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Notice of Patient Rights and Responsibilities

Notice of Patient Rights and Responsibilities

Rockcastle Regional Hospital and Respiratory Care Center along with the Medical Staff have adopted the following patient rights. Patients or legally responsible representatives have the right to receive care without discrimination due to age, sex, race, color, religion, sexual orientation, education, national origin, ancestry, marital status, culture, language, physical or mental disability, gender identity or expression, ability to pay your bill, or socioeconomic status. The patient and/or family is informed of patient’s rights in advance of furnishing or discontinuing patient care whenever possible.

Patients Have the Right To:

1. receive care in a safe, respectful and dignified setting;
2. effective communication and to receive such information tailored to age, language and ability to understand (information is provided to the patient who has vision, speech, hearing or cognitive impairments in a manner that meets the patient’s needs);
3. participate in the development and implementation of the plan of care, discharge plan, and pain management plan;
4. participate in decisions about your care, treatment, and services, and involve family to the extent permitted by the patient or surrogate decision maker;
5. be informed about the outcomes of care, treatment and services in order to participate in current and future health care decisions;
6. be informed about unanticipated outcomes of care, treatment and services that relate to sentinel event considered reviewable by The Joint Commission;
7. be informed of your health status and provided with information to allow you to make informed decisions about your care;
8. request care, this right does not mean you can demand care or services that are not medically indicated;
9. refuse care, treatment and services;
10. receive information about the individual(s) responsible for providing, your care, treatment and services;
11. formulate or review or revise advance directives and have hospital staff and practitioners comply with these directives; (Advance directives are not honored during surgery but will resume upon recovery from anesthesia);
12. have choices about end of life decisions respected;
13. have organ donor wishes honored;
14. give or withhold informed consent;
15. have a family member or support person of your choice and your physician notified promptly of admission to the hospital;
16. be informed of whom to contact at the hospital to file a grievance and to have complaints reviewed by the hospital;
17. personal privacy (including privacy and confidentiality of personal records and written communications, including the right to send and receive mail promptly);
18. religious, pastoral and other spiritual services;
19. free from neglect; exploitation; and verbal, mental, physical and sexual abuse and harassment;
20. be free from restraints of any form that are not medically necessary;
21. confidentiality of your clinical records;
22. access, request amendment to, and obtain information on disclosures of your health information, in accordance with law and regulation, within a reasonable time frame;
23. have your questions about any costs or bills answered;
24. to access protective and advocacy services;
25. designate a support person(surrogate decision maker), if needed, to act on your behalf to assist and protect your rights;
26. be informed of your visitation rights, including any clinical restriction or limitation on such rights (Refer to Visitation Policy);
27. based on your consent and preferences to receive visitors whom you designate and to withdraw or deny consent for visitation (Refer to Visitation Policy);
28. be informed of any continuing healthcare requirements following discharge;
29. have his/her cultural, psychosocial, spiritual and personal values, beliefs and preferences respected;
30. language interpreting and translation services (Refer to Language Access Plan).

Rockcastle Regional Hospital and Respiratory Care Center, Inc:

Provides free aids and services to people with disabilities to communicate effectively with us, such as:
– Qualified sign language interpreters
– Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provides free language services to people whose primary language is not English, such as:
– Qualified interpreters
– Information written in other languages

If you need these services, contact us at 606-256-2195.

Patient/Patient Representative Responsibilities Include:

1. You are responsible for providing accurate and complete information about your medical history, including past illnesses, hospitalizations, medications, pain, sensitivities or allergies to drugs and other agents, and other matters related to your health.
2. You are responsible for informing your healthcare providers of any change in your condition or reaction to your treatment.
3. You are responsible for asking questions or acknowledging if you do not understand the treatment course or care decision.
4. You are responsible for following instructions, policies, rules and regulations in place to support quality care for patients and a safe environment for all individuals in the hospital; the care, treatment, and service plan established by your physician, including the instructions of other health professionals.
5. You are responsible for expressing concerns about your ability to follow and comply with the proposed care, treatment and services.
6. You are responsible for accepting the consequences for refusing treatment or not following healthcare providers’ instructions.
7. You are responsible for providing accurate insurance information for billing purposes and meeting your financial obligations.
8. You are responsible for following hospital rules and regulations affecting your care and conduct. SMOKING IS PROHIBITED WITHIN THE HOSPITAL. You are responsible for accepting medical consequences if you choose to go outside to smoke.
9. You are responsible for showing consideration and respect for other patients, staff and property. This includes limiting the number of visitors when this interferes with others rights, observing the NO SMOKING Policy, and avoiding noisy, threatening, or disruptive behavior.
10. You are responsible for informing the hospital of advance directives and the appointment of a surrogate on your behalf.
11. You are responsible for informing healthcare providers if your pain goal is not met and working with them to develop and follow a pain management plan.
12. You are responsible for notifying healthcare providers as soon as possible if your rights have been or may be violated.
13. You are responsible for supporting mutual consideration and respect by maintaining civil language and conduct in interactions with staff and licensed independent practitioners.

Complaints and Concerns (Patient Grievance Process):

At Rockcastle Regional Hospital and Respiratory Care Center, Inc., we strive to make your stay as pleasant as possible. In the event that there is a conflict concerning your care or treatment, every effort will be made to resolve the conflict in a way that best meets your needs. If problems do arise during your stay, please contact a nurse (or staff assisting with care), a quality representative Tammy Brock at 606-256-7733, or administration at 606-256-7703.

It is the policy of Rockcastle Regional Hospital and Respiratory Care Center, Inc. not to discriminate on the basis of race, color, national origin, sex, age or disability. Rockcastle Regional Hospital and Respiratory Care Center, Inc. has an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. 18116) and its implementing regulations at 45 CFR part 92, issued by the U.S. Department of Health and Human Services. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of Tammy Brock, 145 Newcomb Ave, Mount Vernon, KY 40456; 606-256-7733; Facility TTY number 1-606-256-0556; who has been designated to coordinate the efforts of Rockcastle Regional Hospital and Respiratory Care Center, Inc. to comply with Section 1557.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-868-1019, 800-537-7697 (TDD). Complaint forms are available at

You also have the right to file a complaint with the state survey agency, Cabinet for Health Services, Office of Inspector General, Division for Community Health Services or Division of Long-Term Care, 85 State Police Road, London, KY 40741-9008; Phone 606-330-2030; Fax 606-330-2054. For your Convenience, patient advocacy agencies are listed below.

Adult Protective Services 606-256-2138

Ombudsman 606-864-7391 or 1-800-372-7391

Medicaid Fraud 502-696-5405

Medicare Fraud 1-800-447-8477

Joint Commission:
- At, using the “Report a Patient Safety Event” link in the “Action Center” on the home page of the website.
- By fax to 630-792-5636.
- By mail to The Office of Quality and Patient Safety (OQPS), The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181.
- At, using the “Report a Patient Safety Event” link in the “Action Center” on the home page of the website.


Español (Spanish)
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-606-256-2195 (TTY: 1-606-256-0556).

繁體中文 (Chinese)
注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-606-256-2195(TTY: 1-606-256-0556)。

Deutsch (German)
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-606-256-2195 (TTY: 1-606-256-0556).

Tiếng Việt (Vietnamese)
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-606-256-2195 (TTY: 1-606-256-0556).

العَرَبِيَّة (Arabic)
ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-606-256-2195 (رقم هاتف الصم والبكم: 1-606-256-0556).

Srpsko-hrvatski (Serbo-Croatian)
OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-606-256-2195 2195 (TTY: 1-606-256-0556).

日本語 (Japanese)
注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。1-606-256-2195 (TTY: 1-606-256-0556).

Français (French)
ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-606-256-2195 (TTY: 1-606-256-0556).

한국어 (Korean)
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-606-256-2195 (TTY: 1-606-256-0556).

Deitsch (Pennsylvania Dutch)
Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-606-256-2195 (TTY: 1-606-256-0556).

नेपाली (Nepali)
ध्यान दिनुहोस्: तपार्इंले नेपाली बोल्नुहुन्छ भने तपार्इंको निम्ति भाषा सहायता सेवाहरू निःशुल्क रूपमा उपलब्ध छ । फोन गर्नुहोस् 1-606-256-2195 (TTY: 1-606-256-0556).

Oroomiffa (Cushite – Oromo)
XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-606-256-2195 (TTY: 1-606-256-0556).

Русский (Russian)
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-606-256-2195 (TTY: 1-606-256-0556).

Tagalog (Philipino)
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-606-256-2195 (TTY: 1-606-256-0556).

Ikirundi (Bantu – Kirundi)
ICITONDERWA: Nimba uvuga Ikirundi, uzohabwa serivisi zo gufasha mu ndimi, ku buntu. Woterefona 1-606-256-2195 (TTY: 1-606-256-0556).

Rockcastle Regional Hospital and Respiratory Care Center Copyright © 2015
145 Newcomb Avenue - Mt. Vernon, Kentucky 40456 Ph: (606) 256-2195 E:
Rockcastle Medical Arts Ph: (606) 256-4148