Patient Bill of Rights & Responsibilities

We want to encourage you, as a patient at Pain Care Specialists of Oregon, to communicate openly with your health care team, participate in your treatment choices, and promote your own safety by being well informed and actively involved in your care. Because we want you to think of yourself as a partner in your care, we want you to know your rights as well as your responsibilities during your stay at our facility. We also invite your family to join us as active members of your care team.

Your Rights

  • You have the right to receive considerate, respectful and compassionate care regardless of your age, gender, race, national origin, religion, sexual orientation or disabilities.
  • You have the right to receive care in a safe environment free from all forms of abuse, neglect or harassment.
  • You have the right to be called by your proper name and to be told the names of the doctors, nurses and other health care team members involved in your care.
  • You have the right to be told by your doctor about your diagnosis and possible prognosis, the benefits and risks of treatment, and expected outcome of treatment, including unanticipated outcomes.
  • You have the right to give written informed consent before any non-emergency procedure begins.
  • You have the right to have your pain assessed and to be involved in decisions about managing your pain.
  • You have the right to be free from restraints and seclusion in any form that is not medically required.
  • You can expect full consideration of your privacy and confidentiality in care discussions, examinations and treatments.
  • You have the right to access protective and advocacy services in cases of abuse or neglect. The center will provide a list of protective and advocacy resources.
  • You and family members or friends, with your permission, have the right to participate in decisions about your care, treatment and services provided, including the right to refuse treatment to the extent permitted by law.
  • You have the right to agree or refuse to take part in medical research studies. You may at any time withdraw from a study.
  • You have the right to sign language or foreign language interpreter services. We will provide an interpreter as needed.
  • You have the right to make an Advance Directive, appointing someone to make health care decisions for you if you are unable. If you do not have an advance directive, we can provide you with information and help to complete one.
  • You have the right to be involved in your discharge plan. You can expect to be told in a timely manner of the need for planning your discharge or transfer to another facility or level of care. Before your discharge, you can expect to receive information about any follow-up care that you may need.
  • You have the right to receive detailed information about your facility and physician charges.
  • You can expect that all communications and records about your care are confidential, unless disclosure is allowed by law. You have the right to see or get a copy of your medical records and have the information explained, if needed. You may add information to your medical record by contacting the Medical Records Department. Upon request, you have the right to receive a list of who your personal health information was disclosed to.
  • If you or a family member needs to discuss an ethical issue related to your care please contact our office and ask for the Office Manager, Jennifer Giese at (503) 371-1010.
  • You have the right to voice your concerns about the care you receive. If you have a problem or complaint, you may talk with your doctor, nurse manager or a department manager. You may also contact the Patient Relations Department at (503) 371-1010.
  • If your complaint is not resolved to your satisfaction, you have the right to request a review by the following organizations: Oregon Department of Human Services; 500 Summer Street NE, Salem, OR 97301; (503) 945-5944; Erinn Kelley-Siel, Director.

Your Responsibilities

  • You are expected to provide complete and accurate information, including your full name, address, home telephone number, date of birth, Social Security Number, insurance carrier and employer, when it is required.
  • You should provide the center or your doctor with a copy of your advance directive if you have one.
  • You are expected to provide complete and accurate information about your health and medical history, including present condition, past illnesses, hospital stays, medicines, vitamins, herbal products, and any other matters that pertain to your health, including perceived safety risks.
  • You are expected to ask questions when you do not understand information or instructions. If you believe you can’t follow through with your treatment plan, you are responsible for telling your doctor. You are responsible for outcomes if you do not follow the care, treatment and services plan.
  • You are expected to actively participate in your pain management plan and to keep your doctors and nurses informed of the effectiveness of your treatment.
  • Please leave valuables at home and only bring necessary items for your procedure.
  • You are expected to treat all staff, other patients and visitors with courtesy and respect; abide by all center rules and safety regulations; and be mindful of noise levels, privacy and number of visitors.
  • You are expected to provide complete and accurate information about your health insurance coverage and to pay your bills in a timely manner.
  • You are expected to keep appointments, be on time for appointments, or to call your health care provider if you cannot keep your appointments.

ADVANCED DIRECTIVES
You are not required to have an Advanced Directive. However, if you have one completed, we ask that you bring a copy for the patient chart so that in an event of an emergency, we may perform the desired life-saving measures. An advance directive is a set of instructions that explain the specific health care measures a person wants if he or she should have a terminal illness or injury and become incapable of indicating whether to continue curative and life sustaining treatment, or to remove life support systems. The person must develop the advance directive while he or she is able to clearly and definitively express him or herself verbally, in writing, or in sign language. It must express the person’s own free will regarding their health care, not the will of anyone else. It does not affect routine care for cleanliness and comfort, which must be given whether or not there is an advance directive. In Oregon, the Health Care Decisions Act (ORS 127.505 -127,660 and ORS 127,995) allows an individual to preauthorize health care representatives to allow the natural dying process if he or she is medically confirmed to be in one of the conditions described in his or her health care instructions. This does not authorize euthanasia, assisted suicide or any overt action to end the person’s life.


Advanced Directive Requirements:

Witnesses: Two adults, at least one of them not related to the person by blood or marriage nor entitled to any portion of the person’s estate, must witness or acknowledge the person’s signing the advance directive. The person’s attending physician, attorney-in-fact, and health care or residential staff may not serve as witnesses.

Health Care Instructions: These may either be general, or relate to the four specific conditions outlined below. However, general instructions, such as “the person never wishes to be placed on life support,” may be too vague and not provide for a situation in which an accident or emergency requires that the person be placed on life support temporarily. Specific instructions regarding the person’s wishes in each of the four scenarios listed below are preferred. Some hospitals’ social workers or chaplains will provide instructions and forms for advance directives.

The patient’s physician can determine whether any of these four conditions apply:

Close to death: Terminal illness in which death is imminent with or without treatment, and where life support will only postpone the moment of death.

Permanently unconscious: Completely lacking an awareness of self and external environment, with no reasonable possibility of a return to a conscious state.

Advanced progressive illness: A progressive illness that will be fatal and is unlikely to improve.

Extraordinary suffering: illness or condition in which life support will not improve the person’s medical condition and would cause the person permanent and severe pain.

Advanced Directive Options:

Health Care Representative: An advance directive can appoint someone who is at least 18 years of age to make medical decisions for the person when that individual is not able to do so. Among the decisions this health care representative can make is whether to withhold or remove life support, food or hydration. The health care representative and an alternate must sign the document, accepting their appointment The patient should appoint a health care representative that he or she trusts completely. A patient can voluntarily revoke their appointment of a health care representative at any time. A general Durable Power of Attorney. which is for financial affairs, does not include authority to make health care decisions.

Special instructions and conditions: These can be inserted into the Health Care Plan or included for the health care representatives as long as they don’t deal with the distribution of property.

Durations and changes: The advanced directive can be designated in effect for a limited period of time. If not, it is in effect until the person revokes it in writing, or dies. A person can cross out words or add words to his or her advance directive to make it better express his or her wish. You may download a blank Advanced Directive form from the State of Oregon website: http://www.oregon.gov/DCBS/SHIBA/docs/advance_directive_form.pdf or request a blank form from Pain Care Specialists.


A Guide To Your Insurance Coverage:

For questions regarding your benefits, please contact your Insurance Representative at the number located on the back of your insurance card. We find that each Insurance Company is different and that each member’s benefits – even with the same insurance company – can vary. This is why calling your insurance representative is the best way to determine what the cost of your treatment should be. The Tax ID number for Pain Care Specialists of Oregon is 475408122.

The following are a list of common procedure codes for Pain Management:
20610 – GTB/Large Joint Injection
62310 – Interlaminar Epidural Injection, Cervical/Thoracic;
62311 – Interlaminar Epidural Injection, Lumbar
63650 (x2) and l8680 (x16) – Spinal Cord Stimulator Trial
64490 – Medial Branch Block, Cervical/Thoracic FirstLevel
64493 – Medial Branch Block, Lumbar First Level
64479 – Transforaminal Epidural Steroid Injection, Cervical/Thoracic First Level
64489 – Transforaminal Epidural Steroid Injection, Cervical/Thoracic, Each Additional level
64483 – Transforaminal Epidural Steroid Injection, Lumbar First Level
64484 – Transforaminal Epidural Steroid Injection, Lumbar, Each Additional Level
64520 – Nerve Block Injection, Lumbar/Thoracic
64622 – Radiofrequency Ablation, Lumbar First Level
64626 – Radiofrequency Ablation, Cervical/Thoracic First Level
G0260 – SIJ Injection, (27096 is the Professional/Physician Component)