IL_HSHSStMarys2016 by Patient Point

PATIENT INFORMATION GUIDE

Restoring MOBILITY and QUALITY of Life ÂŽ .

Our highly trained, experienced and compassionate team is on the leading edge of technology, using the most innovative devices and techniques available today.

Changing lives, one step at a time!

Decatur (217) 619-0069 Springfield (217) 717-9221 Peoria (309) 676-2276 Jacksonville (217) 883-4960 Peru (815) 220-5025

Bloomington (309) 664-6930 Rockford (815) 489-3908 Quincy (217) 221-8991

On Call 24 Hours/Day 888-676-2276 www.cpousa.com

Say Goodbye to Varicose Veins

TABLE OF CONTENTS WELCOME LETTER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ABOUT US. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 OUR MISSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OUR VISION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OUR CORE VALUES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 TELEPHONE DIRECTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 DURING YOUR STAY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Visitor Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Surgery Family Lounge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Parking/Valet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Cellphones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Internet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Newspapers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Smoking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Public Restrooms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ATM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Vending. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Spiritual Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Chapel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Paperwork. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Medications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Calling Your Nurse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Discharge Planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Interpretation Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Phone Usage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Personal Items/Valuables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Fire and Disaster Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Flowers and Mail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Cafeteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Meals and Room Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Coughing and Sneezing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Identification Bands. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Isolation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Surgery Specifics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Television Channels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Speak Up! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Pain Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Billing and Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Payment Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 CHARITY CARE PROGRAM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Accidents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Black Lung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Other Providers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Patient Bill of Rights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 You Have the Responsibility to: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Statement of Illinois Law on Advance Directives and DNR Orders �� 20 Health Care Power of Attorney. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Living Will. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 DNR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 ABOUT US. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Auxiliary and Volunteers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Friends of St. Mary’s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 NOTES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

WELCOME As part of faith-based Hospital Sisters Health System (HSHS), HSHS St. Mary’s Hospital is committed to your healing—body, mind and spirit. Guided by the historic mission of the Hospital Sisters of St. Francis, we are devoted to providing quality, compassionate health care to all. In addition to providing the latest technology to ensure your physical healing, we also are dedicated to the well-being of your mind and spirit. To that end, you can expect the highest level of personal care from your nurses, therapists, physicians and other health care professionals within our walls. In addition, spiritual care chaplains are available to you and your family members for counsel, to pray with you or to simply sit by your side. We strive for continuous improvement at HSHS St. Mary’s. From our redesigned Emergency Department and front lobby to our continued successful partnership with Prairie Cardiovascular Consultants, we pledge to provide exceptional health care services to you. Thank you for choosing HSHS St. Mary’s Hospital as your health care provider. Wishing you happiness and health,

Dan Perryman President and Chief Executive Officer

ABOUT US For your convenience, we have compiled this guide to help simplify your hospital admission and answer any questions you may have regarding your treatment at HSHS St. Mary’s. Please bring this guide with you to use during your stay. Our Address: HSHS St. Mary’s Hospital 1800 East Lake Shore Drive Decatur, IL 62521 217-464-2966 In October 1875, 21 Hospital Sisters of the Third Order of St. Francis set sail for New York from Muenster, Germany. Sponsored by Bishop Baltes of Alton, the Sisters arrived in Illinois in November, and at the Bishop’s request, divided into groups and traveled to Springfield, Effingham, Litchfield, Belleville and East St. Louis to care for the sick. On November 19, 1878, three Sisters arrived in Decatur. Two days later, the Hospital Sisters opened their doors in a small frame home on the corner of Wood and Webster Streets. Their mission was to care for the sick, especially the poor, who could not afford private medical care. The first St. Mary’s contained just six beds. During its first year, the hospital admitted 25 patients whose conditions were serious enough to require constant care. During the same year, the Sisters provided home nursing for more than 600 Decatur residents. By 1944, St. Mary’s had outgrown its building on Wood and Webster, in spite of six additions between 1881 and 1926. With little opportunity for expansion at the original site, the Sisters bought 14 acres of property on East Lake Shore Drive near Lake Decatur. In 1953, the Sisters purchased another seven acres, bringing the hospital’s current campus to 21 acres. Today, 136 years after its founding, St. Mary’s is a fully accredited, modern health care center. In technology and appearance, St. Mary’s has made remarkable progress in its 136-year history. But one thing remains unchanged: our commitment to the mission of our founding Hospital Sisters to serve the needs of the sick and the poor with respect, care, competence and joy.

OUR MISSION The mission of HSHS St. Mary’s Hospital is to reveal and embody Christ’s healing love for all people through our high-quality Franciscan health care ministry.

OUR VISION Proclaiming God’s healing presence through our exceptional health care services.

OUR CORE VALUES Respect We respect life and the dignity of every person. When you seek care from HSHS St. Mary’s Hospital or join us as a colleague, we will empower you to grow and develop to the full potential God has given you.

Care When you interact with us, whether as a patient, client or colleague, you are treated with concern, compassion and sensitivity—hallmarks of great care. Our commitment to treating you with exceptional care extends beyond the hospital bed into our offices, cafeteria and board room.

Competence Because we are faithful stewards of the resources God has provided to us, HSHS St. Mary’s Hospital is managed with the highest levels of skill and ability possible. We recruit, develop and retain staff whose values reflect our own so that they may deliver exceptional health care services to you.

Joy Those who join us in our ministry do so with a spirit of joy as caring for you brings us happiness while our joyful spirit brings a sense of hope to those who suffer.

Your Opinion Counts Soon after your discharge, you may be contacted by our patient satisfaction research firm. The brief survey will include a variety of questions about your stay at St. Mary’s and the care you received. Your comments and cooperation with this process are greatly appreciated. Your feedback will enable HSHS St. Mary’s to continue providing exceptional care and services.

TELEPHONE DIRECTORY

Main Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217-464-2966 Information Desk/Lobby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 17-464-2531 Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217-464-7665 Admitting/Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217-464-2962 Advanced Rehabilitation Center (ARC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 17-464-1100 Billing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217-464-2964 Cafeteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217-464-2003 Convenient Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 7- 4 6 4 -1 1 1 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-500-1018 Diagnostic Scheduling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217-464-2976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .800-292-4009 Food & Nutrition Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 17-464-2541 Gift Shop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217-464-2101 Health Information Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217-464-2130 Health Match (Find a health care provider) . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 17-464-1234 Home Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217-464-3800 Pain Medicine Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217-464-7458 Patient Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 17-464-2191 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-792-3771 Patient Experience Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217-464-5099 Quality Management (Service Concerns) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 17-464-2129 Room Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 17-464-1212 Spiritual Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217-464-2045

DURING YOUR STAY We have policies and procedures in place to help you and your family work with our doctors, nurses and staff to get the most from your hospital stay. Please take a few minutes to review these guidelines with your loved ones. General hospital visiting hours are 11:00 am to 8:00 pm. Exceptions may include Intensive Care, Behavioral Health, Maternal Care and Pediatrics. Please ask nursing personnel about extended visiting hours in these departments. At 9:00 pm, the front doors of the hospital lobby are locked. To enter or leave the hospital after 9:00 pm, visitors must use the Emergency Department entrance on the hospital’s northwest side.

Visitor Precautions Children under the age of 18 must be accompanied by an adult at all times. We ask that those with colds or other illnesses refrain from visiting any patient care unit. Those who are experiencing symptoms of respiratory illness should ask for a facial mask at the Lobby Information Desk or at any nurses’ station. The definition of family is different for everyone, and we respect the patient’s right to define his or her family.

Surgery Family Lounge Family members accompanying patients undergoing surgery are asked to wait in the Surgery Family Lounge on the second floor, unless otherwise instructed by the surgeon or hospital staff. All communication will take place in that area immediately after surgery, so it is important that a family representative remain in the lounge throughout the procedure.

Parking Valet parking services are available Monday through Friday, 7:00 am to 5:00 pm. Any car that has not been picked up by Valet closing at 5:00 pm will be moved to a space near the main entrance, and the keys can be picked up at the Lobby Information Desk. Valet parking services also are available at the 1770 professional building weekdays from 9:00 am to 3:00 pm.

Cellphones Cellphone usage is permissible anywhere on campus.

Internet Wi-Fi connectivity is available throughout the building. Patients and visitors may access the Internet through their own Wi-Fi capable laptop, tablet or smartphone by selecting the wireless connection labeled “SMDGuest.”

Newspapers Newspapers are available for purchase in the Gift Shop. Newspapers also are delivered daily to all nurses’ stations. Ask your nurse if you would like a newspaper.

Smoking 6

In compliance with Illinois state law, HSHS St. Mary’s Hospital is a nonsmoking facility. Smoking is strictly prohibited on any part of

HSHS St. Mary’s campus, including the grounds, buildings and parking lots.

Public Restrooms Restrooms are located on each level of the hospital. We ask that visitors not use patient restrooms.

ATM For your convenience, an automated teller machine (ATM) Cash Station is located on the first floor near Medical Records.

Vending Vending machines with beverages and snacks are located on the ground floor, in the Intensive Care Family Lounge and in the Emergency Department Family Lounge.

Spiritual Care The HSHS St. Mary’s Spiritual Care staff is available 24 hours a day to offer patients and family members spiritual and emotional care and counsel. Chaplains are available to assist with ethical issues, sacramental needs and faith concerns. Members of all faiths are welcome at HSHS St. Mary’s and are encouraged to speak with our chaplains. Chaplains also are available to help patients draft advance directives. If you would like to speak with a chaplain, please call 217-464-2045 or ask a member of your patient care team to page the chaplain.

Chapel The hospital’s chapel is located on the first floor and is open 24 hours a day, seven days a week. It is open to all for prayer and meditation. Mass is celebrated on the first and third Sundays of the month at 5:00 pm and Tuesdays and Thursdays at 11:30 am. Mass also can be viewed on channel 73 in patient rooms.

Paperwork When you arrive at the hospital, you will be asked to sign consent and release forms to authorize staff to provide services your physician has ordered for you. Please bring along any paperwork given to you by your doctor, copies of your advance directives, and any other information you would like to have placed in your medical record. Please also bring your identification card and insurance cards at this time. All information will be kept confidential.

Medications While you are in the hospital, nursing staff will administer medications ordered for you by your doctor. Please leave over-the-counter medicines, vitamins and herbal products at home. We request your cooperation in this matter, because some drugs and herbal products can interfere with medicines prescribed by your doctor, seriously affecting your treatment. Your nurse will request a list of medicines and herbal products you are currently taking.

“No Information” Status Your right to privacy is important to us. HSHS St. Mary’s Hospital colleagues are obligated to protect the confidentiality of your personal health information. You may request a “No Information” status upon admission or at any time during your stay by informing a member of your health care team. “No Information” means we will not confirm to callers and visitors that you are being treated at the hospital. Callers and visitors requesting information will not be given your room or phone number. However, you may choose to share this information with friends and family as you see fit. In order to receive flowers, mail or other deliveries, items must be addressed to your correct room number, because your name will not be listed in the hospital’s patient information directory. If you have questions, please ask a member of your patient care team. 7

Calling Your Nurse If you need assistance at any time, press the nurse call button on the hand-held control located near your bed. Your call will be answered promptly. Signal cords are located in each patient bathroom for emergencies. Do not hesitate to pull the cord if you need assistance.

Discharge Planning HSHS St. Mary’s case managers are available 24 hours a day to assist you and your family in making a smooth transition to the next level of care, whether it be at home, a skilled nursing facility or a nursing home. Your discharge planning needs are assessed upon admission and are routinely updated throughout your stay. Case managers work with your health care team to identify services you may need, such as financial aid, community agencies, medical equipment, home health care, nursing home placement, hospice or counseling. Please ask your nurse to contact your case manager if you have questions about any of these issues. When your physician determines you are ready to leave the hospital, your nurse will review discharge instructions with you and give you a copy of them to take home. If you have any questions about your at-home care or medications, ask your nurse at this time. Once your doctor releases you, please allow time for the staff to obtain appropriate physician signatures, prepare your discharge instructions, and arrange for staff to escort, or transport you to the exit.

Interpretation Services The hospital provides services for patients requiring language assistance. Patients who need interpretive services should notify a staff member of this need. The Language Line is available 24 hours a day, seven days a week, for those who have difficulty communicating in English. Hearing impaired (TTY) phones are located in the Emergency Department, Rehabilitation Department, Information and Switchboard.

Additional TTY phones may be accessed through the hospital operator. Interpreters for hearingimpaired people will be arranged upon request. You also may choose to use a family member or friend to interpret.

Phone Usage The hospital telephone number is 217-464-2966. Family and friends may call directly to patient rooms by dialing the following: 464 + 3 + the room number. All incoming calls between 10:00 pm and 6:30 am are answered by the hospital operator. If you do not want to receive telephone calls, please notify your nurse or the operator (0). To make a local outside call, dial 9 + the number. To make a long-distance call, dial 9, then follow the instructions on your calling card. You also may dial 9 + 00 to reach a long-distance operator who can bill the call to your home phone or credit card. Long-distance calls may not be billed to your room.

Personal Items/Valuables For your stay at HSHS St. Mary’s, you only need to bring a few personal items, such as toiletries, bathrobe, slippers and a toothbrush. Please limit additional items to those things you need for daily use such as eyeglasses, contact lenses, dentures or hearing aids. HSHS St. Mary’s Hospital cannot be responsible for lost or stolen items. Leave credit cards, cash or jewelry with a family member, or ask your nurse to put them in the hospital safe.

Fire and Disaster Safety State and local laws require that we periodically conduct fire and disaster drills. Hospital colleagues have been instructed as to what to do in the event of a fire, tornado or other disaster. If a drill occurs, please remain in your room and a staff member will inform you of any necessary procedures. Although these drills may cause an inconvenience, they are necessary to ensure your safety in the event of a real emergency.

Flowers and Mail Flowers or mail sent to you at the hospital will be delivered as quickly as possible. Remember, if you are a “No Information” patient, meaning that your name is not listed in the patient information directory, your correct room number must accompany all deliveries. Flowers are not permitted in the Intensive Care Unit. Mail received after your discharge will be forwarded to your home address.

Cafeteria Meals and snacks are available in the hospital Cafeteria, located on the ground floor. The Cafeteria features a full menu of hot and cold items, including a full salad bar. We accept cash, debit and credit cards. Hours: 7:00 am to 6:30 pm Jazzman’s Cafe 7:00 am to 2:30 pm weekdays

Meals and Room Service Proper nutrition is an important part of your treatment and recovery. HSHS St. Mary’s makes every effort to provide nourishing meals, prepared according to your physician’s orders. Meal trays may be ordered from 6:30 am to 6:30 pm, and delivery times vary, depending on the unit. A nutrition assistant will obtain your preferences and meal selections each morning. For safety reasons, you are asked to notify nursing staff if family members bring food prepared outside the hospital for your consumption. Guest trays are available for a $7 charge per tray, payable with cash upon delivery. Guests can order from the Room Service Menu by calling ext. 1212, and the tray will be delivered to the patient’s room. For pediatric patients, we will send one complimentary tray per meal for the patient’s caretaker.

Coughing and Sneezing Coughing and sneezing can spread germs through the air. When you cough or sneeze, please cough into your upper sleeve or cover your mouth and nose with a tissue. Place used tissues in a waste basket. If you are coughing and sneezing, try to keep your distance from other people. Most importantly, wash your hands frequently with soap and water, or with an alcohol-based hand products after coughing, sneezing or using a tissue. If your family and friends are ill, they should refrain from visiting. Those experiencing symptoms of respiratory illness should ask for a facial mask at the Lobby Information Desk or at any nurses’ station.

Isolation Isolation is used to separate people who have a communicable disease from those who are healthy. The most common type is contact isolation to prevent spread through touch. Signs will be posted on the doors about what to do. Our staff also will follow the isolation precautions. For their protection, we ask visitors to follow the directions also. Isolation supplies can not be worn in the hallways; they need to be removed and thrown away in the patient room. New supplies are available each visit.

Surgery Specifics Identification Bands You will be required to wear an identification band at all times during your stay to ensure you receive proper treatment and medications. If you have allergies, you also will be given a red band to alert nursing staff of your allergies. Please do not remove these bands for any reason until after your discharge from the hospital.

If you will be having a surgical operation, a doctor will use a marker to write on your body the correct site of the surgical procedure before you enter the procedure room. Immediately before the procedure begins, your surgical care team will confirm everything is correct. This includes your name, the intended procedure, the correct site of the procedure, and all preoperative medications and equipment.

Television Channels Televisions are provided in each patient room. Please be considerate of others and keep the TV volume down. A hand-held remote control is located in each patient room. Channel listings are below. All televisions have closed captioning available for the hearing impaired. 2 3 4 6 7 9 10 11 12 13 15 16 17 18 19 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

WICS (ABC) WCIA (CBS) Cable Marketplace WBIU (CW) WRSP (Fox) WGN America WAND (NBC) HSN WILL (PBS) QVC CSPAN TV Guide Network Local Weather Access WCFN (MNT) Educational Access Shop Network VH1 Nickelodeon CNN ESPN ESPN2 BET USA Network Discovery Channel AMC SpikeTV TNT Bravo Headline News A&E TBS

39 40 42 43 44 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 62 63 64 65 67 68 70 71 72 73 96

CNBC MSNBC Lifetime Disney Channel The Weather Channel Animal Planet Cartoon Network Food Network CMT Fox News Channel Hallmark Channel TLC E! FX MTV FSN Midwest HGTV Oxygen ABC Family The History Channel Travel Channel TruTV Comcast SportsNet Style SyFy Channel Speed Channel Big Ten Network The Golf Channel TV Land St. Maryâ&#x20AC;&#x2122;s Chapel Patient Channel

Speak Up! Everyone has a role in making health care safe— physicians, health care executives, nurses and technicians. Health care organizations across the country are working to make health care safety a priority. You, as the patient, also can play a vital role in making your care safe by becoming an active, involved and informed member of your health care team. •S PEAK up Ask questions and voice concerns. It is your health and you have a right to know. • PAY attention Make sure you are getting the right treatments and medicines.

• EDUCATE yourself Learn about your medical tests and treatment plan. •A SK Pick a trusted family member or friend to be your advocate or support person. •K NOW Know what medicines you take and why you take them. • USE an accredited hospital Use a hospital, clinic, surgery center, or other type of health care organization accredited for quality and safety standards. •P ARTICIPATE in your care You are the center of the health care team. HSHS St. Mary’s Hospital is committed to quality care and superior customer service. Our staff will strive to make your hospital stay as comfortable as possible.

Quality You have the right to voice questions, concerns or complaints about your care in our hospital. You have the right to know about resources such as social services, spiritual care or the ethics committee who can help you resolve problems or answer questions. You may do this without fear that it will compromise your care or future access to services. If you have questions or feel that your rights have been violated, please contact Administration at 217-464-7665.

If you are unable to resolve your complaint in this manner, contact the Illinois Department of Public Health’s 24-hour, toll-free Central Complaint Registry: 1-800-252-4343 or TTY 1-800-547-0466 (hearing-impaired use only). Or you may write to the Illinois Department of Public Health at the following address: Illinois Department of Public Health Division of Health Care Facilities and Programs 525 West Jefferson Street Springfield, IL 62761-0001 Fax: 217-782-0382 Patient rooms are designed for your care, comfort and safety. Your room assignment at St. Mary’s Hospital is based upon your medical needs.

Pain Management If you are in pain, take steps to get relief. Medicine and other treatments almost always can relieve pain. To obtain the most effective relief, talk to your doctor or nurse about your pain as soon as it begins. Tell him or her: • Where you hurt. • How strong the pain feels. • What makes the pain worse. • What eases the pain. • How much relief you receive from the medications you are taking currently. Ask him or her: • What medicines can relieve my pain? • How long will the medicine relieve my pain? • Are there any side effects of the medication? • Will non-drug methods ease my pain (relaxation, hot/cold packs)?

Billing and Insurance Your hospital bill is made up of charges for room and board, as well as charges for procedures, radiology, medications, laboratory tests, physical therapy, operating room, recovery room and intensive care. Room rates and other charges are determined by the hospital’s operating expenses, including the cost of nursing care, equipment, supplies, diagnostic and treatment services, and other necessities. Inpatients are charged a fee for their room beginning on the day of admission. No charge

is made for the day of discharge if you are able to leave your room before midnight. The sole exception would be an admission and discharge occurring on the same day. While you are at HSHS St. Mary’s Hospital, your primary focus should be on your health. Because the ultimate responsibility for payment of your hospital bill rests with you or your guardian, you also may be concerned about the financial aspects of your hospitalization. This section of your patient handbook answers many questions you may have about finances and insurance.

Payment Options Questions About My Bill After receiving a hospital bill, many people have questions about the charges and payment options. If you have questions about your hospital bill, please see our Understanding Your Bill brochure located in Patient Registration. It contains information about how services you receive at St. Mary’s will be billed as well as payment assistance options available to you. You also are welcome to contact the HSHS St. Mary’s Business Office with questions about your bill. The Business Office is open Monday through Friday, 8:00 am to 4:30 pm. For billing assistance, please call 464-2964. For payment arrangements, call 464-2360. Billing Information To ensure your peace of mind, we suggest that prior to your admission, you confirm the type of coverage your insurance policy provides. Please remember that many employers, insurance companies and HMOs/PPOs now require notification by the patient, a family member or doctor prior to or shortly after admission. If you do not comply with this requirement, your medical benefits could be jeopardized, or your insurance could refuse to pay your bill in part or in full. For your protection, please check with your place of employment or your insurance company for any unique requirements. After your treatment, a bill will be sent to your insurance company and a summary statement may be sent to you. While your insurance company will probably pay all or some of your bill, you are responsible for paying whatever your insurance company does not cover. Cash, major credit cards, money orders, cashier’s checks and personal checks are accepted methods of payment for your portion of the bill. If you would like to set up a short-term payment plan, please call us at 464-2360. The hospital cannot enter into long-term financing arrangements for balances due, but we do offer Charity Care for those who are unable to pay their bill. Medicare HSHS St. Mary’s will bill Medicare and, as a courtesy, your supplemental insurance carrier.

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Information for our Medicare Patients About the Advance Beneficiary Notice (ABN) Your doctor may order services to help diagnose a condition you may have or evaluate how well your treatment is working. Your doctor also may order hospital treatment to ensure your good health. Before receiving services ordered by your doctor at HSHS St. Mary’s, you may be asked to sign an Advance Beneficiary Notice or an ABN. An Advance Beneficiary Notice (ABN) is a written notice issued to you by your physician or hospital that tells you why Medicare will probably deny payment for that specific service or item in your case. HSHS St. Mary’s or your doctor will provide this notice before you receive hospital services. If you still want to receive the service, you will be asked to sign an agreement that you will pay for the service yourself, if Medicare does not pay. An Advance Beneficiary Notice issued to you by HSHS St. Mary’s will be in writing. It will identify the specific service that may be denied by Medicare and the reason why Medicare may not pay for the specific service. There are certain services that Medicare does not cover under any circumstances. These are excluded services. Examples of these services are cosmetic surgery, play therapy, routine or preventive physical checkups including lab tests that are part of the checkup and most immunizations. Why does HSHS St. Mary’s want me to sign the Advance Beneficiary Notice? Although Medicare pays for most services ordered by your doctor, Medicare will only pay for services that it determines to be “reasonable and necessary.” When this happens, Medicare rules require hospitals to notify patients when it is expected that Medicare will not pay for hospital services. In these situations, we will ask you, the patient, to sign an Advance Beneficiary Notice agreeing to pay and be billed for these services. Must I sign the ABN? No, you have two options: 1) You may sign the ABN and proceed with the test or service. HSHS St. Mary’s will request a deposit prior to services being rendered. 2) You may refuse to sign the ABN and choose not to have the service performed. However, in not having the test or service performed, you will be going against the medical advice of your doctor. HSHS St. Mary’s advises that you consult with your doctor before choosing this option.

Understanding Medicare Self-Administered Drugs Sometimes people with Medicare need “selfadministered drugs” while in hospital outpatient settings. Self-administered drugs are drugs you would normally take on your own. What is the difference between an inpatient, outpatient and observation patient? You are an inpatient starting on the day you are formally admitted to the hospital with a doctor’s order. The day before you are discharged is your last inpatient day. You are an outpatient if you are getting emergency department services, observation services, outpatient surgery, lab tests or X-rays, and the doctor has not written an order to admit you to the hospital as an inpatient. In these cases, you are considered outpatient even if you spend the night at the hospital. You are an observation patient if you are receiving services by a hospital on its premises, including the use of a bed, periodic monitoring by nursing and other staff and any other services that are reasonable and necessary to evaluate your condition or to determine the need for a possible (inpatient) admission to the hospital. Please note that you are classified as an outpatient or observation patient unless there is a written order from the physician to admit you to the hospital. If you are classified as an observation patient, your Medicare Part B may not cover your self-administered drugs, and you may be responsible for the bill. If you are not sure of your status while receiving hospital services, please ask your physician or nurse. Will Medicare Part B cover self-administered drugs? Medicare Part B (Medical Insurance) generally covers care you get in a hospital outpatient setting, like emergency department, observation unit, surgery center or pain clinic. Part B only covers certain drugs in these settings. Part B generally does not pay for self-administered drugs unless they are required for the hospital outpatient services you are getting. If you get self-administered drugs that are not covered by Medicare Part B while in a hospital outpatient setting, the hospital may bill you for the drug. However, if you are enrolled in a Medicare drug plan (Part D), these drugs may be covered.

What should I do if I get a bill for self-administered drugs that are not covered by Part B in a hospital outpatient setting? Follow the instructions in your Medicare drug plan’s enrollment materials on how to submit an out-of-network claim. Your plan will check to see if the drug is on your Medicare drug plans formulary. Be sure to have all of your bills related to your hospital visit. For more information on self-administered drugs, you can contact your State Health Insurance Plan toll free at 800-548-9034 or locally at 217-785-9021. For additional information about Medicare, you can visit the Centers for Medicare and Medicaid Services website. If you have any questions or need additional information, please contact the Patient Financial Services Department at HSHS St. Mary’s Hospital at 217-464-2964. General Insurance HSHS St. Mary’s will bill primary and secondary insurance companies when an assignment of benefits is received. Questions concerning specific benefits should be directed to your insurance company. Get Covered Illinois The Insurance Marketplace allows people to compare prices and shop for health insurance online or by phone. The information about each insurance plan is provided in easy-to-understand language. All insurance plans have to show the costs and what is covered in simple language with no fine print. To sign up, visit www.getcoveredillinois.gov or call 1-866-311-1119. Charity Care at HSHS St. Mary’s Because HSHS St. Mary’s continues the mission of its founding Sisters—to serve the needs of the sick and the poor with dignity and respect, compassion and joy—HSHS St. Mary’s offers a Charity Care Program that offers financial assistance to all who show financial need. To ensure that the hospital’s resources are used by those who need them the most, our staff will

help you explore all other options for financial assistance. If no alternatives exist and you meet the guidelines for receiving Charity Care, you are welcome to apply for the Charity Care Program. To Apply for Charity Care If you want to apply for Charity Care, please call or visit with a patient accounts representative (464-2964 or 464-2360) to discuss your financial need. We will assist you in completing the Charity Care Application form. You will be required to furnish proof of income, possibility of future income and information regarding assets. A tax return from the previous year (if applicable) and payroll stubs for the past 90 days must be submitted as proof of income. You also must demonstrate you have made every effort to secure financial aid from existing programs for which you may be eligible, including private insurance or Public Aid. HSHS St. Mary’s Director of Financial Services will review the application and supporting documents and determine if you are eligible for HSHS St. Mary’s Charity Care. Download a HSHS St. Mary’s Charity Care Application at www.stmarysdecatur.com/ visit/bill.aspx. If You Qualify for Charity Care If you qualify, you will be notified within 10 days regarding the percentage of your account that will be covered by Charity Care. The director of Financial Services will subtract that amount from your bill and confirm payment arrangements on any remaining balance. A notation will be placed in your patient file regarding the portion of the bill waived through the Charity Care Program.

If You Do Not Qualify for Charity Care If you do not qualify for Charity Care, you will be notified of the reasons for your denial. In addition, you will receive an itemized bill for services provided by the hospital. You must make arrangements to pay your account in full. To establish payment arrangements, call 217-464-2360. All accounts not qualifying for Charity Care will be returned to the hospital’s active files for normal follow-up. You are eligible to reapply for Charity Care if your financial situation changes. For more information about HSHS St. Mary’s Charity Care Program or for reconsideration of eligibility, please call 217464-2964 or 217-464-2360. Frequently Asked Questions About Your Hospital Bill Who can change my diagnosis? Only an attending physician is authorized to change your diagnosis. A physician is the only individual at the hospital that has the knowledge and skills to assign diagnosis and determine the appropriate plan of care. The physician must provide the appropriate documentation to request changes to a patient’s diagnosis. Why can’t I get billing and medical information about my spouse, children and/or other members of my family? If the patient is present and has the capacity to make health care decisions, a health care provider may discuss the patient’s health information when the patient gives consent. However, the patient must have a documented consent form in his/her records authorizing this if a family member, friend or other people call for health care information on a patient.

Frequently Asked Questions

I was seen by my physician in the Pain Center and/or Cancer Care Center, but never visited the hospital. Why did I receive a bill from the hospital? The hospital bills are for services that involve hospital staff or facilities. The hospital will bill only for hospital charges and not for services provided by a physician. Why is the hospital billing me for lab work done in the physician office? Some lab tests are done in the physician office and then sent to the hospital for processing. The hospital outpatient lab charge is the cost of processing the test at the hospital. Why am I getting multiple bills from one hospital visit? You may receive separate bills from physicians including radiologists, surgeons, anesthesiologists and other specialists that may have been involved in your care.

Does my hospital bill include my physician fees? No. Pathologists, radiologists, cardiologists, anesthesiologists, emergency room doctors and other specialists who provide services to you are required to submit separate bills. If you have any questions about these bills, please call the number printed on the statement you received from them. Why do I have to give my insurance information every time I come to the hospital? We make every effort to process your bill accurately and on time which is why we ask you for your insurance information every time you visit. This gives us the opportunity to verify your insurance coverage and benefits to ensure that our records are accurate and up to date. Why am I receiving a bill when I have Medicare and supplemental insurance? Why am I getting a bill when I have commercial Insurance? You may receive a bill for deductibles, co-pay and/or non-covered services if you have Medicare, Medicare supplemental insurance or if you have commercial insurance. For more information on deductibles, co-pay and non-covered services, please contact your health care payer. Patients are responsible for all co-pays, deductibles and noncovered services and payment is due at the time services are rendered. If you have any questions or need additional information; please contact the Patient Financial Services Department at HSHS St. Maryâ&#x20AC;&#x2122;s Hospital at 217-464-2964.

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CHARITY CARE PROGRAM HSHS St. Mary’s Charity Care Program offers assistance to all who show financial need. The hospital’s staff will assist patients in exploring all other options for financial assistance, before enrolling them in the Charity Care Program. If no other alternatives exist, patients are welcome to apply for Charity Care and must meet established guidelines. The guidelines are not meant to discourage those in need from seeking treatment; rather, they are designed to ensure the hospital’s resources are used by those who need them most.

Eligibility Any patient or responsible party in need of financial assistance may apply for Charity Care. If eligible, HSHS St. Mary’s Charity Care Program will provide coverage of 25, 50, 75 or 100 percent. Charity Care is limited to patients and/or families whose past 12 months of income does not exceed 200 percent of the poverty guidelines established by the United States Department of Health and Human Services and published periodically in the Federal Register. If you want to apply for Charity Care, please call or visit with a patient accounts representative 217-464-2964 or 2360 to discuss your financial needs. Staff will assist you in completing the Charity Care Application Form. Your insurance policy is a contract between you and your insurance company. Although we bill your insurance company, you are responsible for payment of services within 30 days. Many employers, insurance companies and HMOs/PPOs require notification by the patient, a family member or doctor prior to or shortly after admission. If you do not comply with this requirement, your medical benefits could be jeopardized, or your insurance could refuse to pay your bill in part or in full. For your protection, please check with your benefits provider to see if you need to follow any special procedures. Outpatient visits, inpatient stays and emergency room visits are billed separately to you and to your insurance company. By providing us with complete insurance information as soon as possible, you will make it possible for us to bill your insurance company and settle your account promptly. HSHS St. Mary’s will send a summary bill to you and your insurance company. You should familiarize yourself with the policies and deductibles of your insurance plan. However, you are responsible for paying whatever your insurance company does not cover. Cash, major credit cards, money orders, cashier’s checks and personal checks are accepted methods of payment for your portion of the bill. Please note: The hospital does not enter into long-term financing for balances due.

If you are unable to pay your account in full within 30 days of our billing, contact Patient Accounts at 217464-2964 or 2360, Monday through Friday, from 8:00 am to 4:30 pm, to make payment arrangements. If your insurance company has a contract with HSHS St. Mary’s such as an HMO or a PPO, we will bill you only after your insurance has paid or denied your claim. Balances are due within 30 days after the insurance decision. After Medicare has completed payment, we will bill you or your supplemental insurance for the amount that Medicare states is the portion to be billed. Balances are due within 30 days after Medicare has paid.

Accidents In the event of an accident, federal law requires that the hospital invoice any other possible payor before billing Medicare. Please provide all accident information at the time of registration, including auto insurance name(s), number(s) and the liable party’s insurance information. We will bill your automobile medical insurance for any appropriate claims resulting from an auto accident. To obtain the most complete coverage, please list your auto insurance as primary and your group insurance as secondary. Balances are due within 30 days after billing.

Black Lung In addition, Medicare requires us to bill your group insurance or your spouse’s group insurance for Black Lung benefits prior to billing Medicare. Please provide that information at the time of registration.

Other Providers You may be billed by other providers as a result of your visit to HSHS St. Mary’s Hospital. Physicians, surgeons, anesthesiologists, radiologists and/or pathologists may send you bills for the services related to your care and treatment. These physician charges will be separate from your hospital bill. Questions regarding HSHS St. Mary’s billing policies should be directed to Patient Accounts at 217-4642964 or 2360. Office hours are Monday through Friday, 8:00 am to 4:30 pm. Please provide your account number when you call.

We are partners in your health care. When you are well informed, participate in treatment decisions and communicate openly with your doctor and other health professionals, you help make your care as effective as possible. HSHS St. Mary’s Hospital encourages respect for the personal preferences and values of each individual.

Patients Bill of Rights As a patient at HSHS St. Mary’s Hospital, you have the right to: • Considerate and respectful care in a safe and secure environment, regardless of your sex, disability, race, religion, age, national origin, sexual orientation, personal or cultural beliefs or the source of payment for your care. • Information about hospital policies, rules and regulations governing your conduct as a patient. • Clear and concise explanations of your condition and of all proposed procedures, including the possibility of any risks, problems or side effects which may result. • Be involved in the development and implementation of your plan of care. • Know the names and roles of health care professionals providing service to you. • Refuse treatment to the extent permitted by law and to be informed of the medical consequences of your refusal. • Freedom from restraint or seclusion unless it is the only means to protect your safety. • Prompt, effective and continuous assessment and treatment of pain. •B e advised if any portion of your care or treatment is part of an experimental or research program and to decline participation in such program if you so choose. • Formulate an advance directive, such as a living will or durable power of attorney for health care, and have hospital staff comply with your directives. • Personal dignity and privacy. • Expect that your treatment records are confidential, unless you have given permission to release such information or reporting is required or permitted by law. • Access your clinical records within a reasonable time period. • Request and receive a printed copy of your hospital charges and have them explained to you. • Have an ethics consultation without charge to review the plan of care and discuss your right to attempt to settle ethical disagreements or conflicts with health professionals. • Express complaints and grievances and expect that they will be investigated within a reasonable time frame.

• Know what alternatives exist for your care and treatment when hospital care is no longer appropriate. • To the extent permitted by law, to leave the hospital against your doctor’s advice. Should you do so, however, neither your physician nor the hospital will be responsible for whatever harm such action may cause you or others. • Provide information about illnesses, hospitalizations, medications and other matters related to your health, both past and present. • Report any perceived risks in your care or changes in your condition. • Accept the consequences of refusing treatment or failing to follow your established care, service or treatment plan. • Abide by hospital rules, regulations and policies during your stay. • Respect the rights of other patients, hospital personnel and others you may come in contact with. • Ask questions if you do not understand directions given to you by your health care team. • Pay your hospital bills promptly and provide information necessary for insurance processing. • Express to hospital management complaints about any aspect of your care if you feel your rights have been violated. Health care organizations across the country are working to improve patient safety. The Joint Commission on Accreditation of Healthcare Organizations has sponsored a campaign titled “Speak Up,” which encourages patients and their family members to play an active role in helping health care organizations deliver safe medical care. As a patient, you can make your care safer by being an involved and informed member of your health care team. To help prevent health care mistakes, you are urged to do the following: • Speak up if you have questions or concerns. • Pay attention to the care you receive and expect caregivers to introduce themselves and wash their hands before administering any treatment or medication. • Educate yourself about your illness and treatments. • Ask a trusted family member or friend to be your advocate or support person. • Know what medicines you take and why you take them. • Use only accredited hospitals, clinics, surgery centers or other health care organizations. HSHS St. Mary’s Hospital is accredited by The Joint

Commission on Accreditation of Healthcare Organizations. •P articipate in all decisions about your treatment. You are the center of your health care team. •Y ou have the right to file a complaint or grievance without being subject to coercion, discrimination, reprisal or unreasonable interruption of care. If your concerns are not adequately addressed by nursing staff, please ask to speak with the department manager. If those directly involved with your care cannot resolve your concern, call Patient Concerns to Administration (217-464-2473) HSHS St. Mary’s Safety Hotline (217-464-7233) If your concerns cannot be resolved by working with the hospital representatives, you may take your comments/complaints to: The Illinois Department of Public Health Central Complaint Registry 525 West Jefferson Street Springfield, IL 62761 (800) 252-4343 Illinois Department of Human Rights 222 South College Room 101 Intake Unit Springfield, IL 62704 (217) 785- 5100 The Joint Commission Office of Quality and Patient Safety One Renaissance Boulevard Oakbrook Terrace, IL 60181 (800) 994-6610

You Have the Responsibility to: • Provide complete and accurate information about your health and medical history. • Ask questions and acknowledge when you do not understand information or instruction given to you and actively participate in your treatment plan. • Observe polices, rules and regulations in place at HSHS St. Mary’s to support quality care and a safe environment for all. • Treat all hospital staff, other patients and visitors with consideration and respect. • Provide complete and accurate information about health insurance coverage and meet financial obligations.

Statement of Illinois Law on Advance Directives and DNR Orders Last updated May 30, 2012 You have the right to make decisions about the health care you get now and in the future. An advance directive is a written statement you prepare about how you want your medical decisions to be made in the future, if you are no longer able to make them for yourself. A Do Not Resuscitate order (DNR order) is a medical treatment order that says cardiopulmonary resuscitation (CPR) will not be used if your heart and/or breathing stops. Federal law requires you be told of your right to make an advance directive when you are admitted to a health care facility. Illinois law allows for the following three types of advance directives: (1) health care power of attorney; (2) living will; and (3) mental health treatment preference declaration. In addition, you can ask your physician to work with you to prepare a DNR order. You may choose to discuss with your health care professional and/or attorney these different types of advance directives as well as a DNR order. After reviewing information regarding advance directives and a DNR order, you may decide to make more than one. For example, you could make a health care power of attorney and a living will. If you have one or more advance directives and/ or a DNR order, tell your health care professional and provide him or her with a copy. You also may want to provide a copy to family members, and you should provide a copy to those you appoint to make these decisions for you. Copies of sample advance directives forms and a copy of the Illinois Department of Public Health (IDPH) Uniform Do Not Resuscitate (DNR) Advance Directive can be found at www.idph.state.il.us/public/books/advdir4.htm.

Healthcare Power of Attorney The healthcare power of attorney lets you choose someone to make health care decisions for you in the future if you are no longer able to make these decisions for yourself. You are called the “principal” in the power of attorney form, and the

person you choose to make decisions is called your “agent.” Your agent would make health care decisions for you if you were no longer able to make these decisions for yourself. So long as you are able to make these decisions, you will have the power to do so. You may use a standard health care power of attorney form or write your own. You may give your agent specific directions about the health care you do or do not want. The agent you choose cannot be your doctor or other healthcare provider. You should have someone who is not your agent witness your signing of the power of attorney. The power of your agent to make health care decisions on your behalf is broad. Your agent would be required to follow any specific instructions you give regarding care you want provided or withheld. For example, you can say whether you want all life-sustaining treatments provided in all events; whether and when you want life-sustaining treatment ended; instructions regarding refusal of certain types of treatments on religious or other personal grounds; and instructions regarding anatomical gifts and disposal of remains. Unless you include time limits, the health care power of attorney will continue in effect from the time it is signed until your death. You can cancel your power of attorney at any time, either by telling someone or by canceling it in writing. You can name a backup agent to act if the first one cannot or will not take action. If you want to change your power of attorney, you must do so in writing.

Living Will A living will tells your doctor whether you want death-delaying procedures used if you have a terminal condition and are unable to state your wishes. A living will, unlike a health care power of attorney, only applies if you have a terminal condition. A terminal condition means an incurable and irreversible condition such that death is imminent and the application of any death delaying procedures serves only to prolong the dying process. Even if you sign a living will, food and water cannot be withdrawn if it would be the only cause of death. Also, if you are pregnant and doctors think you could have a live birth, your living will cannot go into effect.

You can use a standard living will form or write your own. You may write specific directions about the death-delaying procedures you do or do not want. Two people must witness your signing of the living will. Your doctor cannot be a witness. It is your responsibility to tell your doctor if you have a living will if you are able to do so. You can cancel your living will at any time, either by telling someone or by canceling it in writing. If you have a health care power of attorney and living will, the agent you name in your power of attorney will make your health care decisions unless he or she is unavailable. A mental health treatment preference declaration lets you say if you want to receive electroconvulsive treatment (ECT) or psychotropic medicine when you have a mental illness and are unable to make these decisions for yourself. It also allows you to say whether you wish to be admitted to a mental health facility for up to 17 days of treatment. You can write your wishes and/or choose someone to make your mental health decisions for you. In the declaration, you are called the “principal” and the person you choose is called an “attorneyin-fact.” Neither your doctor nor any employee of a health care facility in which you reside may be your attorney-in-fact. Your attorney-in-fact must accept the appointment in writing before he or she can start making decisions regarding your mental health treatment. The attorney-in-fact must make decisions consistent with any desires you express in your declaration unless a court orders differently or an emergency threatens your life or health. Your mental health treatment preference declaration expires three years from the date you sign it. Two people must witness you signing the declaration. The following people may not witness your signing of the declaration: your doctor; an employee of a health care facility in which you reside; or a family member related by blood, marriage or adoption. You may cancel your declaration in writing prior to its expiration as long as you are not receiving mental health treatment at the time of cancellation. If you are receiving mental health treatment, your declaration will not expire and you may not cancel it until the treatment is successfully completed.

DNR You also may ask your doctor about a Do Not Resuscitate order (DNR order). A DNR order is a medical order stating that cardiopulmonary resuscitation (CPR) will not be started if your heart or breathing stops. You may sign a document directing that, should your heart or breathing stop, efforts to resuscitate you will not be started. Your attending physician also may sign a DNR order. Before a DNR order may be entered into your medical record, either you or another person (your legal guardian, health care

power of attorney or surrogate decision maker) must consent to the DNR order. This consent must be witnessed by two people who are 18 years or older. If a DNR order is entered into your medical record, appropriate medical treatment other than CPR will be given to you. Under Illinois law, a health care surrogate may be chosen for you if you cannot make healthcare decisions for yourself and do not have an advance directive. A health care surrogate will be one of the following people (in order of priority); guardian of the person, spouse, any adult child(ren), either parent, any adult brother or sister, any adult grandchild(ren), a close friend or guardian of the estate. The surrogate can make all health care decisions for you, with certain exceptions. A health care surrogate cannot tell your doctor to withdraw or withhold life-sustaining treatment unless you have a qualifying condition, which is a terminal condition, permanent unconsciousness, or an incurable or irreversible condition. A terminal condition is an incurable or irreversible injury for which there is no reasonable prospect of cure or recovery, death is imminent and lifesustaining treatment will only prolong the dying process. Permanent unconsciousness, means a condition that, to a high degree of medical certainty, will last permanently, without improvement; there is no thought, purposeful social interaction or sensory awareness present and providing life-sustaining treatment will only have minimal medical benefit. An incurable or irreversible condition, means an illness or injury for which there is no reasonable prospect for cure or recovery, that ultimately will cause the patientâ&#x20AC;&#x2122;s death, that imposes severe pain or an inhumane burden on the patient and for which life-sustaining treatment will have minimal medical benefit. Two doctors must certify that you cannot make decisions and have a qualifying condition in order to withdraw or withhold life-sustaining treatment. If your health care surrogate decision maker decides to withdraw or withhold life-sustaining treatment, this decision must be witnessed by a person who is 18 years or older. A health care surrogate may consent to a DNR order; however, this consent must be witnessed by two individuals 18 years or older. A health care surrogate, other than a court-appointed guardian, cannot consent to certain mental health treatments, including treatment by electroconvulsive therapy (ECT), psychotropic medication or admission to a mental health facility. A health care surrogate can petition a court to allow these mental health services. You should talk with your family, doctor and any agent or attorney-in-fact that you appoint about your decision to make one or more advance directives or a DNR order. If they know what health care you want, they will find it easier to follow your wishes. If you cancel or change an advance directive or a DNR order in the future, remember to tell these same people about the change or cancellation.

No facility, doctor or insurer can make you execute an advance directive or DNR order as a condition of providing treatment or insurance. It is entirely your decision. If a facility, doctor or insurer objects to following your advance directive or DNR order, he or she

must tell you or the individual responsible for making your health care decisions. They must continue to provide care until you or your decision maker can transfer you to another health care provider who will follow your advance directive or DNR order. Illinois Department of Public Health 535 West Jefferson Street Springfield, IL 62761 Phone 217-782-4977 Fax 217-782-3987 TTY 800-547-0466

ABOUT US HSHS St. Mary’s is part of one of the largest Catholic hospital systems in the United States, Hospital Sisters Health System, (HSHS) with 14 hospitals in Illinois and Wisconsin. Illinois HSHS St. HSHS St. HSHS St. HSHS St. HSHS St. HSHS St. HSHS St. HSHS St.

Anthony’s Memorial, Effingham Elizabeth’s, Belleville Francis, Litchfield John’s, Springfield Joseph’s, Breese Joseph’s, Highland Mary’s, Decatur Mary’s, Streator

Wisconsin HSHS Sacred Heart, Eau Claire HSHS St. Joseph’s, Chippewa Falls HSHS St. Mary’s, Green Bay HSHS St. Nicholas, Sheboygan HSHS St. Vincent, Green Bay HSHS St. Clare Memorial, Oconto Falls HSHS Medical Group - HSHS Medical group is the physician organization of HSHS. Founded in 2008, the HSHS Medical group is a growing network of primary care and specialty groups in Illinois and Wisconsin. HSHS has a separate billing system from HSHS St. Mary’s Hospital.

Auxiliary and Volunteers HSHS St. Mary’s Auxiliary was organized in 1954 when 18 ladies dressed in cherry pink smocks traveled the hallways with a gift cart and library books, sharing smiles and words of comfort with the hospital’s patients, young and old. Today, as in 1954, the Auxiliary is a volunteer organization committed to promoting and advancing the mission of HSHS St. Mary’s Hospital. More than 350 men and women serve in excess of 20,000 hours annually.

To find out more about becoming a member of HSHS St. Mary’s Auxiliary, call 217-464-2520. For information about volunteering, call 217-464-5540. At HSHS St. Mary’s, volunteers are special people who provide a valuable service to the hospital. If you enjoy meeting people and have an interest in helping others, HSHS St. Mary’s Auxiliary may be a perfect opportunity for you to share your time and talents.

Friends of HSHS St. Mary’s The Friends of HSHS St. Mary’s Hospital is a division of the Hospital Sisters of St. Francis, Inc. The Hospital Sisters of St. Francis Foundation, Inc., is a nonprofit organization chartered in the state of Illinois, exempt from income tax under Section 501(c)(3) of the United States Internal Revenue Code. Contributions to the Friends of St. Mary’s Hospital qualify as charitable contributions to the fullest extent of the law. The Friends of HSHS St. Mary’s Hospital was established in 1988 to ensure the hospital’s continued growth, stability, and future and to accept and acknowledge charitable contributions. The foundation funds patient programs and state-of-the-art equipment purchases needed to perpetuate the health care mission of HSHS St. Mary’s Hospital. All gifts for HSHS St. Mary’s Hospital and any of its programs and services are processed through the Friends and are used exclusively and in their entirety for HSHS St. Mary’s Hospital. A contribution to the Friends of HSHS St. Mary’s is an excellent way to honor the life or memory of a friend or family member, or perhaps to say “thank you” to a special hospital employee. Contributions in the form of a check can be made out to “The Friends of HSHS St. Mary’s” and mailed to the following address: The Friends of HSHS St. Mary’s Hospital 1800 East Lake Shore Drive Decatur, IL 62521 Contributions also can be made via the website at www.stmarysdecatur.com/foundation. For more information, please call 217-464-5590.

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