As a patient of Evergreen Hospice Care, you have the right to exercise your rights, including the right to:

• have your property and person treated with respect
• receive effective pain management and symptom control from Evergreen Hospice for conditions related to your terminal illness
• be involved in developing your hospice plan of care
• refuse care or treatment
• choose your attending physician
• have a confidential clinical record. Your privacy rights are outlined in more detail in the section entitled:  “Your Privacy” (above)
• be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property
• receive information about the services covered under the hospice benefit
• receive information about the scope of services that Evergreen Hospice will provide and specific limitations on those services
• receive copy of Evergreen Hospice’s written policies and procedures regarding advance directives, including a description of your rights under applicable state law and how such rights are implemented by Evergreen Hospice
• voice grievances regarding treatment or care that is (or fails to be) furnished and the lack of respect for property by anyone who is furnishing services on behalf of Evergreen Hospice and to not be subjected to discrimination or reprisal for exercising your rights
• receive written information describing Evergreen Hospice’s grievance procedure which includes the contact information, contact phone number, hours of operation, and mechanism(s) for communicating problems. Specifically,
  • You may file a grievance with any Evergreen Hospice team member in person, by email, or by phone.
  • You may call the Evergreen Hospice Director at 913.477.8248.
  • Evergreen Hospice regular business hours are Monday – Friday, 8:30 a.m. – 5:00 p.m.; however, time-sensitive grievances can be reported 24-hours-a-day, 7-days-a-week by calling 913.477.8248.
  • You have the right to file a grievance with the toll-free Kansas hotline by calling 1.800.842.0078.
  • You have the right to file a complaint with our accrediting agency—Community Health Accreditation Partner (CHAP) by calling their toll-free hotline:  1.800.656.9656.
  • receive an investigation by Evergreen Hospice (or other organizations listed above) of complaints made by the patient or the patient's family or guardian regarding treatment or care and that the organization will document the existence of the complaint and the resolution of the complaint
  • receive information addressing any beneficial relationship between the organization and referring entities

Additionally, you have the right to expect that Evergreen Hospice will:

• protect and promote your right to exercise these rights
• ensure that all alleged violations involving mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property by anyone furnishing services on behalf of Evergreen Hospice, are reported immediately by hospice employees and contracted staff to the Evergreen Hospice Director
• immediately investigate all alleged violations involving anyone furnishing services on behalf of the hospice and immediately take action to prevent further potential violations while the alleged violation is being verified. Investigations and/or documentation of all alleged violations will be conducted in accordance with established procedures
• take appropriate corrective action in accordance with state law if the alleged violation is verified by the hospice administration or an outside body having jurisdiction, such as the State survey agency or local law enforcement agency
• ensure that verified violations are reported to State and local bodies having jurisdiction (including to the State survey and certification agency) within 5 working days of becoming aware of the violation
• not discontinue or reduce care provided to a Medicare beneficiary patient because of your inability to pay for that care
• has a plan for maintaining continuity of care in the event of your declining or lack of financial resources

Your rights are executed by you or your designee as follows:

• if you have has been adjudged incompetent under state law by a court of proper jurisdiction, your rights are exercised by the person appointed pursuant to state law to act on your behalf
• if a state court has not adjudged you incompetent, any legal representative designated by you in accordance with state law may exercise your rights to the extent allowed by state law
• Evergreen Hospice secures your signature or the signature of your representative confirming that you (or he/she) have received a copy of the notice of these rights and responsibilities and have had any questions answered to your satisfaction