Patient Rights and Responsibilities

You are a full partner in your care.

UnityPoint Health and our team members respect the rights, interests, and well-being of our patients. It is our policy that these rights shall be respected, and no patient — whether receiving care at a UnityPoint Health hospital or clinic — shall be required to waive these rights as a condition of treatment.

As a patient receiving care at a UnityPoint Health hospital or clinic, you have responsibilities to help make your care as effective as possible. For example, we expect you to provide correct and complete information about your health and past medical history, participate in treatment decisions, and communicate openly with our physicians and other health professionals during your planned treatment. In doing so, you are “helping us help you.”

Your rights as a patient—and your responsibilities—are described below. They are also set forth in the following downloadable brochure.

 

As a patient or patient’s representative (such as the parent or legal guardian of a minor patient), you have:

The Right to Respect
  • Be informed of your rights before providing or stopping care, when possible, in a format or manner that is understandable.
  • Be treated kindly and respectfully by UnityPoint Health Team Members.
  • Be treated in an environment that preserves your dignity.
  • Exercise your cultural, psychosocial, and spiritual beliefs and personal values and preferences—and have those beliefs, values, and preferences respected by us. However, the exercise of those beliefs, values, and preferences cannot interfere with the well-being of others and must be legally recognized and permitted.
  • Be free from restraint or seclusion (isolation) of any form that is not medically necessary or is used as a means of coercion (forcing), discipline, convenience, or retaliation (getting back at you). All patients have the right to be free from physical or mental abuse, and corporal (physical) punishment. Restraint or seclusion may only be imposed (used) by trained team members to ensure the immediate physical safety of the patient, our team members, or others and must be discontinued (stopped) at the earliest possible time.
  • Receive care in a safe and secure setting.
  • Be free from all forms of abuse, neglect, exploitation, or harassment.
  • Expect unrestricted access to communication. If visitors, mail, telephone calls, or other forms of communication are restricted as a component of your care, you will be included in any such decision.
  • Expect quality care that is consistent with sound nursing and medical practices.
  • Expect inclusive care. UnityPoint Health does not discriminate, exclude, or treat any person or groups of persons differently—and will not permit discrimination—on the basis of the individual’s inability to pay; on the basis of whether payment for services would be made under Medicare, Medicaid, or CHIP; or on the basis of race, color, creed, ethnicity, culture, language, sex, national origin, age, religion, sexual orientation, gender identity and/or expression, physical or mental disability, socioeconomic status, diagnosis, source of payment for care, marital or parental status, veteran’s status or any other protected class in any manner prohibited by federal or state laws.
The Right to Access Care
  • Receive treatment, care, and services within the capability and mission of UnityPoint Health and in compliance with law, regulation and payment policies.
  • Have language interpreters available at no cost to you. If you have vision, speech, hearing, language, or cognitive impairments, UnityPoint Health will address those communication needs.
  • Receive hospital care, treatment and services regardless of your ability to pay in accordance with the UnityPoint Health Financial Assistance Program.
  • In the hospital setting, receive “total patient care” to the best of our ability, including spiritual and emotional support for you and your family.
The Right to Information
  • Receive effective communication. When written information is provided, we will strive to ensure that it is presented in a format or manner that is understandable to you.
  • Know the name and professional status of the physician or other practitioners providing care, services, and treatment to you at the time of service. If you are in the hospital, you have the right to know the name of the physician or other practitioner who is primarily responsible for your care, treatment, and services.
  • Have a family member (or representative of your choice) and your own physician promptly notified of your admission to a UnityPoint Health hospital.
  • As required by law, access your information contained in your medical record within a reasonable timeframe when requested.
  • As required by law, request an amendment to your medical record, and receive a listing of how certain health information was shared by UnityPoint Health.
  • Be informed of the hospital rules and regulations applicable to your conduct as a patient.
  • Have access to your bill, including itemized charges, and receive an explanation of the charges regardless of the source of payment for your care. UnityPoint Health will provide access within a reasonable period of time following receipt of a request.
  • Receive information about rights as a Medicare beneficiary when admitted to a UnityPoint Health hospital.
  • Have UnityPoint Health hospitals support your right to access protective and advocacy services by providing a list of community resources.
The Right to Medical Treatment and Decision Making
  • Participate in the development and implementation of your plan of care, including your inpatient treatment/care plan, outpatient treatment/care plan, discharge plan, and pain management plan.
  • Be informed of your health status; be involved in care planning and treatment; be able to request or refuse treatment; and be informed of the medical consequences (effects) of such refusal. When you do not have capacity, your decision maker, as allowed by law, has the right to refuse care, treatment, and services on your behalf.
  • Receive appropriate assessment and management of pain.
  • Be informed about the outcomes of your care, treatment, and services, including unanticipated (unexpected) outcomes that you must be knowledgeable about to participate in current and future decisions affecting your care, treatment, and services.
  • Receive complete and current information concerning your diagnosis (what disease or condition you might have), treatment, and prognosis (what to expect) in terms you can understand. When it is not medically advisable to give such information, it may be made available to another person who has the right to know your health information.
  • Be given an explanation of any proposed procedure or treatment. The explanation should include a description of the nature and purpose of the treatment or procedure; the known risks or serious side effects; and treatment alternatives (other ways to provide treatment).
  • Have someone who can make medical decisions for you as allowed by law, when you are not able to make decisions about your care, treatment, and services.
  • Be informed by the practitioner of any continuing healthcare needs following discharge.
  • Consult with an available specialist of your choosing at your request and expense if a referral is not deemed medically necessary by your attending physician.
  • Have an “advance directive” (such as a living will or a healthcare power of attorney) and have your doctor and other team members who provide care to you agree to follow these directives. These documents express your choices about your future care or name someone to make health care decisions for you if you are unable. If you have a written advance directive, you should provide a copy to UnityPoint Health, your family and your doctor. You may review and revise your advance directive. The existence or lack of an advance directive does not affect your access to care, treatment, and services at UnityPoint Health. For more information, visit our Advance Care Planning web page.
  • Keep in mind that your requested facility may be unable to take you at the time of transfer, so your transfer could be to a different facility.
  • Receive medical evaluation, service and/or referral as indicated by the urgency of your situation. When medically permissible, you may be transferred to another facility only after having received complete information and explanation concerning the need for, and an alternative to, such a transfer. The facility to which you will be transferred must first accept the transfer and may not be the facility of your choice.
  • Be involved in decisions subject to internal review within UnityPoint Health or external review (such as by your insurance company) that results in denial (disapproval) of care, treatment, services, or payment based upon your assessed medical needs.
  • If your care involves any experimental methods of treatment, you have the right to consent or refuse to participate. If you do not participate, it will not affect your access to care, treatment, and services.
The Right to Privacy
  • Receive care and treatment that maintains your personal privacy.
  • Expect that all communications and records pertaining to your care will be treated confidentially as described in the UnityPoint Health Notice of Privacy Practices. If you want to have a paper copy of the UnityPoint Health Notice of Privacy Practices, please ask for one when you check in.
The Right to Receive Visitors at UnityPoint Health Hospitals
  • Be informed of your visitation rights, including any clinical restriction or limitation on such rights.
  • Be informed of the right, subject to your consent, to receive the visitors whom you designate (choose) and your right to withdraw or deny such consent at any time.
  • Ensure that all visitors enjoy full and equal visitation privileges consistent with patient preferences, regardless of their race, color, creed, ethnicity, culture, language, sex, national origin, age, religion, sexual orientation, gender identity and/or expression, physical or mental disability, socioeconomic status, marital or parental status, veteran’s status or any other protected class in any manner prohibited by federal or state laws.
Additional Rights if You are Receiving Pregnancy and Childbirth Care
  • Receive health care before, during and after pregnancy and childbirth.
  • Receive care for you and your infant that is consistent with generally accepted medical standards.
  • Choose a certified nurse midwife or physician as your maternity care professional. If your physician is part of a group or if you deliver and your physician is not available, you may not be able to specify services from your designated physician.
  • Choose your birth from the full range of birthing options available in your community.
  • Leave your maternity care professional and select another if you become dissatisfied with your care, except as otherwise provide by law.
  • Receive emotional and physical support during labor and birth.
  • Be informed if your caregivers wish to enroll you or your infant in a research study.
  • Have the ability for freedom of movement during labor and to give birth in the position of your choice, within generally accepted medical standards.
  • Contact with your newborn, except if we must provide necessary care to you or your infant.
  • Receive information about breastfeeding.
  • Decide collaboratively with your caregivers when you and your baby leave the birth site for home, based upon your condition and circumstances.
Additional Rights for Special Circumstances

 

As a patient, you have the responsibility:

  • To read this patient guide or request that it be read to you and ask questions about those parts you do not understand.
  • To provide accurate and complete information about your health care status, including present complaints, past illnesses, hospitalizations, medications, advance directives, and other matters relating to your health. You will report perceived risks in your care and unexpected changes in your condition, and you will affirm whether you clearly comprehend a contemplated course of action and what is expected.
  • To follow the treatment plan recommended by the practitioner primarily responsible for your care. This may include following the instructions of nurses and other health care professionals as they implement the practitioner's orders and enforce the applicable hospital rules and regulations.
  • For your actions if you refuse treatment or if you do not follow the practitioner's instructions.
  • To assure that the financial obligations of your care are fulfilled as promptly as possible.
  • To follow hospital rules and regulations affecting patient care and conduct
  • To be considerate of the rights of other patients and hospital personnel, and for assisting in the control of noise, smoking and the number of visitors in your room.
  • To ask questions when you do not understand what you have been told about your care or what you are expected to do.

 

Filing a Complaint

The Right to File a Complaint with UnityPoint Health
You may use the UnityPoint Health complaint/grievance resolution process for submitting a written or verbal concern to your caregivers, your healthcare practitioners, hospital, or clinic administration, or the guest or patient relations departments at UnityPoint Health locations. See UnityPoint Patient Advocates for where to submit a complaint, as well as questions or requests. Find the location where you are receiving care and use the corresponding contact information. If you submit a complaint or grievance, it will be investigated. Action will be taken to resolve the concern either verbally or in writing, when appropriate. You should receive a prompt written response upon receipt of your grievance from UnityPoint Health.


You may also submit complaints regarding violations of your rights, including the right not to be discriminated against, to other agencies that regulate or provide accreditation to UnityPoint Health locations. See the listing of State Health Agencies and Accreditation Organizations for contact information. It is not necessary to first use the UPH grievance process.

 

Thank you for choosing UnityPoint Health as your health care provider.

State Health Agencies

Iowa

Refer concerns or grievances regarding your hospital care (e.g., quality of care, premature discharge, or beneficiary complaints) to the Iowa Department of Inspections and Appeals, Health Facilities Division, Lucas State Office Building, Des Moines, Iowa 50319; (877) 686-0027 (toll free).

Refer concerns or grievances regarding discrimination to:

Iowa Civil Rights Commission
400 East 14th Street
Des Moines, Iowa 50319-0201

Phone: (515) 281-4121; (800) 457-4416 (toll free)

Fax: (515) 242-5840 (fax)

Use the  online civil rights complaint form when mailing, faxing, or emailing your complaint.

Illinois

Refer concerns regarding your hospital care to the Illinois Department of Public Health, Office of Health Care Regulation, Central Complaint Registry, 525 W. Jefferson St., Ground Floor, Springfield, IL 62761-0001; (800) 252-4343 (Central Complaint Registry Hotline); (800) 547-0466 (TYY); (217) 524-8885 (fax). Complaints may be emailed to  DPH.CCR@illinois.gov. You may use the Health Care Facilities Complaint Form when mailing, faxing, or emailing your complaint.

Refer concerns regarding discrimination to Illinois Department of Human Rights:

Chicago

555 West Monroe Street, Suite 700
Chicago, IL 60661

Phone: (312) 814-6200; (866) 740-3953 (TTY)

Fax: (312) 814-1436 (to Administration); (312) 814-6251 (to Charge Processing)

Springfield

524 S. 2nd Street, Suite 300
Springfield, IL 62701

Phone: (217) 785-5100; (866) 740-3953 (TTY)

Fax: (217) 785-5106

A contact form is available at Contact IDHR (illinois.gov).

Wisconsin

Complaints about hospitals should be directed to the Wisconsin Department of Health Services, Division of Quality Assurance, Bureau of Health Services, Complaint Coordinator, P.O. Box 2969, Madison, WI 53701-2969; 1-800-642-6552; Online Form: Complaint Intake Survey F-00607.

Complaints about discrimination should be directed to:

Wisconsin Department of Health Services
Civil Rights Compliance, 1 West Wilson Street, Room 651
P.O. Box 7850
Madison, WI 53707-7850

Phone: 1-608-267-4955

Fax: 1-608-267-1434; 1-711 or 1-800-947-3529 (TTY)

Email: DHSCRC@dhs.wisconsin.gov

You may use the online form available at Civil Rights Compliance Information | Wisconsin Department of Health Services.

For Medicare Patients

Illinois
Contact Telligen, the Medicare quality improvement organization for Illinois. Telligen may be reached at (800) 383-2856 (toll free); (515) 223-2900 (local); (515) 222-2407 (fax). More information is available at https://www.telligen.org.
Iowa
Refer quality of care concerns, premature discharge grievances or beneficiary complaints to Livanta, the external peer review organization for hospitals in Iowa. You may enter your concern online at www.livantaqio.com/en/States/Iowa or send your concern in writing to Livanta LLC BFCC-QIO, 10820 Guilford Road, Suite 202, Annapolis Junction, MD 20701-1105, or use their Helpline: (888) 755-5580; TTY: (888) 985-9295; Fax: (955) 694-2929.
Wisconsin
Contact Lake Superior Quality Innovation Network (LSQIN). LSQIN may be reached at (877) 787-2847 (toll free); (952) 853-8536 (local); (952) 853-8503 (fax). More information is available at https://www.stratishealth.org.

For Patients of Rural Health Centers

Grievance Related to a UnityPoint Clinic / UnityPoint Health Rural Health Clinic
If you have a grievance related to a UnityPoint Clinic / UnityPoint Health Rural Health Clinic, please speak with the members of your healthcare team or clinic administrator first. They can resolve most issues. In the event your complaint remains unresolved, you may file a complaint with the accrediting agency of the Rural Health Clinic, regardless of whether you contacted the clinic directly.
Anamosa / Jones Regional Medical Center

Contact the Iowa Department of Inspections & Appeals, Health Facilities Division, Lucas State Office Building, Des Moines, Iowa 50319, or telephone (877) 686-0027.

  • UnityPoint Health Jones Regional Medical Center – Anamosa
  • UnityPoint Health Jones Regional Medical Center – Urgent Care
  • UnityPoint Health Family Medical Center – Monticello
  • UnityPoint Health Family Medicine Clinic – Clarence
  • UnityPoint Health Family Medicine Clinic – Tipton
  • UnityPoint Health Family Medicine Clinic – Shellsburg
  • UnityPoint Health Family Medicine Clinic – Belle Plaine
  • UnityPoint Health Family Medicine Clinic – Vinton
Fort Dodge

Contact The Compliance Team, Inc., www.thecomplianceteam.org or telephone 1-888-291-5353.

  • UnityPoint Clinic Family Medicine – Pocahontas
  • UnityPoint Clinic Family Medicine – Lake View
  • UnityPoint Clinic Family Medicine – Eagle Grove
  • UnityPoint Clinic Family Medicine – Sac City
  • UnityPoint Clinic Family Medicine – Laurens
  • UnityPoint Clinic Family Medicine – Humboldt
  • UnityPoint Clinic Family Medicine Family Medicine – Second Avenue North
  • UnityPoint Clinic – Kenyon Road
  • UnityPoint Clinic – Pediatrics Fort Dodge
  • UnityPoint Clinic Family Medicine – Manson
  • UnityPoint Clinic Family Medicine – Buena Vista
  • UnityPoint Clinic Express – Fort Dodge
Grinnell

Contact The Compliance Team, Inc., www.thecomplianceteam.org or telephone 1-888-291-5353.

  • UnityPoint Heath – Grinnell Obstetrics and Gynecology clinic, Orthopedic clinic, ENT clinic or Pain clinic
  • UnityPoint Health – Grinnell Medical Clinic
  • UnityPoint Health – Montezuma Medical Clinic
  • UnityPoint Health – Grinnell Walk-In
  • UnityPoint Health – Internal Medicine
  • UnityPoint Health – Family Practice
Marshalltown

Contact the Iowa Department of Inspections & Appeals, Health Facilities Division, Lucas State Office Building, Des Moines, Iowa 50319, or telephone (877) 686-0027.

  • UnityPoint Health Family Medicine – Marshalltown
  • UnityPoint Health Family Medicine – Conrad
  • UnityPoint Health Family Medicine – State Center
  • UnityPoint Health Family Medicine – Tama/Toledo
  • UnityPoint Clinic Family Medicine – Grundy Center
  • UnityPoint Clinic Parkersburg Family Medicine – Parkersburg
  • UnityPoint Clinic Denver Family Medicine – Denver
  • UnityPoint Clinic Family Medicine – Rohlf Memorial
Muscatine

Contact the Iowa Department of Inspections & Appeals, Health Facilities Division, Lucas State Office Building, Des Moines, Iowa 50319, or telephone (877) 686-0027.

  • UnityPoint Clinic – Mulberry
  • UnityPoint Clinic Pediatrics – Mulberry
  • UnityPoint Clinic Family Medicine – North Port
  • UnityPoint Clinic Express Care – North Port
  • UnityPoint Clinic Express Care – Wilton

For Patients of Siouxland PACE

PACE (Program of All-Inclusive Care for the Elderly)
PACE is the Program of All-Inclusive Care for the Elderly provided by UnityPoint Health – Sioux City. Grievances or complaints related to PACE care may be submitted to the PACE staff verbally or in writing to: Siouxland PACE, 1200 Tri View Avenue, Sioux City, IA 51103. Any questions or complaints submitted must be documented and resolved by the PACE team. If the issue is not resolved to the patient’s satisfaction, they may also contact Iowa Medicaid Member Services at 1-800-338-8366.

For Patients of UnityPoint Health Sleep Labs

Fort Dodge & Grinnell
The Fort Dodge and Grinnell Sleep Labs are accredited by The Accreditation Commission for Health Care (ACHC). You may file a complaint with them via their website (www.achc.org), via phone (855) 937-2242 or via mail at ACHC, 139 Weston Oaks Ct., Cary, NC 27513.
Muscatine & Moline
The Muscatine and Moline Sleep Labs are Accredited by The American Academy of Sleep Medicine (AASM). You may file a complaint by filling out their form (https://aasm.org/wp-content/uploads/2017/07/AccreditationComplaintForm.pdf) and mailing it to The American Academy of Sleep Medicine, Attention: Accreditation Department, 2510 North Frontage Road, Darien, IL 60561, or you may fax it to (630) 737-9790.

Hospital Accreditation Organizations

Location Where Care is Received Accreditation Contact Information

Cedar Rapids,
Des Moines,
Dubuque,
Fort Dodge,
Grinnell,
Madison,
Marshalltown,
Quad Cities,
Sioux City,
Waterloo

To submit complaints directly to the accrediting agency DNV (Det Norske Veritas), patients, family members and other concerned parties should use this web form: www.dnvhealthcareportal.com/patient-complaint-report.

Or you may submit a complaint about your care directly to DNV at 866-496-9647 (phone) or 281-870-4818 (fax), or by e-mail to hospitalcomplaint@dnv.com , or by mail to DNV Healthcare USA Inc., ATTN: Hospital Complaint, 4435 Aicholtz Road, Suite 900, Cincinnati, OH 45245.