When it’s time to see your family doctor, a surgeon, or a specialist, we want to help reduce any stress you and your family might feel. Our patient resources include information on billing, accepted insurance plans, patient rights and privacy as well as important medical forms you can download and fill out at your convenience.
In addition to these online resources, the Upland Hills Health staff is available to answer questions and help make your stay as stress-free as possible.
Release of Medical Information
Need a copy of your medical records? Download the release form below.
Release of Medical Information to an outside facility
To Request Records – Call 608-930-7119
Billing Questions
Healthcare billing can be confusing. This page will help you understand your bill or pay your balance, tell you about Uncompensated Care discounts, and help you get estimates in advance of your procedure.
Notice of Privacy Practice
How your medical information about you may be used or disclosed, and how you can access this information.
Quality and Pricing
See and compare the prices for common procedures at Upland Hills Health, get an estimate for your upcoming procedure and see how our commitment to quality reflects in awards and ratings.
Patient Rights and Responsibilities
Upland Hills Health respects patient rights and serves all people regardless of age, race, ethnicity, culture, national origin, religion, language, values/beliefs, marital status, disability, advance directive, source of payment, socioeconomic status, arrest or conviction record, sex, sexual orientation, gender identity or expression.
The patient or legal representative is told and can participate in decisions of care, treatment, and services. These rights include the decisions to have, not to have, and to stop care, treatment, and services as allowed by law.
Respect and Dignity
The patient has the right to:
- Considerate, ethical and respectful care with recognition of his/her personal dignity.
- Choose and talk with medical, dental, and other licensed independent practitioners/care providers
- Know Upland Hills Health is a critical access hospital that does not provide the opportunity for a swing bed patient to work or perform services
- Have his/her rights exercised by the person appointed as legal guardian or power of attorney for health care agent.
Personal Safety
The patient has the right to:
- Receive care in a reasonably safe environment.
- Be free from physical, sexual, financial and verbal abuse, harassment, neglect, exploitation or involuntary seclusion.
- Be free from chemical and physical restraints or seclusion in any form that are not medically necessary.
- Medication information (a nurse or pharmacist can talk with the patient about his/her medication)
- Be in a tobacco free hospital (Upland Hills Health is a tobacco free campus). A nurse can talk with the patient if he/she wants to stop using tobacco
- Protective and advocacy services for personal safety.
- Place his/her valuables in the hospital locked space. The patient is responsible if he/she chooses not to lock the valuables.
Privacy and Confidentiality
The patient has the right to personal and informational privacy, as defined by law.
The patient has the right to:
- Accept or refuse to talk with or see anyone not officially connected with the hospital, visitors, or Upland Hills Health workers who are not directly involved in patient care.
- Wear his/her clothes and religious/symbolic items, unless it infringes on the rights of others or interferes with diagnostic procedures or treatment.
- Ask that an employee not be assigned to his/her care.
- Be examined and talked to where there is reasonable privacy.
- Have a person of one’s own sex present during a physical exam, treatment, or procedure performed by the health professional of the opposite sex.
- Ask that uninvolved hospital workers or visitors not be present when the patient’s care is being discussed.
- See and get copies of his/her medical record and ask for changes.
- Have patient’s communications, medical information, and payment sources be treated as confidential. Patient may ask how his/her medical information may be disclosed.
- File a complaint with the provider or Secretary of Health and Human Services if he/she thinks “privacy protected” was not followed.
Identity
The patient has the right to:
- Know the identity and profession of UHH workers providing care/services to him/her.
- Know which doctor is responsible for his/her care.
- Know who is involved in the care and be told who is responsible for doing the procedure or treatment.
- Be asked if he/she wants to have care by students in training.
Communication
The patient has the right to:
- Communication in a way the patient understands.
- An interpreter, translator, and TDD device. Other aids can be used for patients with vision, speech, hearing, and cognitive needs.
- Ask that his/her medical record be communicated to another healthcare facility or provider (a medical release of records is signed by the patient).
Information
The patient has the right to:
- Know all information about his/her diagnosis (to the degree known) treatment, any known prognosis and care outcome, including unanticipated outcomes.
- Have visitors, mail, telephone calls, and other communication (these may be stopped as needed for rest, care, and safety reasons).
- Privacy during communication.
- Specialized services as required by the plan of care.
- Have a family member or someone of the patient’s choice, be told of his/her hospital admission.
- Ask and get a total bill that lists each item.
- Timely notice before termination of his/her eligibility for reimbursement by the insurer or third payor for the cost of his/her care.
- Talk with a Business Office worker about the bill and payment. The patient is to tell the Business Office about the patient’s payment source (insurance, Medicare, etc.) and plans for payment as asked for by the Business Office.
- Get Advance Directive information upon admission
Consent
The patient has the right to:
- Give or not give informed consent.
- Make decisions and resolve dilemmas about his/her health care, treatment, and services. Tell a nurse or social worker when there is a conflict about care.
- Give or not give consent for recording or filming for purposes other than identification, diagnosis or treatment.
- Forego or withdraw life-sustaining treatment or withholding resuscitation to the extent permitted by law.
- Agree to or refuse medical care, treatment and services within the law and regulations. Patient consent is not needed in emergencies. The patient is told when there are reasonable alternatives for care or treatment.
- Know the hospital protects and respects his/her rights during research, investigation, and clinical trials. Patient can agree or refuse to participate.
- If patient decides not to follow or fails to follow the doctor’s instructions, he/she assumes full responsibility for the outcome.
Participation in Care
The patient has the right to:
- Be assessed and effectively treated for pain.
- Participate in decisions about care, treatment, and services including having your doctor notified of your admission.
- Complete an advance directive and have the doctor and hospital workers follow the directive within laws and regulations. Upland Hills Health may consult with Corporate Counsel as needed (an example may be for out-of-state directives).
- Comfort measures.
- Have visitation rights based on patient choice. This includes choosing the visitors you want and do not want to visit, having visitors treated fair and equally, flexible visiting hours, and having a support person.
- Pastoral and spiritual services.
- Speak with a specialist at the patient’s expense.
- Ask for a different room or to share a room with his/her spouse when the spouse is a patient.
- Transportation services.
- Pick a doctor, ask for a different doctor. The doctor needs to accept the patient before care is transferred. The patient may pick up and talk with his/her dentist and independent care provider.
- Make his/her wishes known about organ and tissue donation, and for the hospital to honor the wishes within the laws and regulations.
- Meet with Hospice to learn about end-of-life care.
- Ask for a Bio-ethics consult. Let your nurse or a patient and family service staff know.
Patient Responsibilities
The patient has the responsibility to:
- Tell the doctor or staff about his/her health illness and medical history.
- Tell the doctor or staff about his/her medicines including over-the-counter and herbal.
- Ask questions if he/she does not understand or needs more information.
- Follow the medical treatment plan developed by his/her doctor and care team.
- Tell the doctor or care team about any changes in health.
- Accept outcomes when he/she doesn’t follow the recommended course of treatment.
- Be involved in your care and help in providing safe care.
- Respect patients, staff, and Upland Hills Health property.
- Follow hospital rules.
- No smoking on Upland Hills Health property, including the parking lots.
Complaints and Suggestions
The patient has the right to report a complaint about care, treatment, or safety and have it reviewed by Upland Hills Health. How to file a concern or complaint:
- Ask an employee for assistance in completing a written concern or complaint form.
- Ask to speak to a department director or house supervisor.
- Leave a verbal message on our confidential Comment Line; call our Comment Line at 608-930-7100.
- Complete a patient questionnaire or survey.
- Leave a verbal message on our confidential Comment Line; call our Comment Line at 608-930-7100.
- Complete a patient questionnaire or survey.
Write or call:
Administrator
Upland Hills Health
800 Compassion Way
Dodgeville, WI 53533
Telephone Number: 608-930-8000
The Joint Commission
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
Telephone Number: 800-994-6610
Fax Number: 630-792-5005
