you have breast cancer, complete information regarding alternative treatments which are medically viable. If you are having a breast implant, you have the right to know the disadvantages and risks associated with breast implantation, and your physician should discuss this with you at least 10 days before the planned surgery, except in an emergency.
23. To be free from seclusion or restraint of any form, imposed as a means of coercion, discipline, convenience, or retaliation. Restraint or seclusion may only be imposed to ensure the immediate physical safety of a patient, a staff member, or others and must be discontinued at the earliest possible time.
24. To appropriate assessment and management of pain.
25. To have a family member or other representative of your choice and your own physician notified of your admission to the hospital and to designate a Caregiver to participate in your discharge process.
26. To formulate advance directives and revise those directives at any time. In Massachusetts, the tool for implementing your advance directives is a Health Care Proxy.
27. To receive care in a safe setting free from all forms of abuse and harassment.
28. To interpreter services upon request.
29. To be informed about the outcomes of care and treatment that was provided, including unanticipated outcomes.
30. To receive, upon request, an itemized bill reflecting charges from the physician and/or the facility including laboratory charges, pharmaceutical charges, and third-party credits and charges, and to have a copy of said itemized bill or statement sent to your attending physician.
31. If you are asked to remove your clothing and change into hospital attire to enable a medical screening examination (if appropriate) or in the event hospital staff conducts a search for safety reasons, you have the right to refuse unless there is compelling clinical information indicating an imminent risk of harm to you or others and all other reasonable alternatives have been exhausted.
32. If this facility provides maternity services and you are a maternity patient, receive statistical information regarding certain aspects of previous deliveries at this hospital.
As a patient of UMass Memorial Health - HealthAlliance-Clinton Hospital, we ask that you:
1. Give correct and complete facts about your new and old health problems.
2. Ask for help if you do not understand what you have heard about your care.
3. Give the hospital a copy of your Health Care Proxy if you have one.
4. Follow hospital rules and regulations affecting patient care and conduct, including the no smoking and no tobacco products policy.
5. Interact with health care providers, other patients, visitors, and hospital staff in a respectful, civil manner, not using offensive, threatening, and/or abusive language or behavior.
6. Be considerate of the rights of other patients and hospital personnel and assist in the control of noise.
7. Provide the hospital with the information they will need about the payment of your medical care, which includes identification and insurance papers.
8. Work with your caregivers to get the most effective and safe treatment for your health problem.
9. Be respectful of hospital staff, other patients, and visitors when using your cell phone, especially in public areas.
10. Give a family member or caregiver your personal property or have your valuable items locked in the hospital safe.
You have the right to voice your concerns and/or complaints regarding the quality of care and/or services you have received. Voicing a concern or complaint will in no way compromise your access to care or treatment.
If you have a concern or feel your rights have not been respected, contact:
Commonwealth of Massachusetts Board of Registration in Medicine
178 Albion Street. Suite 330
Wakefield, MA 01880
Consumer Hotline: 800-377-0550
Livanta Family Centered Care Quality Improvement Organization
The Joint Commission: Office of Quality and Patient Safety
Patient safety concerns can be reported to The Joint Commission on the Joint Commission website using the “Report a Patient Safety Event” link in the “Action Center” on the home page, by fax to 630-792-5636, or by mail to:
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
Privacy Office, UMass Memorial Health – HealthAlliance-Clinton Hospital
60 Hospital Road
Leominster, MA 01453
Privacy Line: 978-466-4333
U.S. Department of Health and Human Services (HHS)
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, DC 20201
How to File a Health Information Privacy or Security Complaint