NOTICE OF PATIENT RIGHTS AND RESPONSIBILITIES 

This Notice sets forth your rights and responsibilities as a patient at Berkshire Medical Center: 

Privacy and Confidentiality 

• You have the right to privacy when you are receiving medical treatment or other care. This includes the right to be examined in private.  You may request a person of your sex to be present during the exam.  Every effort will be made to accommodate your request.
• We will treat all communications and records about your care as confidential except in cases when the law permits or requires us to disclose that information, such as in cases involving abuse or public health hazards. You have the right to receive a copy of our Notice of Privacy Practices relating to our use and disclosure of your medical information. You may request a copy of our Notice of Privacy Practices by contacting Privacy Officer at (413) 447-2932 or Privacy Coordinator at (413) 447-2114, Ext. 5040.    
• You may, upon request, review your medical records and receive a copy of those records for a fee based on our current copying costs schedule (no fee will be charged for furnishing a medical record if the record is requested for the purpose of supporting a claim or appeal under any provision of the Social Security Act or federal or state financial needs-based benefit program). 

Information 

• You are encouraged to seek information and to ask for explanations of your condition, diagnosis and prognosis, and any treatment offered.
• You have the right, upon request, to be advised of the name and specialty, if any, of the physician(s) and other practitioners responsible for your care or the coordination of your care.
• You have the right to be informed of hospital policies and practices as they relate to your care, treatment, and responsibilities and to receive a copy of any policy that applies to your conduct as a patient.
• You have the right to receive an itemized bill or other statement of charges for services that we provide. The itemized bill will include laboratory charges, pharmaceutical charges and any third party payments and, upon request, copies of itemized bills or other statements of charges submitted to third parties for payment. You have the right to have all charges explained.  You also have the right to have your itemized bill or other statement of charges provided to your attending physician.   
• You have the right, upon request, to obtain an explanation as to the relationship, if any, of Berkshire Medical Center to any other health care facility or educational institution as it relates to your care or treatment.
• You have the right, upon request, to receive any information that the facility has available relating to financial assistance and free health care.
• You have the right to expect that a family member or representative of your choice and your physician will be notified promptly of your admission to the hospital, unless you request this not be done.
• You have the right to access to pastoral care and spiritual services. 

Care and Treatment 

• You have the right to select your physician, except in the case of emergency medical treatment, provided that the physician you requested is able to accommodate you.
• You will receive impartial access to treatment or admission regardless of race, creed, ethnicity, culture, language spoken, gender, sexual orientation, gender identity or expression, physical or mental disability, age, nationality, religion, socioeconomic status or source of payment.
• You have the right to receive care in a safe setting, free from abuse or harassment.
• You have the right to be free from seclusion, physical restraints and medications that are used as restraints except to the extent that they are imposed to ensure your immediate physical safety or the safety of staff members and others.
• You have the right to participate in the development and implementation of your plan of care.
• You have the right to provide your informed consent to treatment the extent provided by law. You have the right to accept or refuse care. If you refuse treatment, you will be told what effect this may have on your health.  You have the right to be informed about the outcomes of care, treatment and services provided, including unanticipated outcomes.
• You have the right to formulate an advance directive, such as a health care proxy, that tells the hospital physicians and staff how you want to be treated and whom you want to make decisions for you if you cannot speak for yourself at the time.
• You may refuse to be a research subject or to be examined or treated when the primary purpose is educational or informational rather than therapeutic.
• You have the right to designate a family member, a domestic partner, friend or other person to be present with you for emotional support.
• You may refuse to talk with or see anyone not officially connected with the hospital.
• You have the right to refuse to be examined, observed, or treated by students or any other staff member without jeopardizing your access to medical care and attention.
• You have the right to prompt lifesaving treatment in an emergency situation, regardless of ability to pay.
• You have the right to appropriate assessment and management of pain.
• If you are refused treatment because of economic status or lack of a source of payment, you have the right to prompt and safe transfer to a facility that agrees to receive and treat you.
• If you are a female rape victim of childbearing age, you have the right to (i) receive medically and factually accurate written information prepared by the Massachusetts commissioner of public health about emergency contraception, (ii) be promptly offered emergency contraception and (iii) be provided with emergency contraception upon request.
• If you have breast cancer, you have the right to complete information regarding all alternative treatments that 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 ten days before the planned surgery, except in cases of emergency surgery.
• If you are a maternity patient, you have the right to receive statistical information regarding certain aspects of previous deliveries at Berkshire Medical Center.
• You have the right to have issues related to care at the end of life addressed with sensitivity. 

Communications 

• You have the right to unrestricted access to communication, visitors, mail and telephone calls, unless such access would interfere with your care or the care of other patients. Any restrictions will be explained fully to you at the time they are imposed.  All visitors will enjoy full and equal visitation privileges consistent with your preferences, and visitation privileges will not be restricted, limited or otherwise denied on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation or disability.
• You have the right to receive information in a manner that you can understand. For example, if you cannot speak or understand English, interpreter services will be available.  If you are deaf or hard of hearing, a sign language interpreter will be requested through the Commission for the Deaf and Hard of Hearing.
• You have the right to have all reasonable requests responded to within the capacity of the staff and hospital. 

Complaint Process 

• You (or a family member or friend on your behalf) have the right to express your concerns or complaints regarding the quality of care or services you have received without fear that your treatment or care will be affected in any way or that we will take any retaliatory action against you. If you have a concern or complaint, please contact the nursing director or clinical leader of your nursing unit, or Patient Relations at 413-447-2466.
• In addition, you have the right to report your concerns to the Board of Registration in Medicine at 781-876-8200 or to the Department of Public Health’s Office for Patient Protection at 1-800-436-7757 (Hotline), or the Joint Commission’s Office of Quality Monitoring at 1-800-994-6610 or complaint@jointcommission.org. 

Your Responsibilities 

As a patient at Berkshire Medical Center, you are responsible for: 

• Providing accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to your health.
• Reporting any unexpected change in your condition to your doctor or nurse.
• Cooperating with all hospital personnel who care for you, following their instructions and asking questions when you do not understand directions.
• Taking responsibility for your own actions if you refuse treatment or do not follow the instructions of those providing care.
• Complying with your physician's recommendations regarding your follow-up care, including keeping appointments.
• Providing information regarding the existence of your advance directive (health care proxy or a Medical Order for Life Sustaining Treatment (MOLST)).
• Providing a valid copy of your advance directive (health care proxy or MOLST) for inclusion into your medical record.
• Being considerate of other patients and hospital personnel, and asking that your visitors are considerate.
• Observing rules about noise, no smoking and the number of visitors.
• Being respectful of others, their property, and the hospital's property.
• Leaving your valuable personal items at home or sending them home with family if possible.
• Sharing your concerns, complaints, and suggestions so we may continually improve our care.
• Paying your bills or responding to questions about your bills, providing information for insurance processing, and assuring that your financial obligations are promptly fulfilled to the extent of your ability.