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   [Visiting Hours]
          ° Surgery (Pre-OP)
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          ° In-Patient Care

   [Hospital Amenities]
          ° St Elizabeth Pharmacy
          ° Subway
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      [Hospital Services]



                You have the right….
1. To have Medical Center at Elizabeth Place respond to your requests and needs for treatment or service provided that the               space is available, and to receive the care that reflects your interests and that has been determined by your physician, and               respects your advance directives or your rights to formulate advance directives.
         2. To be informed of the right to care that is respectful, recognizes dignity and is private to the extent possible.
         3. To have patient information treated confidentially based on applicable laws and regulations.
         4. To be involved in making decisions regarding your care, including assessment and for employees of pain.
         5. To be given information in the language you understand or to have information interpreted.
         6. To give informed consent, that is, to make decisions in collaboration with your physician that involve your health care.              Consent may be given by the patient or the patient's legal representative. In order to give consent, the patient will be              provided information to include:
 A. An explanation of recommended treatments or procedures in terms, that are, understandable.
 B. An explanation of the risks and benefits of treatment, including the chance of success, mortality risk and serious      side-effects.
 C. An explanation of the alternatives and the risks and benefits of such.
 D. An explanation of the likely consequences if no treatment is pursued.
 E. An explanation of the recuperative period, including anticipated problems and anticipated length of recuperation.
 F. An explanation that the patient or his/her legal representative is free to withdraw consent and discontinue      participation in treatment.
 G. A disclosure statement that the patient's physician is participating in teaching, research, experimental or education       projects relating to the patients case.
         7. To an explanation of admission procedures, this shall include disclosure upon admission, of the facilities policy statement               on patient rights which shall include:
 A. The right to participate in all decisions involving care or treatment, consistent with state and federal statutes.
 B. The right to refuse any drug, test, treatment, procedure or treatment consistent with the state and federal statutes,       including likely medical consequences of such refusal.
 C. The right to receive considerate and respectful care in a clean and safe environment, free of unnecessary restraint.
 D. The right to be informed of the facilities rules and regulations applicable to the patient
 E. The right to be informed of the facilities grievance procedure. The executive director may be reached at       937-223-MCEP (6237).
  F. The right to file a grievance with the appropriate state agency.
          8. To know name, professional status and experience of the staff providing care or treatment.
          9. To be informed prior to the initiation of general billing procedures:
 A. Prior to the initiation of non-emergency treatment, upon request, the patient has the right to be informed of routine,      usual and customary charges or estimated charges for service based on an average patient with diagnosis similar      to the tentative admission diagnosis for the patient.
 B. If you have questions please call 937-223-MCEP (6237) for medical cost information between the hours of 8:00 am       and 4:30 pm on weekdays.
 C. Based upon insurance information provided by the patient, the facility shall provide assistance as needed with       estimates of co-payments, deductibles and other charges that must be paid by the patient. Such assistance may       be obtained weekdays between 8:00 am and 4:30 pm by calling the facility business office manager.
  D. The facility may include a disclaimer with the disclosure of any charges.
       Such disclaimer may include further variables, which may alter any disclosed charges. Any charges prohibited by        law or third party payor contract will include a no charge disclaimer in the disclosure.
         10. To be provided with information regarding teaching, research, educational or experimental projects related to your care.                 You have the right to refuse to participate in such projects.
         11. To have your medical records maintained in confidence and in accordance with the medical staff bylaws, rules and                 regulations. You have the right to have access to your medical record by contacting the facility at 937-223-MCEP (6237).
937.223.MCEP | One Elizabeth Place Dayton, Ohio 45417
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