Authorization for Care and Services:
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Resident consents to the administration
of care and treatment services that are determined by the facility, resident's physician
and the resident, and to be appropriate to the residents well being, health and safety.
- The facility agrees to fully inform the resident in advance about
care and treatment, and to involve the resident in planning his or her care and treatment
program.
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Selection of Health
Care Professionals:
- The resident has the right to use any licensed, certified or registered health care professional as long as the professional complies with the facility's procedures and all rules and regulations of local, state and federal government. The facility will notify the resident or legally authorized representative that an alternative physician must be selected if the physician fails to comply with federal or state laws and the facility's procedures and rules. The parties agree the facility is not responsible for any acts or omissions of the resident's health care professional.
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Choice of Pharmacy:
- The facility offers pharmaceutical services through an independent pharmacy by contract. The resident has the right to select an alternate pharmacy, provided that the chosen pharmacy agrees in writing to provide all services set in forth by the facility's current pharmaceutical supply contract.
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Emergency Health Care
Services:
- The resident authorizes the facility to obtain emergency health care services when services are required and the resident's health care provider or alternate is unavailable.
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Medical Tests and Admissions
Exams:
- Wisconsin state law requires that a physician must certify in writing that the resident is free of communicable tuberculosis and clinically apparent communicable disease or that a physician has ordered procedures to treat any disease the resident may be found to have.
- Every resident shall have a physical exam by a physician within 48 hours following admission, unless an exam was performed within 15 days of admission.
- Every resident shall have a dental exam by a licensed dentist within six months after admission unless a dental exam was performed within six months before admission.
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Resident Responsibilities:
- The resident agrees to abide by the facility's rules and guidelines
as set forth in the resident guide. It is understood that these
rules and guidelines are subject to change from time to time
as conditions and circumstances may require. If and when any
of the policies and regulations change, the facility will notify
the resident in writing with as much advance notice as practical.
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Grievance procedures:
- If a resident is dissatisfied with any aspect of the facility's operation or the care provided, the resident or anyone acting on the resident's behalf may file a grievance with the facility.
- The facility will review the grievance as soon as possible in the manner set forth in the facility's grievance procedure. The resident may also contact the State Nursing Home Ombudsman or the Bureau of Compliance. A copy of the grievance procedure is available upon request.
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Personal Property, Valuables
and Funds:
- The resident has the right to retain and use personal clothing
and possessions and have the availability of storage as space
permits for personal effects and possessions. The facility has
the right to remove items if they violate any applicable statutes,
rules and laws. The facility maintains provisions for the safekeeping
of money and valuable personal property and the facility shall
not be liable for loss or damage to personal property unless
deposited with the facility. The resident is also responsible
for replacing or repairing damaged property.
- In order to ensure the safety of others, the resident agrees to obtain the facility's prior written agreement before bringing any electrical appliance on premise.
- The resident may manage his or her own financial affairs unless the resident delegates in writing such responsibility to the facility and the facility accepts such responsibility. Deposits and withdrawals for personal use may be made by authorized persons through the business office.
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Transfers within
the Facility:
The facility may transfer the resident for the following reasons:
- When necessary for the resident's health, medical reasons, safety or welfare.
- When the health, safety and welfare of other residents in the facility are endangered.
- Upon a resident's request.
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Transfers to Hospitals
or Other Facilities:
- A transfer will be the resident's choice and ordered by a physician. The facility will immediately notify the legally authorized representative of any such transfer. All pertinent information shall be transferred with the resident. All transfers, inter and intra facility, will be in accordance with state and federal laws.
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Photo Identification:
- The resident authorizes the facility to take his or her photo upon admission. The facility will only use the photo for the purpose of assisting staff or others in identifying residents. In the case of unauthorized absence from the facility, the resident authorizes the facility to use the photograph for the purpose of assisting the authorities in their efforts to locate the resident. The facility will make no other use of the photograph.
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Educational Programs
and Experimental Research:
- The facility cooperates with various educational programs.
Unless specifically denied elsewhere in writing, a resident
and/or legally authorized representative gives permission for
those students involved in educational programs to review the
resident's medical records and to attend resident's exams. The
facility will instruct students about confidentiality of medical
information. If the resident does not want to participate, he
or she can refuse at any time.
- Where experimental research is being conducted, the resident's consent in writing will be obtained for that specific program. The facility will inform the resident he or she is being considered for participation in experimental research. The resident may refuse to participate in experimental research.
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Smoking, Food
and Beverage:
- The facility has been designated as a smoke free building. Although, smoking is permitted in designated areas by facility residents only. There shall be no drinking of alcoholic beverages except as prescribed by the resident's physician. The resident or legally authorized representative agrees to obtain facility permission before bringing food or beverages into the facility.
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Insurance:
- If requested by the resident and/or legally authorized representative,
the facility will file the necessary information to collect
from the insurance company. The facility does not accept insurance
assignment.
- If the facility is requested by the resident or legally authorized representative to file insurance claims, the insurance benefits will be assigned to the facility.
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Removal from Facility:
No resident may be discharged except on the following conditions:
- Voluntary removal from the facility upon the request with
the informed consent of the resident or guardian.
- Involuntary removal for non-payment of charges, following
reasonable opportunity to pay any deficiency.
- The resident requires care other than that which the facility is licensed to provide.
- The resident requires care which the facility does not provide and is not required to provide under state law.
- Medical reasons ordered by the physician.
- Medical emergency or disaster.
- For resident's welfare or the welfare of other residents.
- The resident does not need nursing home care.
- The short-term care for which the resident was admitted expired.
- All other reasons as otherwise permitted by law.
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Refund Policy:
- Upon transfer, discharge or death of a resident, the facility
shall refund any prepaid amounts for services not rendered.
However, the facility shall not refund any amount for bedhold
days, unless the resident had requested the facility discontinue
a bedhold.
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Disposal of Personal
Belongings:
- Any personal belongings that are left with the facility after a resident's discharge, transfer or death should be picked up as soon as possible. The facility will dispose of said personal belongings within 30 days if not removed.
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General Guidelines:
- All residents are to treat other residents, staff, volunteers and visitors with dignity and respect.
- For the safety of all residents sharp objects such as scissors,
pocketknives, razor blades, etc. are housed on each resident's
unit and made available to the resident as needed. Residents
are asked to access them through the nursing staff when they
are needed.
- Residents are discouraged from borrowing, exchanging, selling, buying, stealing, begging, bartering, etc. personal belongings, money, cigarettes, etc. between residents. All problems in this area are handled on an individual basis.
- Each resident has all personal items inventoried upon admission.
Questions related to missing articles should be reported to
the nurse.
- All residents are encouraged to display appropriate, socially acceptable behaviors towards one another.
- Residents may not possess or consume drugs other than those
prescribed by the facility physicians.
- Residents may not possess or consume alcohol on the grounds
unless physician approved.
- Non-residential buildings which are not part of ongoing programming
are restricted to residents.
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Medicare:
Medicare is a Federal Health Insurance Program which can help pay
for inpatient care in a skilled nursing facility. For eligibility,
all of the following conditions must be met:
- You have been in a hospital at least 3 days (not counting the day of discharge) before you transfer to a participating skilled nursing facility.
- You are admitted to the facility within a short time (generally within 30 days) after you leave the hospital.
- A doctor certifies that you need, and you actually receive, skilled nursing or skilled rehabilitation services on a daily basis.
After these are met, you must meet the requirement
of skilled care five days a week. Medicare will not pay if you need
skilled care only occasionally. If you are eligible, Medicare will
pay for all covered services for the first 20 days you are in a
skilled nursing facility. For the 21st day through the 100th day,
Medicare will pay for all covered services except for $114.00 a
day. You will be billed for this amount. Rocky Knoll Health Care
Center is a Certified Facilitiy.
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