UNIVERSITY HOSPITAL OF BROOKLYN IS PROUD OF ITS OUTSTANDING TRADITION OF PROVIDING QUALITY MEDICAL AND SURGICAL CARE. THE FOLLOWING STATEMENT HAS ADOPTED BY THE HOSPITAL'S MEDICAL BOARD AS A REAFFIRMATION OF THIS CUSTOM.

AS A PATIENT IN A HOSPITAL IN NEW YORK STATE, YOU HAVE THE RIGHT, CONSISTENT WITH LAW, TO:

1. Understand and use these rights. If for any reason you do not understand or you need help, the hospital must provide assistance, including an interpreter.

2. Receive treatment without discrimination as to race, color, religion, sex, national origin, disability, sexual orientation, or source of payment.

3. Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints.

4. Receive emergency care if you need it.

5. Be informed of the name and position of the doctor who will be in charge of your care in the hospital.

6. Know the names, position, and functions of any hospital staff involved in your care and refuse their treatment, examination or observation.

7. A no smoking room.

8. Receive complete information about your diagnosis, treatment and prognosis.

9. Receive all the information you need to give informed consent for any proposed procedure or treatment. This information shall include the possible risks and benefits of the procedure or treatment.

10. Receive all the information you need to give informed consent for and order not to resuscitate. You also have the right to designate an individual to give this consent for you if you are too ill to do so. If you like additional information, please ask for a copy of the pamphlet "Do Not Resuscitate Orders- A Guide for Patients and Families."

11. Refuse treatment and be told what effect it may have on your health.

12. Refuse to take part in research. In deciding whether or not to participate, you have the right to full explanation.

13. Privacy while in the hospital and confidentiality of all information and records regarding your care.

14. Participate in all decisions about your treatment and discharge from the hospital. The hospital must provide you with a written discharge plan and written description of how you can appeal your discharge.

15. Review your medical record without charge and obtain a copy of your medical record of which the hospital can charge a reasonable fee. You cannot be denied a copy solely because you cannot afford to pay.

16. Receive an itemized bill and explanation of all charges.

17. Complain without fear of reprisals about the care and services you are receiving and have the hospital respond to you as you request it with a written response. If you are not satisfied with the hospital's response, you can complain to the New York State Health Department. The hospital must provide you with the Health Department's telephone number.

18. Authorize those family members and other adults who will be given priority to visit consistent with your ability to receive visitors.

19. Make known your wishes in regard to anatomical gifts. You may document your wishes in your health care proxy or on a donor card, available from the Hospital.

If you are dissatisfied with the services given to you or wish to make a complaint or recommend changes you may do so in the following ways:

1) Call the Patient Representative number at extension 2121 or 1111

2) If you are not satisfied with the hospital's response, you may call the New York State Department of Health at (1-800) 804-5447or contact the Joint Commission on Accrediation of Healthcare Organizations (JCAHO) @ 1-800-994-6610.