12 speak to the Nursing Supervisor if you have a concern. Concerns may also be addressed to the Georgia Department of Human Resources, Office of Regulatory Services at 404-657-5728. In addition, you may contact DNV for any patient care and safety concerns that are not resolved by the hospital by calling 1-866-496- 9647 or completing the online form at http:// dnvglhealthcare.com/patient-complaint-report. • Have a family member or representative of your choice or own physician notified promptly of your admission to the hospital. • Receive care in a safe and secure environment. • Be free from all forms of abuse including mental, physical, sexual, and or verbal abuse, neglect, harassment, or exploitation. • Be free from seclusion or restraints of any form that are not medically necessary. • Receive information about pain and pain relief measures as appropriate to the medical diagnosis or surgical procedure. • A concerned staff committed to pain prevention and management. • Effective communication. If you need a translator, one will be provided for you for language interpreting and translation services. • Have information provided to you if you have vision, speech, hearing, or cognitive impairments in a manner that meets your needs. • Consent or refuse to participate in any research or treatment that is considered experimental in nature and to have those studies fully explained prior to consent. • Participate in decisions regarding ethical issues surrounding your care, treatment, and services, including issues of conflict resolution, withholding resuscitation, forgoing or withholding of life sustaining treatment and participations in investigational studies or clinical trials. You may ask your nurse or physician to consult the Ethics Committee for resolution of conflicts in decision making regarding your care. • Have your spiritual, psychosocial and cultural beliefs respected. • Have access to protective, and advocacy services, if necessary. • Access information contained in your medical records (inspect and obtain a copy), within a reasonable time frame and have information explained or interpreted as necessary, except as restricted by law. • Request restrictions on the hospital’s use and disclosure of protected health information. • Receive confidential communications about your protected information in a certain way or at a certain location. The hospital will grant any reasonable request. • An accounting of disclosures of your protected health information made in the 6 years prior to the date of request, except for disclosures to carry out treatment, payment and healthcare operations. • Request that your medical information be amended. The hospital will respond to all requests. The hospital may deny a patient’s request if the medical information is accurate and complete, or if the request pertains to information the hospital did not create. • Receive a copy of Evans Memorial Hospital’s Notice of Privacy Practices for Protected Health Information. • Examine and receive an explanation of your hospital bill, regardless of the source of payment. • Respect patient’s right to refuse care, treatment, and services, in accordance with law and regulations.
20264RD
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