It is anticipated that observance of these rights, grievances, and responsibilities will contribute to more effective care and greater satisfaction for the client as well as the staff. The rights will be respected by all personnel and integrated into all Health Care programs. A copy of these rights will be given to clients and their families or designated representative. The client or his/her designated representative has the right to exercise these rights. In the case of a client adjudged incompetent, the rights of the client are exercised by the person appointed by law to act on the client's behalf. In the case of a client who has not been adjudged incompetent any legal representative may exercise the client's rights to the extent permitted by law.

I understand that Ascension Rehab Care (ARC) will maintain my privacy to the highest standards and may use or disclose my personal health information for the purposes of carrying out treatment, obtaining payment, evaluating the quality of services provided and any administrative operations related to treatment or payment.
I give my consent Ascension Rehab Care (ARC) to evaluate my condition and furnish Physical, Occupational, and Speech Therapy treatment as considered necessary and proper by the Physical, Occupational, and/or Speech Therapist, through its appropriate personnel, agents and affiliates to perform the evaluation, care and treatment procedures that are deemed necessary by my physician(s) and other healthcare providers and Physical, Occupational, and/or Speech Therapist. The purpose of Physical, Occupational, and Speech Therapy is to treat disease, injury and disability by examination, evaluation, diagnosis, prognosis and intervention by use of rehabilitative procedures, mobilization, massage, exercises, and physical agents to aid the patient in achieving their maximum potential within their capabilities. Therapeutic exercises are an integral part of most Physical, Occupational, and/or Speech Therapy treatment plans. Exercise has inherent physical risks associated with it. If you have any questions regarding the type of exercise you are performing and any specific risks associated with your exercises, your therapist will be glad to answer them.  

• To be fully informed and knowledgeable of all rights and responsibilities before providing preplanned care and to understand that these rights can be exercised at any time.
• To appropriate and professional care relating to physician orders.
• To choose a health care provider.
• To request services from the Health Care Provider of their choice and to request full information before care is given concerning services provided, alternatives available, licensure and accreditation requirements, and organization ownership and control.
• To be informed in advance about care to be furnished and of any changes in the care to be furnished before the change is made.
• To be informed of the disciplines that will furnish care and the frequency of visits proposed to be furnished.
• To information necessary to give informed consent prior to the start of any procedure or treatment and any changes to be made.
• To participate in the development and periodic revision of the plan of care/service. Confidentiality and privacy of all information contained in the client record and of Protected Health Information.
• To information necessary to refuse treatment within the confines of the law and to be informed of the consequences.
• To treatment with utmost dignity and respect by all provider representatives, regardless of the client's chosen lifestyle, cultural mores, political, religious, ethical beliefs, having or not having executed an advanced directive and source of payment without regard to race, creed, color, sex, age, or handicap.
• To have his/her property and person treated with respect, consideration, and recognition of client dignity and individuality.
• To receive and access services consistently and in a timely manner from the Provider to his/her request for service.
• To be admitted for service only if the provider has the ability to provide safe professional care at the level of intensity needed and to be informed of limitations.
• To reasonable continuity of care.
• To an individualized plan of care and teaching plan developed by the entire health team including the client and/or family.
• To be informed of client rights under state law to formulate advanced care directives.
• To be informed of anticipated outcomes of service/care and of any barriers in outcome achievement.
• To expect confidentiality of the access to medical records according to State Statutes.
• To be informed within a reasonable time of anticipated termination of service of plans for transfer to another health care facility/provider.
• To be informed verbally and in writing and before care is initiated of the organization's billing policies and payment procedures and the extent to which
  • Payment may be expected from Medicare, Medicaid, or any other federally funded or aided program known to the organization.
  • Charges for services that will not be covered by Medicare.
  • Charges that the individual may have to pay.
• To be able to identify visiting staff members through proper identification.
• To be informed orally and in writing of any changes in payment information as soon as possible, but no later than 30 days from the date that the organization becomes aware of the change.
• To be honest, accurate, forthright information, regarding the health care industry in general and his/her chosen provider in particular, including cost per visit, employee qualifications, names and titles of personnel, etc.
• To be referred to another provider if he/she is dissatisfied with the provider or the provider cannot meet the client's needs.
• To receive disclosure information regarding any beneficial relationship the organization has that may result in profit for the referring organization.
• To education, instruction, and a list of requirements for continuity of care when the services of the provider are terminated.
• To be free of abuse of any kind.
• To privacy to maintain his/her personal dignity and respect.
• To know that the provider has liability insurance sufficient for the needs of the provider.
• To voice grievances regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect of property or recommend changes in policy, staff, or service/care without restraint, interference, coercion, discrimination, or reprisal.

Your concerns are important to the provider. We will give full consideration to all concerns and make every effort to resolve the issue in an agreeable manner. We assure you that you will have the opportunity to voice grievances and recommend changes in services and/or policies without discrimination, coercion, reprisal, or unreasonable interruption of services or reprisal in any manner from the provider. If you have a concern, please: (1) Submit the concern either verbally or in writing to the Ascension Rehab Care regional leadership. (2) Ascension Rehab Care leadership will contact you or your representative and will make every effort to resolve the concern to your satisfaction. They will document all activities involved with the grievance/concern, investigation, analysis, and resolution. You will be notified of the decision within 10 days. (3) If the concern cannot be resolved to your satisfaction, you may request that the regional leadership submit your concern to Administration. (4): Ascension Rehab Care's executive leadership team can be contacted by calling: 844-973-6159

• To provide, the best of his/her knowledge accurate and complete information about: (a) Past and present medical histories, (b)Unexpected changes in his/her condition, (c) Whether he/she understands a course of action selected.
• To follow the treatment recommended by the particular handling of the case.
• For his/her actions if he/she refused treatment or does not follow the physician’s orders.
• For accruing the financial obligations of his/her health care are fulfilled as promptly as possible.
• To respect the rights of all staff providing service.
• To notify the Provider promptly in advance of an appointment or visit you must cancel.
• To become independent in care to the extent possible, utilizing self, family, and other sources.
• To pay for care or services not covered by third party payers.
• For complying with the rules and regulations established by the Provider and any changes subsequent to the rules.