The Hospital of the University Of

Home , Pennsylvania Hospital

The Hospital of the University of Pennsylvania (HUP) is world-renowned for its clinical and research excellence, forging the way for new and better ways to diagnose and treat illnesses and disorders. Its long and rich history of patient care began more than two centuries ago as the nation’s first medical school, the University of Pennsylvania. Since 1765 when it first opened its doors, Penn has been dedicated to the training of physicians and the discovery and implementation of new medical knowledge.

HUP is consistently ranked as one of the top 10 hospitals in the nation.* Many of its clinical specialties are among the nation’s best, including:

■■ Cardiology and Cardiac ■■ Gynecology ■■ Otorhinolaryngology Surgery ■■ Nephrology (Ear, Nose and Throat) ■■ Endocrinology, Diabetes ■■ Neurology and ■■ Psychiatry and Metabolism Neurosurgery ■■ Pulmonology ■■ Gastroenterology ■■ Oncology ■■ Rheumatology ■■ Geriatrics ■■ Orthopaedics ■■ Urology

*U.S.News & World Report Best Hospitals Honor Roll

1 Planning for dispenses them. The nurse explains them and the Visit gives them to patients. Always ask about the medications you are given before taking them. What to bring: ■■ Photo identification Patients should never take medication from ■■ Health insurance information home without discussing this with the doctor ■■ Copy of any advance directive, durable power or nurse first. If the doctor wants a patient of attorney and living will documents to take their medication from home, a ■■ List of medications with doses and frequency pharmacist will make sure it does not interfere ■■ List of doctors and relatives with phone with the other medications they are taking. numbers and email addresses Patient and Guest Relations Family ■■ Robe, slippers and toiletries (toothbrush, Patients are asked to define their family and HUP’s staff continually strives to meet patients’ needs and provide comfort and toothpaste, etc.) peace of mind to patients and their families. The Patient and Guest Relations staff explain how they will be involved in patient ■■ Eye glasses, hearing aids and dentures serves as a liaison between HUP and patients, families and visitors. They address care, care planning and decision making. (and cases labeled with full name) concerns, forward suggestions and extend compliments. Patient and Guest Relations Patients should plan to keep their family ■■ Cane and walker (labeled with full name) staff can also help patients receive special services such as notary, interpretation informed about their care—they are advised (including sign language) and TTY phone support. For assistance, please contact: ■■ Medical equipment if absolutely necessary to identify one person who can communicate with family members. Patients should share their plan with HUP staff. Patient and Guest Relations Personal items Bring only necessary items. Patients may Silverstein Building, 1st Floor, 215.662.2575 be moved to different care areas during their Support Person(s) Mona Matson, Associate Director, Patient and Guest Relations and Reception hospital stay. Labeling all personal items Patients are asked to identify their support Robin Arrington-Thompson, Manager of Reception and Patient Coordinator helps to keep track of them. At times, the person(s) whose presence will provide Amanda Esterly, Patient Coordinator nursing staff may need to do an inventory emotional support, comfort and help alleviate Steven Rose, Patient Coordinator of patient belongings. Please do not bring fears. With patient permission, this person Annie Gilbert, Patient and Family Liaison valuables such as jewelry and electronics. may stay throughout the inpatient stay, participate in planning for care and discharge, and provide support by learning new Reception Medications Patients’ medication history is very important. information. The Reception teams at HUP (main entrance and Silverstein 1, Mezzanine) and Doctors and nurses will ask repeatedly about Perelman Center for Advanced Medicine (ground lobby and 1st floor atrium) are medications taken at home. Clinical rounds, patient education sessions happy to assist you and your family members by providing information, wheelchair and discharge planning will accommodate assistance, and escort to your destination, if requested. These members of the Patient Medications taken while in the hospital are having the support person(s) present. The and Guest Relations team are our ‘welcoming partners’ and want to meet the needs prescribed specifically for the hospital stay. support person(s) may be present throughout of our guest. Please do not hesitate to ask any of our Reception team members for Some may be new or different compared to the stay unless their presence infringes on assistance. a patient’s medication history. A hospital others’ rights, safety, or is medically or pharmacist reviews all medications and therapeutically contraindicated. For urgent needs, please call HUP security at 215.662.2677 (COPS).

2 3 Support persons will receive a blue identification The Patient Experience ■■ Medical Student: Student learning to Advance Practice Provider Team: bracelet. They will need to show the bracelet become a doctor. ■■ Nurse Practitioner (NP): Registered nurse Know who is providing care—it’s your right! to the information desk, security and other ■■ Consultant: Doctor with expertise in a with advanced education and clinical training All employees and volunteers at the Hospital HUP staff. If the support person(s) plans particular area; may be called on by the who provides a wide range of preventive and of the University of Pennsylvania wear photo to remain in the hospital overnight, the medical team to help with patient care. acute health care services. nursing staff will coordinate while taking identification badges and should tell patients their name and role. ■■ Physician Assistant (PA): Trained and into consideration the needs of other patients Discharge Planning Team: licensed to practice medicine under the and families in the area. In situations where ■■ Clinical Resource Coordinator: Nurse supervision of a physician. there are shared rooms, coordination may The Nurse Team provides direct care to who sets up home needs (medications, ■■ Certified Nurse Midwife (CNM): Provides include the other patient, his or her family patients and helps coordinate care. ■■ Nurse Manager: Leader of the floor. medical equipment, visiting nurses and counseling and care during preconception, and their support person(s). home therapists), transportation and can ■■ Charge Nurse: Works as a problem solver pregnancy, childbirth and the postpartum help with insurance issues. period. Visitors and can address any patient concerns. ■■ Social Worker: Offers support, makes Visiting hospitalized loved ones is a way of ■■ Clinical Nurse Specialist: Assists with skilled referrals to community support agencies, and showing support and offering encouragement. needs such as wound care. Other Important Team Members: arranges patient transfers to nursing homes, ■■ Phlebotomist: Collects blood tests ordered Patients should discuss with family and ■■ Registered Nurse: Coordinates patients’ daily rehab centers and other facilities. by physicians. friends when they would like to receive schedules, gives medications and provides visitors and who should visit. education; works with the doctors to keep ■■ Transport Staff: Takes patients to tests and Therapist Team: patients and their families updated. studies around the hospital. ■■ Physical Therapist: Works with patients to - They are dressed in navy blue uniforms. - They are dressed in teal uniforms. maintain and improve strength, walking and ■■ ■■ Certified Nursing Assistant (CNA):Assists Chaplain: Brings expertise in helping patients balance. and families draw upon their own spiritual with bathing, dressing, grooming, eating and - They are dressed in light blue uniforms. other needs. resources, values and traditions for healing. ■■ Occupational Therapist: Works with patients - They are dressed in maroon uniforms. Care is provided for all persons, not only those on self-care activities such as feeding, bathing who identify as religious or spiritual. ■■ Unit Secretary: Answers call bell system and and grooming. assists visitors. - They are dressed in light blue uniforms. - They are dressed in tan uniforms. Registered Nurse ■■ Respiratory Therapist: Evaluates and treats patients with breathing disorders. The Physician Team performs a daily Certified Nursing ■■ Speech Therapist: Helps patients with a medical history and physical exam, and Assistant (CNA) variety of speech and swallowing disorders. orders tests and treatments. ■■ ■■ Attending: Doctor in charge of patient care. Nutritionist: Evaluates and recommends Unit Secretary dietary changes that will promote recovery ■■ Fellow: Doctor receiving advanced training and maintain health. in a specific area. Physical and Occupational ■■ Pharmacist: Reviews all aspects of patients’ Therapists ■■ Resident: Doctor who supervises the intern medications, including education about new to direct patient care. medications and their side effects. Transport Staff ■■ Intern: Doctor responsible for coordinating

all aspects of patient care.

4 5 Room Accommodations security department. HUP is not responsible Stop Smoking Resources Discharge Room assignments are based on medical needs for belongings or valuables that are not ■■ Pennsylvania Quitline: 1.877.724.1090 The doctor and nurse provide patients with and bed availability. During hospitalization, secured with the security department. ■■ SmokeFree Philly: 1.800.QUIT.NOW, detailed instructions about post-hospital patients may be asked to change rooms to smokefreephilly.org care. Questions about diet, activities or accommodate their medical needs or the Safety other matters should be directed to the nurse. ■■ Centers for Disease Control and Prevention: As part of HUP’s emergency management medical needs of other patients. cdc.gov/tobacco/quit_smoking The entire care team works with patients to system, alarms may be activated and support their transition out of the hospital. ■■ American Lung Association: Telephone announcements made over the loud speaker. lungusa.org/stop-smoking A telephone is located at every bedside. Local Fire and disaster drills are conducted regularly. Pharmacy calls are free within area codes 215, 267, If an alarm occurs, please follow the direction ■■ American Heart Association: Patients can have their prescriptions filled 610, 484, 856, 609 and 302. All other calls of HUP staff. The hospital is a fire-resistant heart.org/quitsmoking at the hospital, prior to discharge. The HUP require operator assistance and are charged building. HUP staff is trained in fire pharmacy accepts most insurance plans. to a home phone bill, credit card, calling card protection, fire safety and disaster response Leaving the Hospital (Discharge) Location: (available in the gift shop) or the call recipient to ensure safety for patients and visitors. Planning for discharge begins when patients ■■ Ravdin Building, 1st Floor are admitted to the hospital. Throughout (calling collect). Hours of operation: Security the hospital stay, HUP staff will work with ■■ Monday to Friday, 7 am to 5:30 pm Television HUP security staff is focused on the safety patients, their support person(s), and their ■■ Saturday and Sunday, 9 am to 2 pm Patients have access to a television with and welfare of everyone utilizing HUP family to assess patient needs and identify closed captioning free of charge. The unit facilities and services. resources to meet these needs. Patients may ■■ Closed major holidays secretary can provide headphones—to be Locations: meet with a social worker or clinical resource Telephone: used while watching TV late at night or at a HUP Security Office coordinator who will discuss options for ■■ 215.662.2920 high volume. Please call 215.662.3900 for ■■ Emergency Department, Silverstein Building, discharge, recommend a plan and coordinate repair service. Ground Floor the arrangements. Patient and Perelman Center Security Office Visitor Resources Pastoral Care ■■ Atrium Lobby, Ground Floor Social workers and clinical resource coordinators are part of the interdisciplinary Interfaith chaplains are available to visit with Penn Tower Security Important Telephone Numbers care team at HUP. Social workers can link patients and families 24 hours-a-day. They ■■ Main Lobby, Ground Floor For emergency situations of any type, can be reached at 215.662.2591. After 5 patients to community resources (such as please call 215.662.2677 (COPS). pm, please contact the hospital operator for skilled nursing and rehabilitation facilities) Smoke-free Environment Operator...... 215.662.4000 or (0) the chaplain on call. An interfaith chapel that meet health-related needs or concerns. The Hospital of the University of Pennsylvania is located on the first floor of the Dulles They can help patients and families cope with Patient room number....215.622.4000 or (0) discourages smoking and supports a smoke- building and is open 24 hours-a-day. illness or injury during their stay, and provide Patient and Guest Relations free environment for patients, staff and referrals to agencies at discharge. Clinical (see page 2)...... 215.662.2575 visitors. Patients are not permitted to smoke Valuables resource coordinators work with patients and Security...... 215.662.2677 (COPS) in or near the hospital. Smoking is prohibited HUP staff strive to provide a safe and secure families to arrange home care such as home Admissions office...... 215.662.2335 in and around all Penn Medicine facilities environment, but strongly recommend that nursing care and home medical equipment. and property, including sidewalks along Business office...... 215.662.2672 patients’ valuables be sent home. Valuables 34th Street and 50 feet from any entrance. Gift shop...... 215.662.2701 that must remain should be secured with the Patient accounts...... 215.662.2672

6 7 Parking for Patients and Visitors Long-Term Parking ■■ SEPTA Market/Frankford blue line Beauty and Grooming Services Penn Tower Garage* For patients requiring an extended (train/subway) stops at 34th and Market A hair stylist provides services for both men Self Park hospitalization, parking passes are available Streets. Once above ground, walk south on and women at bedside or the hospital salon ■■ 24 hours-a-day to family members at a discounted rate: 34th Street exactly three blocks to HUP. located on the first floor of the Maloney ■■ 15 day pass–allows unlimited in/out parking in ■■ Building. Hair services are available Patients/Family Non-Patients SEPTA Green Line (trolley) stops at 37th Up to 3 hours $ 7 $13 Penn Tower Garage for 15 consecutive days. and Spruce Streets, three blocks from HUP. during regular business hours and cash 3 to 7 hours $10 $18 (Cost: $80) Use any westbound trolley except Route 10. payment is expected at the time of service. 7 to 24 hours $11 $20 ■■ 7 day pass—allows unlimited in/out parking ■■ LUCY Gold & Green buses run from A care provider can assist in scheduling in Penn Tower Garage for seven consecutive 30th Street Station to HUP at 34th and appointments for patients. Hospital of the University of Pennsylvania* days. (Cost: $45) Spruce streets. Valet Parking (main entrance) There is no reimbursement for days not used Surgical Family Waiting Area Dulles Building, 2nd Floor ■■ 5:30 am to 10 pm, Monday through Friday or lost/stolen cards. New Jersey PATCO Trains ■■ Hours: 6:30 am to 9 pm ■■ Closed Saturday and Sunday PATCO provides transportation to 8th and Long-term parking passes can be purchased Market streets. Follow the underground The Surgical Family Waiting Area is a quiet, Patients/Family Non-Patients at the Penn Tower Garage cashier’s office concourse to the SEPTA Market East Station. comfortable lounge available for loved ones Up to 3 hours $10 $15 located on the Bridge Level of the Penn Tower From there take SEPTA regional rail lines of patients receiving surgery. Courtesy phones 3 to 7 hours $13 $19 building. Airport, Wilmington/Newark or Media-Elwyn and internet access are provided. Patient 7 to 24 hours $14 $21 to the University City Station on HUP campus. progress is displayed on digital displays and Public Transportation a nurse liaison is available for questions and Perelman Center for Advanced Medicine* SEPTA regional rail lines, Airport, Wilmington/ Alternate Route: Take SEPTA Market/ patient status updates. Self Park Newark, and Media-Elwyn and most Frankford blue line westbound to 34th and ■■ 5 am to 11 pm, Monday through Friday Warminster and West Trenton trains provide Market Streets. Once above ground, walk The Pavilion ■■ 7 am to 2 pm, Saturday direct service to the University City Station on south on 34th Street exactly three blocks to The Pavilion is an inpatient unit designed ■■ Closed Sunday the Hospital of the University of Pennsylvania HUP at the corner of 34th and Spruce streets. for patients requesting amenities usually Patients/Family Non-Patients campus. From other regional rail lines, found at deluxe hotels. Amenities include Up to 3 hours $ 7 $13 passengers should transfer to the Airport, Mass Transit Telephone Numbers express check-in and check-out, private 3 to 7 hours $10 $18 Wilmington-Newark or Media-Elwyn. The ■■ SEPTA information: 215.580.7800 rooms, chef-prepared meals and a concierge 7 to 24 hours $11 $20 train ticket serves as the transfer ticket. ■■ PATCO information: 215.922.4600 to assist in scheduling personal services. There are additional fees associated with The ■■ AMTRAK information: 800.872.7245 Valet Parking Northeast corridor AMTRAK trains stop at Pavilion that are not covered by insurance. 30th Street Station. From there, the SEPTA To reserve a room, please contact a Pavilion ■■ 5:30 am to 9 pm, Monday through Friday regional rail lines Airport, Wilmington-Newark Walking Escorts representative by calling 215.662.4141. ■■ Closed, Saturday and Sunday or Media-Elwyn travel to the University City HUP Security provides walking escorts to Patients/Family Non-Patients Station. Taxi services are available from 30th any employee, patient or visitor who requests Up to 3 hours $10 $15 Street Station. an escort to parking garages, lots and streets 3 to 7 hours $13 $19 surrounding the hospital perimeter. Escorts 7 to 24 hours $14 $21 are always available—timing depends on security officer availability. Please call *For ages 62 and over: 215.662.2677 to request a walking escort. $1 discount for up to three hours, $2 discount for three hours or more 8 9 Patient and Family Education Center Insurance and Billing companies. Regardless of the type of insurance, Silverstein Building, 1st Floor bills are ultimately the responsibility of patients. Patients are responsible for providing The Patient and Family Education Center Any portion of the bill not paid promptly by necessary insurance information and for is an area for patients and families to learn insurance companies is charged directly to working with the hospital to make payment more about their health through access to: patients, such as co-payments and deductibles. arrangements when necessary. ■■ Health magazines, pamphlets, videotapes and reference books Understanding the Hospital Bill Penn Medicine provides financial counseling Shortly after returning home, patients will receive ■■ Computer programs and, where appropriate, significant discounts a statement, or bill, listing the charges for the ■■ Online health information (including to uninsured and underinsured persons in hospital stay. Depending on the services received, PennMedicine.org and OncoLink®) myPennMedicine accordance with the Patient Protection and there may be more than one bill. In addition to ■■ Affordable Care Act. Patients’ concerns myPennMedicine Patient-accessible, online health the daily charge for the room, this statement about their ability to pay their hospital bill ■■ Information on local and national support records includes charges for such services as anesthesia, groups and agencies should be directed to HUP’s Patient Financial X-rays, laboratory work, blood transfusions and Penn’s online health management tool, Services Office at 877.433.5299. ■■ Health education classes myPennMedicine, provides patients with the operating room. The initial statement also secure and confidential access to their shows an estimate of payments expected from Insurance Information insurance companies. Later statements show Lost and Found personal medical record. Insurance and third party payer information Lost and found items are accepted and stored payments received from insurance companies and must be provided. Patients should have their payments due from the patient, if any. in the Security Operations Center located on FEATURES: insurance cards with them when speaking the ground floor of the Silverstein building, ■■ Request an appointment, view future with a pre-admission representative by phone Physicians’ Bills next to the Emergency Department entrance. appointments or cancel an existing or when arriving at the hospital. HUP staff Charges for physicians’ services are not Reasonable effort is made to contact owners appointment. contacts insurance carriers to verify patient of lost property and return identifiable items. included in the hospital bill. Most of the ■■ Request prescription renewals, physician benefits, co-pay and deductible information physicians involved in patient care send Employees, patients and visitors can call HUP referrals, and pre-certifications. and assist with any required approvals and Security at 215.662.2677 to inquire about separate bills for their services. Patients may ■■ View lab results, list of medications and referrals. HUP staff may contact patients to lost items. receive bills from their primary physician, health summaries. review this information. anesthesiologist, radiologist and/or pathologist. ■■ Communicate with the doctor’s office. Charges for some specialized services are After Hours Access Payment Due Prior to Service On a daily basis, all entrances to the hospital ■■ Review details of previous appointments. also billed separately. Payments or payment Payments of deductibles, co-payments and non- questions about these bills should be directed to are locked from 11 pm to 5 am. During ■■ Access discharge instructions. covered services (such as transportation) are the appropriate physician’s office. this time, everyone must enter through the expected at or prior to the time of service. Payments Emergency Department entrance on 34th To learn more about myPennMedicine, visit can be made by cash, credit card or check. Street. Questions about the Bill? myPennMedicine.com. For any questions about the hospital bill prior Filing an Insurance Claim to or during hospitalization, please contact a The Hospital of the University of Pennsylvania business services representative. Please note that files insurance claims on patients’ behalf. This explanations of charges for hospital services does not release patients from responsibilities are available for review in the Business Services for charges billed to their account. Insurance office during regular working business hours. contracts are between patients and insurance After leaving the hospital, patients may call 10 877.433.5299. 11 Ways to Give Back Philanthropy – Giving to Penn Patient Bill of Rights confidential and should be conducted to the Hospital of Every day, the physicians, nurses and staff at and Responsibilities discreetly, giving reasonable visual and auditory Penn Medicine work tirelessly to improve the privacy when possible. This includes the the University of As a health care facility within the University health of every patient. The costs of this work right, if requested, to have someone present Pennsylvania of Pennsylvania Health System (UPHS), we can seem staggering, and they are not covered while physical examinations, treatments, or Patient Survey are committed to delivering quality medical by billing, insurance and government funds procedures are being performed, as long as Hospital of the University of Pennsylvania care to you, our patient, and to making your alone. From the research that leads to cures they do not interfere with diagnostic procedures staff is interested in patients’ feedback stay as pleasant as possible. The following and compassionate care that promotes healing, or treatments. This also includes the right to about their stay. When patients share their “Statement of Patient’s Rights,” endorsed by to the technology that saves lives—donations request a room transfer if another patient or a experiences, HUP staff learns what was the administration and staff of this facility, from patients and families make critical visitor in the room is unreasonably disturbing helpful and can identify opportunities for applies to all patients. In the event that you advances possible. you and if another room equally suitable for improvement. Some patients will receive are unable to exercise these rights on your your care needs is available. a formal survey by mail—HUP staff asks own behalf, then these rights are applicable Each gift, large or small, to the Penn Medicine ■■ You have the right to have all information, that they complete the survey and return as to your designated/legally authorized Friends Fund makes a difference. Making including records, pertaining to your medical indicated. representative. As it is our goal to provide a gift is also a wonderful way to honor a care treated as confidential except as otherwise medical care that is effective and considerate physician, nurse, friend or family member. provided by law or third-party contractual Any patients not receiving a survey may within our capacity, mission, and philosophy, To learn more or make a gift, please visit arrangements. send feedback by mail to: applicable law and regulations, we submit PennMedicine.org/giving, send an e-mail to these to you as a statement of our policy. ■■ You have the right to know what hospital Hospital of the University of [email protected] or call 215.898.0578. Pennsylvania policies, rules, and regulations apply to your Patient and Guest Relations Statement of Patient’s Right conduct as a patient. Blood Donation 3400 Spruce Street ■■ You have the right to respectful care given ■■ You have the right to expect emergency Silverstein Building, First Floor Every day, patients at Penn Medicine hospitals by competent personnel which reflects procedures to be implemented without Philadelphia, PA 19104 require blood transfusions while being treated. consideration of your personal values and unnecessary delay. One out of every 10 hospital patients needs a belief systems and which optimizes your ■■ Volunteer blood transfusion. For these patients, there is You have the right to good quality care comfort and dignity. The volunteers at the Hospital of the no substitute for human blood. and high professional standards that are University of Pennsylvania are an integral ■■ You have the right, upon request, to continually maintained and reviewed. part of life in the hospital. These members of The Penn Medicine Blood Donation be given the name of your attending ■■ You have the right to full information in the health care team visit patients, as well as Center was established to provide the Penn physician, the names of all other physicians or layperson’s terms, concerning diagnosis, staff the Emergency Department, Welcome community and visitors with a convenient practitioners directly participating in your care, treatment, and prognosis, including information Center, Surgical Waiting Lounge and various means of donating blood that will be and the names and professional status of about alternative treatments and possible office areas. Volunteers are always welcome used for patients at the Hospital of the other health care personnel, including medical complications. When it is not medically to give of their time during the weekday and University of Pennsylvania. This helps students, residents or other trainees, having advisable that such information be given to evenings. For more information, please call to ensure a continuous, uninterrupted direct contact with you. you, the information shall be given on your 215.662.2576. supply of blood. Family and visitors can ■■ You have the right to every consideration behalf to your designated/legally authorized schedule an appointment to donate blood at of privacy concerning your medical care representative. Except for emergencies, the PennMedicine.org/giveblood. program. Case discussion, consultation, physician must obtain the necessary informed examination, and treatment are considered consent prior to the start of any procedure or treatment, or both.

12 13 ■■ You have the right to not be involved in any ■■ You cannot be denied the right of access to ■■ You have the right to make decisions ■■ You have the right to participate in the experimental, research, donor program, or an individual or agency who is authorized to act regarding the withholding of resuscitative consideration of ethical issues surrounding educational activities unless you have, or your on your behalf to assert or protect the rights set services or the foregoing of or the withdrawal your care, within the framework established by designated/legally authorized representative out in this section. of life-sustaining treatment within the limits of this organization to consider such issues. has, given informed consent prior to the actual ■■ You have the right to have a family member the law and the policies of this institution. ■■ You have the right to formulate an participation in such a program. You or your or representative of your choice and ■■ You have the right to receive care in a safe “advance directive,” including the right to designated/legally authorized representative your physician notified promptly of your setting, and be free from all forms of abuse appoint a health care agent to make health may, at any time, refuse to continue in any admission to the hospital. and harassment. care decisions on your behalf. These decisions such program to which informed consent has ■■ You have the right to medical and nursing ■■ You have the right to be free from restraint will be honored by this facility and its health previously been given. services without discrimination based upon and seclusion not medically necessary or care professionals within the limits of the law ■■ You have the right to accept medical age, sex, race, color, ethnicity, religion, gender, used as a means of coercion, discipline, and this organization’s mission, values and care or to refuse any drugs, treatment, or disability, ancestry, national origin, marital convenience or retaliation by staff. philosophy. If applicable, you are responsible procedure offered by the institution, to the for providing a copy of your “advance status, familial status, genetic information, ■■ You have the right to have your medical extent permitted by law, and a physician shall gender identity or expression, sexual orientation, record read only by individuals directly directive” to the facility or caregiver. inform you of the medical consequences of culture, language, socioeconomic status, involved in your care, by individuals monitoring ■■ You are not required to have or complete such refusal. domestic or sexual violence victim status, the quality of your care, or by individuals an “advance directive” in order to receive ■■ You have the right to assistance in source of income, or source of payment. authorized by law or regulation. You have the care and treatment in this facility. obtaining consultation with another ■■ You have the right to appropriate right to receive written notice that explains When this facility cannot meet the request or physician at your request and expense. assessment and management of pain. how your personal health information will be need for care because of a conflict with our ■■ You have the right to expect good ■■ You have the right, in collaboration with used and shared with other health care mission or philosophy or incapacity to meet management techniques to be implemented your physician, to make decisions involving professionals included in your care. You or your your needs or request, you may be transferred within this health care facility considering your health care. This right applies to the family designated/legally authorized representative, to another facility when medically permissible. effective use of your time and to avoid your and/or guardian of neonates, children, and upon request, will have access to all Such a transfer should be made only after personal discomfort. adolescents. information contained in your medical records, you or your designated/legally authorized unless access is specifically restricted by the ■■ You have the right to examine and receive a ■■ While this health care facility recognizes representative has received complete detailed explanation of your bill. your right to participate in your care and attending physician for medical reasons. information and explanation concerning the ■■ You have the right to full information and treatment to the fullest extent possible, ■■ You have the right to be communicated need for, and alternatives to, such a transfer. counseling on the availability of known there are circumstances under which you with in a manner that is clear, concise and The transfer must be acceptable to the other financial resources for your health care. may be unable to do so. In these situations understandable. If you do not speak English, institution. you should have access, where possible, free ■■ ■■ You have the right to expect that the health (for example, if you have been adjudicated You have the right, to decide whether you care facility will provide a mechanism whereby incompetent in accordance with law, are found of charge, to an interpreter. This also includes want visitors or not during your stay here. you are informed upon discharge of continuing by your physician to be medically incapable providing you with help if you have vision, You may designate those persons who can health care requirements following discharge of understanding the proposed treatment speech, hearing or cognitive impairments. visit you during your stay. These individuals and the means for meeting them. or procedure, are unable to communicate ■■ You have the right to access protective do not need to be legally related to you. They your wishes regarding treatment, or are an services. You have the right to be free from may include, for example, a spouse, domestic ■■ You have the right to seek review of quality partner, including a same sex partner, another of care concerns, coverage decisions, and unemancipated minor) your rights are to be neglect, exploitation, and verbal, mental, family member, or a friend. The hospital will concerns about your discharge. exercised to the extent permitted by law, by physical and sexual abuse. your designated representative or other legally not restrict, limit, or deny any approved visitor authorized person. 14 15 on the basis of race, color, national origin, Penn Presbyterian Medical Center Statement of Patient’s refrain from conducting any illegal activity on religion, sex, gender identity, sexual orientation 286 Wright Saunders Responsibilities UPHS property. If such activity occurs, UPHS or disability. The hospital may need to limit or 39th & Market Streets will report it to law enforcement. Philadelphia, PA 19104 As a patient, you should act in accordance restrict visitors to better care for you or other ■■ In order to facilitate your care and the efforts of 215-662-9100 with UPHS policies, rules, and regulations patients. You have the right to be made aware the health care personnel, you are expected to and assume responsibility for the following: of any such clinical restrictions or limitations. Pennsylvania Hospital help the physicians, nurses, and allied medical ■■ You have the right to designate a family 800 Spruce Street personnel in their efforts to care for you by ■■ This health care facility expects that you member, friend, or other individual as a 1 Preston following their instructions and medical orders. Philadelphia, PA 19107 or your designated/legally authorized support person during the course of your 215-829-8777 representative will provide accurate and ■■ Duly authorized members of your family or stay or during a visit to a physician, or other complete information about present designated/legally authorized representative are ambulatory care treatment. If you or a family member thinks that a complaints, past illnesses, hospitalizations, expected to be available to UPHS personnel ■■ You have the right to give or withhold complaint or grievance remains unresolved, medications, “advance directives,” and other for review of your treatment in the event you informed consent to produce or use through the hospital process you also have matters relating to your health history or care are unable to properly communicate with your recordings, films or other images of you for the right to contact one of the following in order for you to receive effective medical health caregivers. purposes other than your care. organizations about your care or treatment if treatment. ■■ It is understood that you assume the financial ■■ You have the right, without recrimination, it has not been resolved to your satisfaction: ■■ In addition, you are responsible for reporting responsibility of paying for all services to voice complaints regarding your care, to whether you clearly understand the planned rendered either through third-party payers The Division of Acute and have those complaints reviewed, and, when course of action and what is expected of you. (your insurance company) or being personally possible, resolved. Ambulatory Care responsible for payment for any services which Pennsylvania Department of Health (DOH) ■■ It is expected that you will cooperate with are not covered by your insurance policies. P.O. Box 90 all hospital personnel and ask questions if For Further Information Harrisburg, PA 17120 directions and/or procedures are not clearly ■■ It is expected that you will not take drugs which If you have questions or problems concerning 800-254-5164 understood. have not been prescribed by your attending your care, please speak with your physician, physician and administered by appropriate staff ■■ You are expected to be considerate of other nurse or other hospital or ambulatory Centers for Medicare and and that you will not complicate or endanger Medicaid Services (CMS) patients and health care personnel, to assist in practice representative before you leave the the healing process by consuming alcoholic 800-MEDICARE. the control of noise and visitors in your room, clinical site. beverages or toxic substances during your and to observe the non-smoking policy of hospital stay and or visit. The Joint Commission, this institution. You are also expected to be You may also direct your concerns regarding Office of Quality Monitoring respectful of the property of other persons ■■ Our entire Penn Medicine team thanks you for your health care or questions about the Patient One Renaissance Boulevard choosing to receive your care here. It is our Oakbrook, Terrace, IL 60181 and the property of the Health System. Bill of Rights and Responsibilities to the pleasure to serve and care for you. 800-994-6610 Threats, violence, disruption of patient care or appropriate Patient & Guest Relations Office: Email: [email protected] harassment of other patients, visitors or staff Rev. date July 2011 will not be tolerated. You are also expected to Hospital of the University of Pennsylvania Information regarding your rights as a 3400 Spruce Street patient should be provided to you during the 1 Silverstein admissions process or at the earliest possible Philadelphia, PA 19104 appropriate moment during the course of 215-662-7378 Garry L. Scheib Michele M. Volpe Elizabeth Johnston R. Michael Buckley, M.D. your hospitalization. Executive Director, Executive Director, Executive Director, Clinical Executive Director, Hospital of the University of Penn Presbyterian Medical Practices of the University of Pennsylvania Hospital Pennsylvania Center Pennsylvania

16 17 USES AND DISCLOSURES OF YOUR PERSONAL HEALTH Persons Involved In Your Care. Unless you object, we may in our • We may release your personal health information to certain HIPAA: Notice of INFORMATION professional judgment disclose to a member of your family, a close governmental agencies if we suspect child abuse or neglect; we may The following categories detail the various ways in which we may use friend, or any other person you identify, your personal health also release your personal health information to certain governmental Privacy Practices or disclose your personal health information. For each category of uses information to facilitate that person’s involvement in caring for agencies if we believe you to be a victim of abuse, neglect, or domestic This notice describes how medical information about you may be used or disclosures, we will give you illustrative examples. It should be noted you or in payment for that care. We may use or disclose personal violence; and disclosed, and how you can get access to this information. Please that while not every use or disclosure will be listed, each of the ways health information to assist in notifying a family member, personal • We may release your personal health information to entities regulated review it carefully. Changes on this notice will not be honored. we are permitted to use or disclose information will fall into one of the representative or any other person that is responsible for your care by the Food and Drug Administration if necessary to report adverse following categories. of your location and general condition. We may also disclose limited events, product defects, or to participate in product recalls; You will be asked to acknowledge that you have received our notice of personal health information to a public or private entity that is privacy practices. Your Authorization. Except as outlined below, we will not use or authorized to assist in disaster relief efforts in order for that entity to • We may release your personal health information to your employer disclose your personal health information for any purpose unless locate a family member or other persons that may be involved in some when we have provided health care to you at the request of your We understand that information about you and your health is very you have signed a form authorizing the use or disclosure. This form aspect of caring for you. employer for purposes related to occupational health and safety; in personal and therefore, we will strive to protect your privacy as required will describe what information will be disclosed, to whom, for what most cases you will receive notice that information is disclosed to your by law. We will only use and disclose your personal health information purpose, and when. You have the right to revoke that authorization in Fundraising. We may contact you, at times in coordination with your employer; as allowed by applicable law. writing, except to the extent we have already relied upon it. physician, to donate to a fundraising effort on our behalf. If we contact • We may release your personal health information if required by law you for fundraising purposes, you will be provided with the opportunity to a government oversight agency conducting audits, investigations, We are committed to excellence in the provision of state-of-the-art Uses and Disclosures for Treatment. We will make uses and disclosures to opt out of receiving any future solicitations. inspections and related oversight functions; health care services through the practice of patient care, education, of your personal health information as necessary for your treatment. and research. Therefore, as described below, your health information For instance, doctors, nurses, and other professionals involved in your Appointments and Services. We may use your personal health • We may use or disclose your personal health information in emergency will be used to provide you care and may be used to educate health care will use information in your medical record and information that information to remind you about appointments or to follow up on your circumstances, such as to prevent a serious and imminent threat to a care professionals and for research. We train our staff and workforce you provide about your symptoms and reactions to plan a course of visit. person or the public; to be sensitive about privacy and to respect the confidentiality of your treatment for you that may include procedures, medications, tests, etc. • We may release your personal health information if required to do so personal health information. We may also disclose your personal health information to institutions Health Products and Services. We may from time to time use your by a court or administrative order, subpoena or discovery request; in and individuals outside the University of Pennsylvania Health System personal health information to communicate with you about treatment most cases you will have notice of such release; We are required by law to maintain the privacy of our patients’ personal and the Perelman School of Medicine that are or will be providing alternatives and other health-related benefits and services that may be of health information and to provide you with notice of our legal duties treatment to you. interest to you. • We may release your personal health information to law enforcement and privacy practices with respect to your personal health information. officials to identify or locate suspects, fugitives or witnesses, or victims We are required to abide by the terms of this Notice of Privacy Practices Uses and Disclosures for Payment. We will make uses and disclosures Research. We may use and disclose your personal health information of crime, or for other allowable law enforcement purposes; so long as it remains in effect. We reserve the right to change the terms of your personal health information as necessary for payment as permitted or required by law for research, subject to your explicit • We may release your personal health information to coroners, medical of this Notice of Privacy Practices as necessary and to make the new purposes. For instance, we may forward information regarding your authorization, and/or oversight by the University of Pennsylvania examiners, and/or funeral directors; Notice of Privacy Practices effective for all personal health information medical procedures and treatment to your insurance company to Institutional Review Boards (IRBs), committees charged with protecting maintained by us. You may receive a copy of any revised notice at arrange payment for the services provided to you or we may use your the privacy rights and safety of human subject research, or similar • We may release your personal health information if necessary to any of our hospitals or doctors’ offices, or a copy may be obtained by information to prepare a bill to send to you or to the person responsible committee. In all cases where your specific authorization has not been arrange an organ or tissue donation from you or a transplant for you; mailing a request to the UPHS Privacy Office, 3rd floor, 3550 Market for your payment. obtained, your privacy will be protected by confidentiality requirements • We may release your personal health information if you are a member Street, Philadelphia PA 19104-3329. evaluated by such committee. For example, the IRB may approve the of the military for activities set out by certain military command Uses and Disclosures for Health Care Operations. We will use use of your health information to conduct outcomes research to see if a authorities as required by armed forces services; we may also release The terms of this Notice of Privacy Practices apply to the following and disclose your personal health information as necessary, and as particular procedure is effective. your personal health information if necessary for national security, entities owned and operated by and/or affiliated with the Trustees of permitted by law, for health care operations. This is necessary to run intelligence, or protective services activities; and the University of Pennsylvania: the University of Pennsylvania Health the University of Pennsylvania Health System and the Perelman School Business Associates. Certain aspects and components of our services System and its subsidiaries and affiliates, including but not limited to the of Medicine and to ensure that our patients receive high quality care are performed through contracts with outside persons or organizations, • We may release your personal health information if necessary for Hospital of the University of Pennsylvania, Pennsylvania Hospital, Penn and that our health care professionals receive superior training. For such as auditing, accreditation, legal services, etc. At times it may be purposes related to your workers’ compensation benefits. Presbyterian Medical Center, the Clinical Practices of the University example, we may use your personal health information in order to necessary for us to provide certain of your personal health information of Pennsylvania (CPUP), Clinical Care Associates (CCA), Clinical conduct an evaluation of the treatment and services we provide, or to to one or more of these outside persons or organizations who assist us Confidentiality of Alcohol and Drug Abuse Patient Records, HIV- Health Care Associates of New Jersey, P.C. (CHCA), Surgery Center review the performance of our staff. And, for education and training with our payment/billing activities and health care operations. In such Related Information, and Mental Health Records. The confidentiality of of Pennsylvania Hospital, Penn Medicine at Radnor, Penn Center for purposes, your health information may also be disclosed to doctors, cases, we require these business associates to appropriately safeguard alcohol and drug abuse patient records, HIV-related information, and Rehabilitation and Care, Penn Home Infusion Therapy, Wissahickon nurses, technicians, medical students, residents, fellows and others. the privacy of your information. Hospice, Penn Care at Home, the Ruth and Raymond Perelman Center mental health records maintained by us is specifically protected by state and/or Federal law and regulations. Generally, we may not disclose such for Advanced Medicine, Presbyterian Anesthesiology Foundation, Our Facility Directory. We use information to maintain a directory Other Uses and Disclosures. We are permitted or required by law information unless you consent in writing, the disclosure is allowed by a Presbyterian Multi-Specialty Group Practice Foundation, the Perelman function listing your name, room number, general condition and, if to make certain other uses and disclosures of your personal health court order, or in limited and regulated other circumstances. School of Medicine, Good Shepherd Penn Partners, Good Shepherd you wish, your religious affiliation. Unless you choose to have your information without your consent or authorization. Subject to Penn Partners Specialty Hospital at Rittenhouse, Good Shepherd information excluded from this directory, the information, excluding conditions specified by law: RIGHTS THAT YOU HAVE Penn Partners Penn Therapy and Fitness, and the physicians, licensed your religious affiliation, will be disclosed to anyone who requests it • We may release your personal health information for any purpose Access to Your Personal Health Information. Generally, you have the professionals, employees, volunteers, and trainees seeing and treating by asking for you by name. This information, including your religious required by law; right to access, inspect, and/or copy personal health information that we patients at each of these care settings. This Notice of Privacy Practices affiliation, may also be provided to members of the clergy, even if they maintain about you. Unless you are currently a patient in our hospital does not apply when visiting a non-CPUP, non-CCA or non-CHCA don’t ask for you by name. Please let our staff know when you check • We may release your personal health information for public health or during a scheduled appointment with a clinician, requests for access physician in their private medical office. in or register if you would like to have your information excluded from activities, such as required reporting of disease, injury, and birth and must be made in writing and be signed by you or your representative. this directory function. death, and for required public health investigations; We will charge you for a copy of your medical records in accordance with a schedule of fees established by applicable state law. You may obtain an access request form from the doctor’s office or Medical Records department of the hospital you visited.

18 19 Amendments to Your Personal Health Information. You have the ADDITIONAL INFORMATION right to request that personal health information that we maintain Complaints. If you believe your privacy rights have been violated, you about you be amended or corrected. We are not obligated to make all may file a complaint in writing with the doctor’s office or Guest Services requested amendments but will give each request careful consideration. department of the hospital you visited. You may also file a complaint All amendment requests, in order to be considered by us, must be with the Secretary of the U.S. Department of Health and Human in writing, signed by you or your representative, and must state the Services in Washington D.C. All complaints must be made in writing reasons for the amendment/correction request. If an amendment or and in no way will affect the quality of care you receive from us. correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe For further information. If you have questions or need further assistance that such notification is necessary. Please note that even if we accept regarding this Notice of Privacy Practices, you may contact us in writing your request, we may not delete any information already documented at UPHS Privacy Office, Office of Audit, Compliance and Privacy, 3819 in your medical record. You may obtain an amendment request form Chestnut Street, Suite 214, Philadelphia, PA 19104, or by telephone at from the doctor’s office or Medical Records department of the hospital (215) 898-7260, or by e-mail at [email protected]. you visited.

Accounting for Disclosures of Your Personal Health Information. You Effective Date. have the right to receive an accounting of certain disclosures made by This Notice of Privacy Practices is effective May 5, 2008. us of your personal health information except for disclosures made for purposes of treatment, payment, and healthcare operations or for certain other limited exceptions. This accounting will include only those disclosures made in the six years prior to the date on which the accounting is requested but, in no event will include disclosures prior to April 13, 2003. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from the doctor’s office or Guest Services department of the hospital you visited. The first accounting in any 12-month period is free; you will be charged a fee of $20 for each subsequent accounting you request within a 12-month period.

Restrictions on Use and Disclosure of Your Personal Health Information. You have the right to request restrictions on certain of our uses and disclosures of your personal health information for treatment, payment, or health care operations. For example, you may request that we do not share your health information with a certain family member. A restriction request form can be obtained from the doctor’s office or Guest Services department of the hospital you visited. We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event we have terminated an agreed upon restriction, we will notify you of such termination.

Confidential Communications.You have the right to request communications regarding your personal health information from us by alternative means or at alternative locations and we will accommodate reasonable requests by you. You must request such confidential communication in writing to each department to which you would like the request to apply.

Paper Copy of Notice. As a patient you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means. Our Notice may also be obtained on our website at www.uphs.upenn.edu.