Woods and Water Medical
Center1900 College(800)243-9482
Woods & Water Medical Center want every patient to receive the best possible care. To that end, want you to know what your rights are.
For example, it is your right to receive care without discrimination, have your family involved, participate in planning your medical
treatment, complete an advance directive outlining your healthcare wishes, and have your healthcare kept confidential. Specific rights are
listed below.
As a patient at Woods & Water Medical Center I, or my legally authorized representative, have the right to:
 Receive care without discrimination
due to my race, creed, color,
Patient Signature
national origin, ancestry, religion,
sex, sexual orientation, marital
status, age, newborn status,
handicap, or source of payment.
 Have my family and physician
notified promptly of my admission
and have my family participate in
my care decisions.
 Know the name of the physician or
other practitioner who has primary
responsibility for my care and know
the identity and professional status
of the people caring for me.
 Receive from my physician, in
terms I can understand, current
information about my diagnosis,
treatment, and prognosis.
 Receive from my physician, except
in emergencies, information that
allows me to give informed consent
before beginning any procedure or
treatment.
 Participate in the planning of my
medical treatment and decline to
participate in experimental
research.
 Receive care for symptoms that will
respond to treatment, even if they
are not related to my primary
healthcare condition.
Dr, Rice Lake, WI 54868
www.WWMC.com
Patient Rights
I have read and understood my
Date
right.  Complete an advance directive
outlining my wishes regarding my
healthcare should I become unable
 Receive evaluation and
to express my wishes. This may
management of pain.
include my wishes regarding organ
 Receive considerate and respectful
and tissue donation.
care in a safe and private
 Refuse treatment to the extent
environment free of neglect,
permitted by law and be informed
harassment, and abuse.
of the medical consequences of my
 Be free from restraints of any form
actions.
that are not medically necessary or
 Be informed of the need for, an
are used as a means of coercion,
alternative to, and acceptance by
discipline, convenience,
another facility when transfer to
 or retaliation by staff.
the facility is planned.
 Be free from seclusion and
 Have all communications and
restraints of any form that are not
records pertaining to my
necessary for emergency behavior
healthcare kept confidential.
or management or are imposed as
 Have access to my medical record
a means of coercion, discipline,
within a reasonable timeframe.
convenience, or retaliation by staff.
 Examine and receive an
 Receive evaluation and provision of
explanation of my bill regarding of
protective services.
the source of payment and receive
 Designate who is permitted to visit
information regarding financial
me during my hospitalization.
assistance.
 Receive care and treatment that
 Receive information regardless the
respects my values, beliefs, and life
relationship of Woods & Water
philosophy.
Medical Center to other healthcare
 Address ethical questions that arise
or educational institutions involved
in my healthcare.
in my care.
 Receive emotional and spiritual
 Receive complete language
support for my family and me.
translation, free of charge.
 | Created: 04/18/2023
 | Created: 04/18/2023