PLEASE RETAIN FOR FUTURE REFERENCE

Transcription

1 PLEASE RETAIN FOR FUTURE REFERENCE CLEVELAND CLINIC AT HOME QUICK REFERENCE TELEPHONE LIST HOURS OF OPERATION: Monday Friday 8:00 A.M. 5:00 P.M. As part of providing Patients First service to you, our customer, we have assigned a service representative specializing in your therapy to routinely contact you. Please call your representative directly with any questions regarding supplies, prescriptions or deliveries. If necessary, he/she will refer you to the appropriate professional staff member. Our service representatives are an integral part of our patient care teams which include experienced Pharmacists, Nurses and Technicians. Your Service Representative for Infusion Therapy at Home needs is checked below: Sharman Thomas Long distance , option 7, 68896# Herb Wright Long distance , option 7, 68710# Emily Jarrett Long distance , option 7, 68711# Be aware the phone numbers listed above do not forward to our on-call operator; after hours numbers are listed below. PHARMACY SERVICES or AFTER 5:OO P.M. /Weekends/Holidays (On-Call/After Hours: 24 hrs/day or or In the rare event that the above telephone numbers are out-of-service, call The Cleveland Clinic at or Be sure to identify yourself as an Infusion Therapy at Home patient. Cleveland Clinic at Home does not provide EMERGENCY CARE. For an EMERGENCY, dial 911 or the local emergency number for your area.

2 Cleveland Clinic at Home MISSION The mission of The Cleveland Clinic is to provide better care of the sick, investigation into their problems, and further education of those who serve. Six fundamental values form the Cleveland Clinic culture: Quality Innovation Team work Service Integrity Compassion PATIENT BILL OF RIGHTS Home care patients have a right to be notified in writing of the obligations as listed below, before treatment or service begins and to exercise those rights. The patient s family or guardian may exercise the patient s rights when the patient has been judged incompetent. Home care providers have an obligation to protect and promote the rights of their patients. Please read and discuss any questions with your home care provider. PATIENT AND PROVIDERS HAVE A RIGHT TO DIGNITY AND RESPECT Home care patients and their formal caregivers have a right to not be discriminated against based on race, color, religion, national origin, age, sex, or handicap. Furthermore, patients and caregivers have a right to mutual respect and dignity, including respect for property. Home care providers are prohibited from accepting personal gifts. Patients have the right: To receive care and treatment from home care providers that is based on honesty and ethical standards of conduct. To be informed of the procedure that you can follow to lodge complaints with the home care provider about the care that is or fails to be furnished or a lack of respect for property. Complaints can be lodged directly with Cleveland Clinic at Home by calling Donald Carroll, R.Ph., MHA, Administrator, at To know about disposition and resolution of such complaints. If you are not satisfied with the resolution you also have the option of contacting the Complaint Hotline at the Ohio Department of Health, , or the Peer Review Systems. The telephone numbers and hours of operations are included with your patient information packet. To voice grievances without fear of discrimination or reprisal for having done so. To have pain acknowledged monitored and managed appropriately

3 DECISION MAKING Patients have the right: To be notified in advance about the care/service that is to be furnished, the types (disciplines) of caregivers who will furnish the care and the frequency of the visits/services that are proposed to be furnished. To be advised of any change in the plan of care before the change is made. To participate in the planning of the care and in the planning of changes in the care, and to be advised that you have the right to do so. To make an informed choice regarding your selection of a home care provider. To be informed in writing of rights under Ohio law to make decisions concerning medical care, including the right to accept or refuse treatment and the right to formulate Advance Directives. Advance Directives are decisions put in writing concerning when you would choose resuscitation or when you would desire no to be resuscitated. Other decisions to be considered might include the use of antibiotics, blood transfusions, dialysis, ventilators, and medicines to stimulate the heart or blood pressure and artificial feeding. Ohio law permits two forms of Advance Directives. They are the Living Wills and Durable Power of Attorney for Health Care. A Living Will tells your doctor what decisions you have made in advance about your medical care if you become unable to make these decisions. And, if you sign a Durable Power of Attorney you are appointing someone to make decisions. And, if you sign a Durable Power of Attorney you are appointing someone to make decisions for you when you are unable to make informed health care decisions for yourself.) To be informed of processes and procedures for implementing Advance Directives, including any limitations if the provider cannot implement an Advance Directive on the basis of conscience. To have health care providers comply with Advance Directives in accordance with state law requirements. To receive care without fear of reprisal or discrimination. The home care provider or the patient s physician may need to refer the patient to another source of care if the patient s refusal to comply with the plan of care threatens to compromise the provider s commitment to quality.

4 PRIVACY Patients have the right: To confidentiality of their medical record as well as information about their health, social and financial circumstances and about what takes place in their home. To expect Cleveland Clinic at Home to release information only as required by law or authorized by the patient. Patient s have the right: FINANCIAL INFORMATION To be informed of the extent or limitations to which payment may be expected or will not be covered from Medicare or Medicaid, or any other payer known to the home care provider. To be informed of the charges for which the patient may be liable. To have access, upon request, to all bills for service the patient has received. Patient s have the right: To receive care of the highest quality. QUALITY OF CARE In general, to be accepted by Cleveland Clinic at Home only if we have the resources needed to provide the care safely and at the required level of intensity, as determined by a professional assessment. To be advised on what to do in case of an emergency.

5 PATIENT RESPONSIBILITY AS A PATIENT YOU HAVE THE FOLLOWING RESPONSIBILITIES: PROVIDING INFORMATION: To provide accurate and complete information about present complaints, past illnesses, hospitalization, medications, and other matters relating to your health. You and your family must report perceived risks in their care and unexpected changes in their condition. You and your family must provide feedback about service needs and expectations. ASKING QUESTIONS: You and your family must ask questions when you do not understand your care, treatment, and service or what you are expected to do. FOLLOWING INSTRUCTIONS: You and your family must follow the care, treatment, and service plan developed. You and your family should express any concerns about your ability to follow the proposed care plan or course of care, treatment, and services. If possible we will make every effort to adapt the plan to your specific needs and limitations. When such adaptations to the care, treatment, and service plan are not recommended, you and your family will be informed of the consequences of the care, treatment, and service alternatives and not following the proposed course. ACCEPTING CONSEQUENCES: You and your family are responsible for the outcomes if you do not follow the care, treatment, and service plan. You will provide a safe environment for Cleveland Clinic at Home staff. FOLLOWING RULES AND REGULATIONS: You and your family must follow our organization s rules and regulations. SHOWING RESPECT AND CONSIDERATION: You and your family must be considerate of our organization s staff and property, as well as other patients and their property. MEETING FINANCIAL COMMITMENTS: You and your family should promptly meet any financial obligation agreed to with our organization.

6 PATIENT COMMENT PROCESS If you, as a patient or caregiver have any comments or concerns about the services that you received, we will respond to these concerns and attempt to resolve any problems. Please contact us by telephone as listed below or by mail using the attached Patient Comment Process. 1. Pharmacy Services Pharmacy Delivery Services option 7 ext If your issue has not been able to be resolved to your satisfaction through the above resources you may call the following: 1. Administrator of Pharmacy option 7 ext Reimbursement Manager option 7 ext Questions or Concerns? You and your family should feel you can always voice your concerns. If you share a concern or complaint, your care will not be affected in any way. The first step is to discuss your concerns with your nurse, or other caregiver. If you have concerns that are not resolved, please contact the Ombudsman office at ombudsman@ccf.org and Should you continue to remain concerned after contacting the Ombudsman office, you may contact The Joint Commission s Office of Quality Monitoring by either calling or ing complaint@jointcommission.org

7 PATIENT COMMENT FORM Cleveland Clinic at Home continuously strives to provide care and services of the highest quality to our patients in their home. If you, as a patient or a caregiver, have any comments about the services or the service providers at any time, please complete and mail this Patient Comment Form to our Ombudsman. Or you may place a call directly to us using the telephone numbers listed on the previous page. All concerns will be investigated. You will be advised either by telephone or in writing regarding the disposition or resolution of the matter. Your assistance in taking the time to let us know about the care and services you re received assists us in our dedication to being quality home care provider and our commitment to excellent customer service. Patient Name: Date of Event: Description of Comment or Concern: Person Completing Form: Relationship: Telephone Number You Can Be Reached: Mail to: Administrator Cleveland Clinic at Home 6801 Brecksville Road, Ste 10 Independence, Ohio JCAHOINFUSIONPATIENTQUICKREFPHONELIST2011.doc