The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

NYACK HOSPITAL 160 NORTH MIDLAND AVENUE NYACK, NY 10960 Jan. 24, 2018
VIOLATION: PATIENT RIGHTS: NOTICE OF RIGHTS Tag No: A0117
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

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 [AGE] year old female patient who was admitted on [DATE] 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 [AGE] year old female patient who was admitted on [DATE] 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.