As a recipient of hospice services, you have certain rights that you are entitled to exercise. If you are
unable to communicate with Serenity HospiceCare staff, your family, representative or guardian may
exercise your rights for you. These rights are as follows:
1. The right to have your rights explained to you verbally and in writing.
2. The right for all to respect your property and person.
3. The right to receive quality hospice care and to receive pain management and symptom control.
4. You have the right to voice grievances without fear of discrimination or compromising future care.
You have the right to be free from mistreatment, neglect, or verbal, mental, sexual, and physical
abuse; and the right to voice grievances regarding treatment or care that is, or fails to be furnished by
or on behalf of Serenity HospiceCare. You also have the right to voice grievances regarding lack of
respect for your property by anyone who is furnishing you services by or on behalf of Serenity
HospiceCare. You can express your complaints/grievances to any Serenity HospiceCare employee in
writing to P.O. Box 1000, Park Hills, MO 63601, by phone, 573-431-0162 or toll free at 800-876-0162
or in person. If you call after hours, you will reach a staff member of our answering service, who will
take your complaint/grievance and forward it to the on-call staff. Once the complaint has been
received, it will be reported to the appropriate supervisor as well as the Executive Director within 24
hours of receipt and an investigation will be initiated. The manager/designee must respond to the
complainant within 2 working days. Response may be via telephone, letter or in person. For any
verified violation, appropriate corrective actions will be taken and within 5 working days, the results
of the investigation will be reported to the proper state and local officials/bodies.
5. The right to choose your attending physician.
6. The right to participate in the development of your plan of care and in the planning of changes in
7. You have the right to refuse care or treatment.
8. The right to be informed about your care alternatives from Serenity HospiceCare, and
payment resources available to you.
9. The right to be informed in advance about the care to be furnished you and any limitations of those
10. The right to be informed in advance of the disciplines that will furnish your care and
the frequency of visits proposed to be furnished.
11. The right to be informed in advance of any change in your plan of care before the change is made.
12. The right to receive information on advance directives, including a living will and healthcare
13. The right to confidentiality of your clinical record maintained by Serenity HospiceCare and to be
informed of Serenity HospiceCare’s policy for disclosure of clinical records.
14. The right to be informed in writing of the extent to which payment may be required from you and
any changes in your liability within 30 days of Serenity HospiceCare becoming aware of the new
amount of the liability.
15. The right to access the Missouri State Department of Health and Senior Services toll-free hotline at
1-800-392-0210; the operating hours are 7:00 A.M. to 12:00 A.M. daily and serve the purpose of
Hospice Information Patient Rights and Responsibilities receiving complaints and questions regarding hospice services.
I may also call the Missouri Patient
Review Foundation at 1-800-347-1016.
PATIENT RESPONSIBILITIES: In order for Serenity HospiceCare to provide you the best possible care, we
will need for you to fulfill a few responsibilities as follows:
1. Provide Serenity HospiceCare staff with accurate and complete health information as requested.
2. Remain under a doctor’s care while receiving hospice service.
3. Participate in your plan of care and updating it as your condition or needs change.
4. Assist Serenity HospiceCare staff in developing and maintaining a safe environment in which your
care can be provided.
5. Attain the agreement of a primary caregiver upon admission to Serenity HospiceCare, or if none is
initially available, reach agreement with Serenity HospiceCare staff as to how this role will be fulfilled
at the time it becomes necessary. Call us any time you have a question,
you need help or, even think you may need help.
6. Being respectful and considerate of the rights of the hospice staff who provide care and services.