The disclosure document required under section 1 of this chapter must contain at least the following:

1. (1) A description of all hospice services provided by the hospice program, including the:

   1. (A) types of nursing services;
   2. (B) other services;
   3. (C) specific services available during the progressive stages of the terminal illness and thereafter; and
   4. (D) a statement that the extent of hospice services and supplies are dispensed based on the hospice program patient's individual needs as determined by the interdisciplinary team.
2. (2) An explanation of the hospice program's internal complaint resolution process.
3. (3) A statement that the hospice program patient has the right to participate in the planning of the patient's care.
4. (4) A statement that a hospice program patient may refuse any component of hospice services offered by the hospice program.

5. (5) A statement that a hospice employee may provide supplies to a:

   1. (A) hospice program patient; or

   2. (B) hospice program patient's family;

      in addition to the supplies provided by the hospice program, but the employee may only be reimbursed for the supplies by providing a written receipt to the hospice program patient or the hospice program patient's family.

6. (6) A statement that the hospice program patient may request the hospice program to provide, on a monthly basis, an itemized statement of services and supplies delivered to the patient, as submitted to the patient's payor.
7. (7) The toll free number established by the state department under IC 16-25-5-4 to receive complaints from hospice program patients and the family members of hospice program patients regarding the hospice program.

As added by P.L.256-1999, SEC.17.