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160 NORTH MIDLAND AVENUE

NYACK, NY 10960

PATIENT RIGHTS: NOTICE OF RIGHTS

Tag No.: A0117

Based on medical record (MR) review, document review, and interview, in five (5) of 17 medical records reviewed, the facility did not provide patients or their representatives with the "Important Message from Medicare" (IM or IMM) within two (2) days of admission. This was evident for Patients # 2, 3, 4, 5 and 6.

Findings:

Review of facility's policy titled "Important Message from Medicare," last revised 01/18, revealed that "Hospitals must issue the important Message for Medicare (IM) within two (2) days of admission and must obtain the signature of the beneficiary or his/her representative."

Review of Patient # 2's medical record identified: this 89 year old female patient who was admitted on 01/12/2018 and was discharged from the facility on 01/18/18. There was no documented evidence that the patient had received the IMM.

Patient # 3 is a 74 year old female patient who was admitted on 01/13/2018 and as of 1/19/18, there was no documented evidence that the patient received the IMM.

Similar findings were found for patients #4, # 5, and #6.

These findings were confirmed with Staff B, Vice President, Chief Nursing Officer on 1/19/18 at 12:30 PM.