You have the right to reasonable access to care that is considerate and respectful of your personal dignity, values and beliefs. You have the right to access care without regard to your race, sex, national origin, handicap, age, HIV status, sexual orientation, religious beliefs or source of payment. You have the right to spiritual care and services and may express your cultural beliefs and practices if these do not harm others or interfere with treatment. You have the right to expect that Mary Free Bed will give you necessary health services to the best of its ability. You have the right to be told of realistic care alternatives when hospital care is no longer appropriate and treatment, referral or transfer is recommended. If transfer is recommended or requested, we will inform you of the risks, benefits and alternatives. Mary Free Bed will not transfer you as an inpatient until the other institution agrees to accept you. You have the right to agree or decline to take part in research affecting your care. If you choose not to take part, you will receive the most effective care Mary Free Bed otherwise provides. You have the right to consent to or refuse a treatment, as permitted by law, throughout your care. If you refuse a recommended treatment, you will receive other needed and available care. You have the right to know about Mary Free Bed policies that affect you and your treatment, and about charges and payment methods. A Patient Financial Services Representative will meet with you to help you understand your insurance coverage or to assist you in obtaining coverage or assistance. You have the right to know about Mary Free Bed resources, such as a patient representative or the ethics committee that can help you resolve problems and questions about your care.

When you are an inpatient, you have the right to create an advance directive, such as a living will or durable power of attorney for health care decision-making. These documents express your choices about your future care or name someone to decide if you cannot speak for yourself. You have the right to have caregivers provide care that is consistent with these directives. Mary Free Bed is unable to honor advance directives in the outpatient setting.

The hospital provides you with information in the language and format that you can understand, including use of interpreters. You have the right to unrestricted access to communication, such as visitors, mail, telephone calls and the right to receive a full explanation if Mary Free Bed places restrictions on communication. You have the right to full and equal visitation privileges. If Mary Free Bed restricts or limits visitors, these restrictions/limitations must be clinically necessary and reasonable. You have the right to have a family member or representative and your personal physician notified promptly upon your admission to Mary Free Bed. You can appoint a Patient Representative who can assist you with coordinating your care and communications. You have the right to be well informed about your health status and to participate in all aspects of your care. If anything unexpected and significant happens to you during your hospital stay, you will be told what happened, and any resulting changes in your care will be discussed with you including planning for your discharge. You have the right to participate in any ethical decisions that arise during your care. You have the right to be involved in care planning, treatments and likely outcomes. You have the right to discuss information with your doctor and to be cared for by staff that supports your rights. You have the right to include or exclude any or all family members from participating in your care decisions. You have the right to know the names and roles of people treating you.

Mary Free Bed Rehabilitation Hospital strives to provide excellent care and outstanding customer service. Feedback from our customers is used to evaluate our performance and make improvements. All concerns or complaints may be shared by the patient or patient’s representative with the clinical team, the nursing or therapy managers, and/or the patient’s physician. A Nursing Clinical Care Coordinator is available 24 hours a day. We provide the patient or the patient’s legal representative an opportunity to submit a grievance when we are unable to resolve patient care issues to the patient’s satisfaction. A patient or the patient’s representative may file a grievance with a representative of the Quality and Risk department. (Email feedback@maryfreebed.com.) This grievance will be investigated according to hospital policy, and a written response will be provided to the patient within seven days. If the patient is not satisfied with the outcome of the grievance investigation, they have the right to an appeal, and may request a hearing with the Mary Free Bed Grievance Committee. This hearing will occur within 21 days of the request, unless a delay is requested by the patient or patient’s representative. If a patient files a complaint (grievance), that action will not result in retaliation of barriers to service. Retaliation of any nature is a violation of hospital policy. A patient or the patient’s representative also has a right to lodge a complaint (grievance) with a state regulatory agency or a state quality improvement organization. This may be done regardless of whether the patient or patient’s representative has first used the Mary Free Bed grievance process.

Michigan Department of Community Health
Bureau of Health Systems
Complaint Investigation Unit
P.O. Box 30664
Lansing, MI 48909
Toll-free Complaint Hotline: 800.882.6006
Fax: 515.241.0093

MPRO
22670 Haggerty Road
Suite 100
Farmington Hills, MI 48335-2611
800.365.5899

You have the right to expect medical records are confidential unless you have given permission to release information or unless the law or an accrediting agency requires release. You will receive a Notice of Privacy Practices that describes the ways we use, disclose and safeguard patient information. When Mary Free Bed releases records to others who are entitled to review information in your record (for treatment, payment or operational purposes), we emphasize your records are confidential and only release the minimum necessary information. You have the right to access the information contained within your medical record or to obtain, for a fee, copies of your medical record within a reasonable period of your request. You have the right to have the information contained in your medical record explained to you, except when restricted by law. You have the right to know if Mary Free Bed has relationships with outside parties that may influence your treatment and care. These relationships may be with educational institutions, other health care providers or insurers.

You are responsible for providing information about your health, including past illnesses, hospital stays, use of medicine and/or other substances and healing and health practices that may affect your care. You are responsible for asking questions when you do not understand the information or instructions. You are responsible for recognizing the effect of lifestyle on your personal health. Your health depends on your daily lifestyle and your hospital care. You are responsible for following the recommendations, advice and treatments prescribed by your doctor and for telling your doctor if you believe you cannot follow through with your treatment. You are responsible for reporting perceived risks in your care and unexpected changes in your condition. You are responsible for informing Mary Free Bed if you have an advance directive, such as a living will. If you have a written advance directive, you are responsible for providing a copy to Mary Free Bed, your family and your doctor. You are responsible for working with caregivers to develop a plan for pain management that addresses your needs. You and your visitors must be considerate of the privacy, safety and security rights of other patients and staff, and respect Mary Free Bed property. You are responsible for providing accurate and timely information for insurance processing purposes and for working with Mary Free Bed to arrange payment, when needed.

Mary Free Bed Rehabilitation Hospital complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity).

Mary Free Bed Rehabilitation Hospital does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity).

Mary Free Bed Rehabilitation Hospital:

• 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 1-800-528-8989 (TTY:711)

If you believe that Mary Free Bed Rehabilitation Hospital has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity), you can file a grievance with:

• Compliance Officer/Civil Rights Coordinator,
• 235 Wealthy SE, Grand Rapids, MI 49503,
• Phone: 616-840-8706 (TTY:711)
• Fax: 616-840-9763
• compliance@maryfreebed.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Compliance Officer who is our Civil Rights Coordinator is available to help you.

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 https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at https://www.hhs.gov/ocr/complaints/index.html.

ATENCIÓN: si habla español, tiene a su disposición servicers gratuitos de asistencia lingüística. Llame al 616.840.8706.

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 1-616-840-8706 ھاتف الصم والبكم:

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 1-616-840-8706

ܢܿ ܘܬܼ ܝܠ ܒܼܿ ܩܕ ܢܘܿ ܬܝܼܨܡܵ ،ܐܝܵ ܪܵ ܘܿ ܬܐܵ ܐܢܫܠ ܢܘܿ ܬܝܼ ܡܙܡ ܿ ܿ ܿ ܸܗܼ ܐܟ ܢܘܬܚܐܼ ܢܐ :ܐܪܗܘܙ ܵܵ ܿ .ܵܵܿ ܵܵܵܿܿܿ1-616-840-8706-ܐܢܝܢܡܸܠܥܢܘܪܩܬܝܐܼܢܓܡܼܐܢܫܠܒܸ ܐܬܪܝܼܗܼܕ ܐܬܹܡܠܼܚܸ xxxx) ܼܿ

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 616.840.8706.

KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 616.840.8706.

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 616.840.8076번으로 전화해 주십시오.

ল�য্ কর‍নঃ যিদ আপিন বাংলা, কথা বলেত পােরন, তাহেল িনঃখরচায় ভাষা সহায়তা পিরেষবা উপল� আেছ। েফান কর‍ন ১ 616.840.8706

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 616.840.8706.

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 616.840.8706

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 616.840.8706

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。1-616-840-8706まで、お電話にてご連絡ください。

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 616.840.8706

OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 616.840.8706x

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 616.840.8706

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Notice of Nondiscrimination Mary Free Bed at Home complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.

Llame al 1-855-602-2500 (TTY: 711).

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1-855-602-2500（TTY: 711）。

View the complete notice of nondiscrimination here.

You have the right to appropriate assessment and management of pain. In addition, you have the right to education about your role in managing pain and the potential limitations and side effects of pain treatments.

You have the right to personal privacy. Mary Free Bed, your doctor and other caregivers will protect your privacy as much as possible. You have the right to receive care in a safe and secure setting. You have the right to be free from all forms of abuse, neglect, exploitation, retaliation, humiliation or harassment. Mary Free Bed supports your right to access protective services if needed.

You have the right to be free from physical restraints and drugs used as restraints and to expect that restraints only will be used when necessary and not used as a means of coercion, discipline, convenience or retaliation.