Every patient has a right to adequate relevant information about the nature, cause of illness, provisional / confirmed diagnosis, proposed investigations, risks, benefits, expected treatment outcomes and possible complications to enable them to make informed decisions, and involve them in the care planning and delivery process and it shall be explained at their level of understanding in language known to them.

Every patient and his/her designated caretaker have the right to complete information on the expected cost of treatment based on factual evidences. Patients and their caretakers also have a right to know the identity of various care providers and Doctors / Consultants who are primarily responsible for his / her treatment.

Reference:

Patients are given cashless services under AB PM-JAY scheme. Consents are being uploaded on TMS portal by EHCPs, which include investigations, risks, benefits, complications & outcomes NHA’s claim adjudication team & Medical audit is monitoring the process and raising queries to hospitals if records are missing https://pmjay.gov.in/sites/default/files/ 2021-01/Claims-AdjudicationManual-2_0-final.pdf

In case of any grievance- Central System Grievance Redressal Management System (CSGRMS) http://cgrms.pmjay.gov.in/ or AB PMJAY National Help Line-14555/1800-111-565 can be reached 24*7

Patient’s or their authorized individuals have the right to access the original copy of their all medical records (during period of admission, preferably within 24 hours and after discharge, within 72 hours)and request to receive a copy of their clinical records.
The relatives / caregivers of the patient have a right to get discharge summary or in case of death, death summary along with original copies of investigations.

Reference:

If patient is denied to access their medical records, complaints can be raised on Central System Grievance Redressal Management System (CSGRMS) http://cgrms.pmjay.gov.in/ or AB PM-JAY National Help Line14555/1800-111-565 or Email/Letter to NHA’s Public Grievance Officer.

All patients have a right to privacy and medical information of the patient given to a health care provider shall not be divulged to others unless the patient gives his consent to disclose such information to other.
Female patients have the right to presence of another female person during physical examination by a male practitioner.
The hospital management has a duty to ensure that its staff upholds the human & personal dignity, respecting special needs such as spiritual and cultural preferences of every patient in all situations. All records & data concerning the patient shall be kept restricted and insulated from data theft and leakage

Reference:

NHA has constituted Data Privacy Committee and appointed one data safety officer for data privacy & safety. Reference: https://pmjay.gov.in/sites/default/files/2018-08/NHA-Data-Privacy-Policy.pdf

Patient has the right to a seek a second opinion on medical condition form a doctor or hospital of his/her choice. Doctors and the hospital must respect patient’s decision to seek a second opinion and shall provide all necessary records and information to the patients caregivers without any extra cost or delay

Reference:

Beneficiary Self Help Portal & PMJAY Mobile App allows beneficiaries to find out their eligibility, nearest empanelled hospita if beneficiaries
want to visit another hospitals https://mera.pmjay.gov.in

Patient has the right to a seek a second opinion on medical condition form a doctor or hospital of his/her choice. Doctors and the hospital must respect patient’s decision to seek a second opinion and shall provide all necessary records and information to the patients caregivers without any extra cost or delay

Reference:

AB PM-JAY has developed quality certification program, checklist and empanelment & de-empanelment guidelines to ensure safe & clean environment for patients https://pmjay.gov.in/sites/default/files/2020-06/Empanelment-and-Deempanelment-guidelines.pdf

A patient has the right to continuity of care and the patient and caregivers have the right to be informed by the hospital about any continuing health
care requirements following discharge from the hospital. They have to be provided with information and access on whom to contact in case of an emergency. In case of transfer & referral patient shall be given right explanation that justifies the transfer, as well as confirmation from the hospital receiving the patient about their acceptance of the transfer

Reference:

All medical records are uploaded on TMS portal by EHCPs. NHA’s medical audit team has developed triggers & checklist for monitoring of
continuity of care and raising queries to empanelled hospitals if records are missing https://www.pmjay.gov.in/sites/default/files/2018-12/Fraud_Investigation_and_Medical_Audit_Manual.pdf

Every patient has a right that informed consent must be sought prior to invasive investigation/surgery (e.g. invasive investigation / surgery / chemotherapy) which carries certain risks. The patient or their family shall be explained about risks, benefits, and alternatives of a given procedure or intervention to enable them to make an informed decision about their care. Informed consent is both an ethical and legal obligation of medical practitioners and originates from the patient’s right to direct what happens to their body.

Reference:

Consents are being uploaded on TMS portal along with other medical records by EHCPs. NHA’s claim adjudication team is monitoring the process and raising queries if consents are not being filled by hospitals. https://pmjay.gov.in/sites/default/files/2021-01/Claims-AdjudicationManual-2_0-final.pdf

Patient has the right to give feedback, make comments, or lodge complaints about the health care they are receiving or had received from a doctor or hospital and all complaints must be given a registration number and there should be a robust tracking and tracing mechanism to ascertain the status of the complaint resolution.
The patient/caregiver has the right to a fair and prompt redressal of his/her concern and every hospital has the duty to set up an internal redressal mechanism to address such complaints.
The patient in addition has the right to appeal to a higher authority in the health care provider organization and insist in writing on the outcome of the complaint

Reference:

AB PM-JAY Central System Grievance Redressal Management System (CSGRMS) http://cgrms.pmjay.gov.in/  Email to NHA’s Public Grievance Officer
 AB PM-JAY National Help Line14555  Letter Addressing to Public Grievance Officer on official address of NHA