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1. To Our Patients

  • Fort HealthCare believes that a patient who understands and participates in his or her healthcare will benefit to a greater extent than one who does not.
  • The following statement is a formal expression of our commitment to you and also informs you of your responsibilities in the care process as a patient of Fort HealthCare. Please do not hesitate to discuss any concerns regarding your care or any aspect of your visit with the healthcare team. If you feel your needs are not adequately addressed, please contact the president at ext. 5401 or (920) 568-5401 and explain your concerns.
  • Patients have a fundamental right to considerate care that safeguards their personal dignity and respects their cultural, psychosocial and spiritual values. These values often influence patients’ perception of care and illness. Understanding and respecting these values guide us in meeting your care needs and preferences. The goal of Fort HealthCare and our staff is to help improve patient outcomes by respecting each patient’s right and conducting business relationships with patients and the public in an ethical manner.
  • Patients further have the right to be free from neglect, exploitation, and abuse while receiving care, treatment and services.

2. Patient and Physician

  • The hospital care team informs you of the name of the physician (often a hospitalist) or other practitioner who has primary responsibility for your care, treatment, or services.
  • Physicians should give patients complete and current information concerning their diagnosis, treatment, alternatives, risks and prognosis as required by the physician’s legal duty to disclose. This information shall be in terms and language patients can reasonably be expected to understand. Patients may be accompanied by a family member or other chosen representative when this information is presented and/or throughout their stay. This information shall include the likely medical or major psychological results of the treatment and its alternatives. In cases where it is medically inadvisable, as documented by the attending physician in a patient’s medical record, the information shall be given to the patient’s guardian or other person designated by the patient as his or her representative. Individuals have the right to refuse this information.

3. Pain Management

  • Patients at Fort HealthCare can expect to have ongoing assessment of their pain with pain control measures incorporated into their plan of care.
  • Patients are encouraged to take a proactive approach to pain management, working with their nurse and physician on identifying appropriate pain management techniques and therapies.

4. Equal Treatment

  • Patients of Fort HealthCare can expect the same care, consideration, respect and treatment regardless of age, race, culture, creed, language, color, religion, gender identity or expression, sex, sexual orientation, physical or mental disability, source of payment or socioeconomic status. Patients have the right to be treated with courtesy and respect for their individuality by employees or persons providing service in our healthcare facilities. Reasonable accommodations shall be made for those with communication impairments, and those who speak a language other than English. Fort HealthCare will accommodate the patient’s right to religious and other spiritual services as long as such services do not impede the patient’s safety or plan of care.
  • Patients shall, upon registration, be informed that there are legal rights for their protection during their stay at the facility and throughout their course of treatment and that these are described in this Bill of Rights.

5. Confidentiality of Medical Records

  • The information you share with your physician and healthcare team is confidential. Your medical record will not be shown to anyone not associated with Fort HealthCare without your permission unless ordered by a court of law, or as special legislation requires. If anyone else wants information from your medical record, your permission in writing is necessary before it will be released. This right does not apply to complaint investigations and inspections by the department of health, where required by third party payment contracts, or where otherwise provided by the law.

6. Right to Refuse Care

  • You may refuse treatment and your physician and healthcare personnel will respect your desires. You may choose to leave Fort HealthCare against your physician’s advice. However, your physician and Fort HealthCare are not held responsible for any harm that may result if you refuse recommended treatment or leave against advice. You should discuss with your physician any decision to leave and what risks you take. On the other hand, if you have been discharged from Fort HealthCare and don’t feel ready to leave, please discuss your reasons with your physician.

7. Advance Directives

  • Everyone admitted to Fort HealthCare will be asked about an advance directive. You have the right to have an advance directive, such as a living will or healthcare power of attorney, concerning treatment preferences and/or identifying a substitute decision maker. The hospital will honor the guidelines of the directive as permitted by the law and hospital policy, or can assist you in developing a living will or healthcare power of attorney. Staff throughout Fort HealthCare will direct you on obtaining information on advance directives.

8. Hospital Transfer

  • You may be transferred to another facility when medically necessary and permissible. In this case, you are given complete information and explanation concerning the need for, risks, benefits and alternatives to the transfer and the institution to which you are to be transferred.

9. Managing Your Care or Coordinating Your Care

  • You will be informed of the choices available when acute hospital care is no longer required. The patient care coordinator will work with you, your family and your physician to determine your continuing healthcare needs. These include pre- and post- hospital needs.

10. Medical Research

  • On occasion, patients are asked to participate in research programs. You will not be involved in a research program without your full knowledge and consent, and you have an absolute right to refuse to participate in any such program.

11. Privacy

  • Patients shall have the right to respect and privacy as it relates to their medical and personal care program. Case discussion, consultation, examination and treatment are confidential and shall be conducted discretely. Privacy shall be respected during examination and treatment, grooming, bathing and other activities of personal hygiene, except as needed for patient safety or assistance.
  • Patients shall have the right to every consideration of their privacy, individuality and cultural identity as related to their social, religious and psychological well-being.
  • Upon registration to Fort HealthCare, a patient or the patient’s legal guardian or conservator shall be given the opportunity to authorize disclosure of the patient’s presence in the facility, to callers or visitors who may seek to communicate with the patient.
  • Because we respect your confidentiality, we do not contact family and friends unless you ask. Feel free to contact family and friends or we will be happy to contact them for you.

12. Visitors

  • Patients have the right to receive visitors designated by the patient, including, but not limited to a spouse, a domestic partner (including same-sex domestic partner), another family member, or a friend. Included is the right to withdraw or deny visitation by any/all at any time.

13. Grievances

  • Patients can voice complaints and recommend changes freely without being subject to coercion, discrimination, reprisal, or unreasonable interruption in care.
  • Fort HealthCare has a formal process for reviewing patient complaints and helping to resolve conflicts. This process includes a plan to inform patients and their families of their right to make complaints and how to go about having them resolved. This process also involves a patient advocate or representative who reviews the complaint and consults with the appropriate staff (for example, nursing, medical staff, housekeeping). Those issues that cannot be resolved in this manner are referred to Fort HealthCare’s administration for intervention.

14. Restraint

  • Every patient shall be free from restraints, except in fully documented emergencies for a specified and limited period of time, and only when necessary to protect the patient from self-injury or injury to others. Protective devices may be used only upon the authorization of a physician.

15. Fort HealthCare Billing

  • You are entitled to examine and receive an explanation of your hospital bill regardless of the source of payment. Also, you may request information relating to financial assistance from government programs to meet your obligations to the health system. Itemized bills will not be provided automatically due to costs. You are entitled to receive an itemized copy upon request. Please call 568-6580 for an itemized copy.

16. Your Responsibilities as a Patient

Patient responsibilities generally include at least the following:

  • Providing information: The patients and family are responsible for providing, to the best of their knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to the patient’s health. They are responsible for reporting unexpected changes in the patient’s condition to the responsible practitioner.
  • Asking questions: The patient and family are responsible for asking questions when they do not understand what they have been told about the patient’s care or what they are expected to do.
  • Following the instructions: The patient and family are responsible for following the treatment plan developed with the practitioner. They should express any concerns they have about their ability to follow the proposed course of treatment; the health system, in turn, makes every effort to adapt the treatment accordingly, including pain management.
  • Taking accountability for your personal health and well-being.
  • Accepting the consequences of not following instructions: If the patient or family refuses treatment or fails to follow the practitioner’s instructions, the patient is responsible for the outcomes.
  • Following Fort HealthCare rules and regulations: The patient and family are responsible for following the Fort HealthCare’s rules and regulations in place to support quality care for patients and in a safe environment for all individuals in the hospital.
  • Acting with consideration and respect: Patients and families are expected to be considerate of other patients and personnel by not making unnecessary noise, not smoking, and by using proper language and conduct in interactions. Patients and families are responsible for respecting the property of other persons and that of Fort HealthCare.
  • Meeting financial obligations and ensuring current health insurance coverage.

The organization’s environment may be confusing and we may overlook matters which are important to you. The following suggestions may be helpful for you:

  • Ask all of those who are involved in your care to identify themselves if they are not known to you.
  • Participate in your care by helping to establish the goals for your treatment plan. Be actively involved with your physician, nurses and other care providers.
  • Ask that visitors and others not involved in your care be restricted if you do not feel up to seeing other people.
  • Your health and comfort are the primary interest of your medical staff and employees.
  • Ask all of those caring for you to follow safety procedures including hand washing. We invite you to Speak Up with any questions you have regarding your care or treatment.
You have the right to report concerns or complaints to:

The WI Division of Quality Assurance
P.O. Box 2969 Madison, WI 53701-2969
Phone (800) 642-6552


The Joint Commission
1 Renaissance Blvd.
Office of Quality Monitoring Oakbrook Terrace, IL 60181 Phone (800) 994-6610


Livanta is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) under contract with the Centers for Medicare & Medicaid Services (CMS) in the state of Wisconsin. As part of this contract, Livanta reviews Medicare recipient appeals of hospital discharge and determines whether skilled services need to continue. Livanta has recently added a new feature to the website, Providers and beneficiaries can now access case status information directly from the website without having to call the BFCC-QIO. It’s as simple as putting in the case number and the state, and a status update will appear. When the case is complete, the decision will also be listed along with the financial liability date. Livanta hopes this new feature will give providers and beneficiaries easy access to the most up-to-date information available. or 1-888-524-9900.

Revised: 7/8/2019