St Nicholas Hospital

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Patients > Rights & Responsibilities

Health Information Form
My Medications
Patients Rights
Patients Responsibilities
Spiritual and Pastoral Support Services
Your Opinions

Health Information Form - PDF

My Medications - PDF

Patients Rights
St. Nicholas Hospital believes that good healthcare is responsive to the needs of the whole person – one's physical, emotional, social, intellectual, and spiritual well-being. We serve our patients with compassion and dignity and recognize each person's unique needs. At St. Nicholas Hospital, you have the right to:

Respect, considerate care regardless of race, color, religion, ethnic origin, handicap or disability, financial status, age, marital status, sex, or sexual orientation.

Have a family member and your own physician notified promptly of your admission to the Hospital.

Voice complaints regarding care you have received, have them reviewed, and, when possible, resolved.

Participate in all decision-making about your care and treatment and receive clear, concise explanations of all proposed procedures/ treatments, prior to their administration. You are the center of the healthcare team.

Have an Advance Directive and have your legal representative make care decisions for you if necessary.

Accept, consent to, or refuse care or treatment and be informed of the probable implications of that decision.

Request a consultation with the Hospital Ethics Committee.

Review and receive a copy of your medical records and have information explained, except when restricted by law.

Ask a trusted family member or friend to be your advocate.

Express spiritual beliefs and cultural practices that do not harm others or interfere with the plan of care.

Safe, therapeutic healthcare provided by competent, qualified personnel.

Know the names, credentials, and roles of individuals providing care to you and to accept or refuse care by students.

Healthcare providers who provide information about pain and pain management, respect your reports of pain, respond to your reports of pain in a timely manner, and provide ongoing appropriate assessment and management of your pain.

An explanation from your physician about your medical treatment given in a manner which you can understand, to includes advantages, disadvantages, probable outcomes, and alternatives.

Speak up if you have questions or concerns and, if you do not understand, ask again.

Privacy concerning medical care and records and to expect that your records are confidential unless you have given permission to release information or reporting is required by law.

Have access to interpretive services and have unrestricted communication, such as visitors, phone calls, and mail.

Be told of realistic alternatives when hospital care is no longer appropriate and the right to be informed of the need for transfer or discharge to another facility.

Be informed when the Hospital is unable to provide care you may be requesting, and to be provided with information about alternatives for care.

Be free from seclusion and restraint unless they are deemed medically necessary and ordered by your physician.

Receive information about your bill, including methods of payment.

Be informed of the Organ and Tissue Donation Policy.

Consent or decline to take part in research affecting your care.

Know if this Hospital has relationships with outside parties that may influence your treatment and care.

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Patient Responsibilities
Just as you have inherent rights at St. Nicholas Hospital, you and/or your family have certain obligations and responsibilities. In order for this Hospital to provide the best possible care, it is necessary for you to:

Provide accurate information relating to your health to appropriate staff and to report unexpected changes in your condition.

Know what medications you take and why you take them.

Be an active participant in your care and ask questions if you do not understand directions or procedures.

Educate yourself about your diagnosis, medical tests you may be undergoing, and your treatment plans.

Inform your healthcare providers about your pain (location, intensity, and quality), develop a pain management plan with your healthcare providers, and let your healthcare providers know the effectiveness of your pain management plan.

Pay attention to the care you are receiving and make sure you are getting the right treatments and medications by the right healthcare professionals.

Be respectful and considerate of other patients who are also in need of care as outlined in the Hospital rules and regulations.

Be responsible for your decisions and actions if you refuse treatment or do not follow your physician's instructions.

Ensure that the financial obligation of your healthcare is met by:

  • Providing accurate address, telephone numbers and insurance information upon registration.
  • Knowing and understanding your insurance benefits.
  • Notifying your insurance company for pre-approval of your visit.
  • Being responsible to set up a payment plan

Avoid discriminating against any staff caring for you.

Provide a copy or make staff aware of the content of your Advance Directive.

Be responsible for personal belongings and take precautions to prevent the loss of valuables.

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Should anything in your room require repair, please notify your nurse so that the repair can be made promptly.

Because your safety is our main concern, the Hospital maintains an active safety program. All personnel are trained to be alert in the area of safety; drills are conducted regularly.

Small UL-approved personal electrical appliances may be used. Notify your nurse if you wish to use a personal electrical appliance in your room or if you have any questions/concerns.

Smoking is prohibited throughout the Hospital and all Hospital grounds. If you choose to smoke off Hospital property, please respect our neighborhood by not littering. The Hospital offers a Smoking Cessation program for inpatients and the public. Ask a staff member for more information.

There are also some things you or your family members/significant others can do to help us keep our patients safe:

Always call a nurse and ask for help rather than attempting anything that might result in an accidental strain or fall.

Wear non-skid slippers; do not walk barefoot.

Ask a nurse for help if you feel dizzy or weak when getting out of bed.

Never attempt to get in or out of a wheelchair by yourself. Ask your nurse for assistance.

Remain lying or seated while waiting for assistance.

If the side rails on your bed are lowered or restraints (see below) are removed by family members, please alert your nurse of the change before leaving the room.

Sometimes a restraint is needed to protect a patient. Restraints are only used when necessary to protect a patient or others from injury. These measures are used only when other, less restrictive interventions have failed. If restraints are necessary, nursing staff will check them frequently to assure you and your loved ones that adequate circulation, skin care, food, fluid, and elimination needs are maintained.

We continually reassess patients for timely release from restraints. When a patient no longer presents a risk of injury to self or others, or when other less restrictive alternatives are effective, restraints are removed.

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Spiritual and Pastoral Support Services
The Hospital Chapel, located on the First Floor, is available to all denominations and is open 24 hours a day. Members of the Pastoral Care Team are available to offer emotional and spiritual comfort to patients and families. As requested, they visit patients regularly and meet the needs of each, whether those needs be for prayer, conversation, or simply a quiet presence. Please inform your nurse if you wish to see a Hospital chaplain, one is available 24 hours a day.

Your Opinions
If something about your stay particularly pleases or concerns you, or if you have a question or worry, please tell us! If there is a problem, we would like to hear about it. If something or someone has helped to make your stay more comfortable and satisfying, we would like to hear about that, too.

Feel free to discuss whatever is on your mind about our services with your nurse or physician. There is a Nurse Director/Coordinator on your unit who is also able to discuss with you the care you are receiving and address any concerns. Additionally, the Hospital Patient Advocate is available to assist with questions, concerns, or complaints and can be reached at 920-459-4620 or by calling the Hospital Operator.

If your concerns cannot be resolved through the Hospital, you may contact the Joint Commission on Accreditation of Healthcare Organizations. The public may contact the Joint Commission's Office of Quality Monitoring to report any concerns or register complaints about a Joint Commission accredited healthcare organization by either calling 1-800-994-6610 or emailing

Complaints may also be filed with the State of Wisconsin Division of Quality Assurance, Department of Health & Family Services, P.O. Box 2969, Madison, WI 53701-2969; 608-266-8084 or 1-800-642-6552. Complaints may also be filed online by visiting

Following your stay, you may be contacted for a telephone survey about your experience. This is done by an independent research firm on behalf of the Hospital. We hope you will participate as your input helps us make improvements in the quality of our service.

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Patients > Pre-Registration > Scheduling > Billing > Billing Practices
Community Care > Medical Records > Advance Directives
Do-Not-Resuscitate (DNR) > Rights & Responsibilities
Freedom of Choice (Providers) > Notice of Privacy Practices

St. Nicholas HospitSt. Nicholas Hospital, 3100 Superior Avenue, Sheboygan, WI Ph:920-459-8300
 100 Superior Avenue
 Sheboygan, WI 53081