Patient’s Rights and Responsibilities

Each patient receiving care in the ambulatory center shall have the following rights:

1. To be informed of these rights, as evidenced by the patient’s written acknowledgment or by documentation by staff in the medical record, that the patient was offered a written copy of these rights and given a written or verbal explanation of these rights, in terms the patient could understand. The Center shall have a means to notify patients of any rules and regulations it has adopted governing patient conduct in the Center;
2. To be informed of services available in the Center, of the names and professional status of personnel providing and/or responsible for the patient’s care, and of fees and related charges, including the payment, fee, deposit and refund policy of the Center and any changes for services not covered by the sources of third-party payment or not covered by the Center’s basic rate;
3. To be informed if the Center has authorized other healthcare and educational institutions to participate in the patient’s treatment. The patient also shall have a right to know the identity and function of these institutions, and to refuse to allow their participation in the patient’s treatment;
4. To receive from the patient’s physician(s) or clinical practitioners), in terms that the patient understands, an explanation of his or her complete medical/health condition or diagnosis, recommended treatment, treatment options, including the option of no treatment risk(s) of treatment, and expected result(s), before it is performed. If this information would be detrimental to the patient’s health, or the patient is not capable of understanding the information, the explanation shall be provided to the patient’s next of kin or guardian. This release of information to the next of kin or guardian, along with the reason for not informing the patient directly, shall be documented in the patient’s medical record;
5. To participate in the planning of the patient’s care and treatment, and to refuse medications and treatment. Such refusal shall be documented in the patient’s medical records;
6. To be included in experimental research only when the patient gives informed, written consent to such participation, or when a guardian gives such consent for an incompetent patient in accordance with law, rule and regulation. The
7. Patient may refuse to participate in experimental research, including the investigation of new drugs and medical devices;
8. To voice grievances or recommend changes in policies and services to Center personnel, the Board of Directors, and/or outside representatives of the patient’s choice either individually or as a group. and free from restraint, interference, coercion, discrimination or reprisal;
9. To be free from mental and physical abuse, free from exploitation, free from all forms of harassment, and free from use of restraints unless they are authorized by a physician for a limited period of time to protect the patient or others from injury. Drugs and other medications shall not be used for discipline of patients or for convenience of Center personnel;
10. To confidential treatment of information about the patient. Information in the patient’s medical record shall not be released to anyone outside the Center without the patient’s approval, unless another healthcare Center to which the patient was transferred requires the information, or unless the release of the information is required and permitted by law, a third-party payment contract or peer review, or unless the information is needed by the New Jersey State Department of Health for statutorily authorized purposes. The Center may release data about the patient for studies containing aggregated statistics when the patient’s identity is masked;
11. To be treated with courtesy, consideration, respect and recognition of the patient’s dignity, individuality and right to personal privacy, including. but not limited to, auditory and visual privacy. The patient’s privacy shall also be respected when the Center’s personnel are discussing the patient;
12. To not be required to perform work for the Center unless the work is part of the patient’s treatment and is performed voluntarily by the patient. Such work shall be in accordance with local, state and federal laws and rules;
13. To exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices or any attendance at religious services, shall be imposed upon any patient;
14. To not be discriminated against because of age, race, religion, sex, nationality, or ability to pay, or deprived of any constitutional civil, and/or legal rights solely because of receiving services from the Center; and
15. To expect and receive appropriate assessment, management and treatment of pain as an integral component of that person’s care in accordance with N.J.A.C. 8:43E-6. 8:43A-16.3 Notice.

If you have a patient safety event or concern about a health care organization, feel free to contact the following:

Natalia Diaz 
Administrator
1 Bridge Plaza N
Fort Lee, NJ 07024 551-465-5595

Office of Quality & Patient Safety The Joint Commission
One Renaissance Blvd
Oakbrook Terrace, IL 60181
Fax: 630-792-5636

Office of Acute Care Assessment and Survey New Jersey State Department of Health
PO BOX 358
Trenton, NJ 08625
Telephone: 609-292-9900
To make a complaint about any NJ licensed healthcare Facility call: 800-792-9770

State of New Jersey of the Ombudsman for the Institutionalized Elderly
PO Box 808
Trenton, NJ 08625
Telephone: 877-582-6995

1. The administrator shall also provide all patients and/or their families upon request with the names, addresses and telephone numbers of offices where information concerning Medicare and Medicaid coverage may be obtained:

• Bergen County Medicaid: (201) 368-47200
• Bergen County Dept of Human Services (201) 336-7400
• Passaic County Medicaid: (973) 881-0100
• Passaic County Dept of Human Services (973) 881-2834
• Union County Medicaid: (732) 499-5700 Union County Dept of Human Services (201) 336-7400 http://www.medicare.gov/Ombudsman/activities.asp

15. The patient has the right to information regarding credentialing of Health Care Professionals at the Center.

16. The patient has the right to refuse any treatment, except as otherwise provided by law.

17. The patient has the right to choose his/her own pharmacy.

18. The patient has the right to receive care in a safe setting.

Each patient receiving care in this ambulatory Center shall have the following responsibilities:

1. Patients are required to:
2. Provide complete and accurate information to the best of his/her ability about his/her health, any medications including over-the-counter products and dietary supplements and any allergies or sensitivities.
3. Follow the treatment plan prescribed by her/her provider
4. Provide a responsible adult to transport him/her home from facility and remain with him/her for 24 hours, if required by the provider
5. Inform his/her provider about any living will, medical power of attorney, or other directive that could affect his/her care
6. Accept personal financial responsibility for any charges not covered by his/her insurance
7. Be respectful of all the health care providers and staff, as well as other patients.