Patient Rights - You or your representative has the right to:

• Be informed of your rights before patient care is given or discontinued whenever possible
• Personal privacy
• Interpreters to assist with language needs
• Information concerning diagnosis, evaluation, treatment, and prognosis
• Choose or change your health care provider
• Participate in making informed decisions regarding care and treatment except when such participation is contraindicated for medical reasons
• Request a second opinion
• Write a Living Will, Medical Power of Attorney, and/or a CPR directive
• Request an Advanced Directive Form approved by the State of Wisconsin
• Accept, refuse or withdraw from clinical research

• Respectful treatment, which recognizes and maintains your dignity and values
• Care in a safe setting
• Be free of all forms of abuse or harassment
• Exercise his or her rights without being subjected to discrimination or reprisal • Personal information being shared with those who are involved in your care • Confidentiality of your medical and billing records
• Reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations
• Inspect and request copies of your protected health information
• Receive an accounting of non-routine disclosures of protected health information
• Voice a complaint and/or grievance to your health care providers and administration without fear of reprisal

Patient Responsibilities- You have the responsibility to:

• Provide accurate and complete information to the best of your ability about your health, any medications taken, including over-the-counter products and dietary supplements, and any allergies or sensitivities
• Report perceived risks in your care and unexpected changes in your condition
• Understand your treatment plan and ask questions when needed
• Follow the agreed-upon treatment plan prescribed by the provider and participate in your care
• Provide a responsible adult to provide transportation home and to remain with you as directed by the provider or as indicated on discharge instructions as applicable

 • Provide accurate and updated information for insurance and billing
• Accept personal financial responsibility for any charges not covered by insurance as promptly as possible
• Know your insurance requirements such as pre-authorization, deductibles and co-payments
• Call the billing office with questions or concerns
• Behave respectfully toward all health care professionals and staff, as well as other patients and visitors; physical or verbal threats will not be tolerated
• Respect the property of others

Contact: Eleve Chief Executive Officer
2606 Stewart Ave Ste 100, Wausau, WI 54401
Department of Health Services of the Division of Quality Assurance 1-800-642-6552

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