KMU Tower HotelKMU Hospital

Faculty ofNursing

Communication Center

Faculty of Medicine

Patient rights
1.
2.
3.
4.
5.
6.
7.
8.

You have the right to human dignity and to receive warm and compassionate medical care.
You have the right to privacy.
You have the right to receive medical care with safety taken into consideration.
You have the right to receive sufficient explanation from a physician or healthcare professional andto receive medical care based on your own choice.
You have the right to ask and/or seek advice regarding your medical care.
You have the right to view your own medical records and seek opinions of doctors at other medical
institutions.
You have the right to receive medical care in a comfortable environment.
You have the right to receive information about medical expenses and public assistance for
medical care.

Children’s charter
1.
2.
3.
4.

You are valued as an individual, regardless of illness, disability, or age.
You can ask healthcare staff to consider the best treatment for you.
You can receive treatment in a safe and secure place.
Even if you are staying in hospital, you can be with people whom you feel safe with and your loved
ones.
5. You can speak up about your interest in your illness and how to cure it, and ask others to tell about
them in an easy-to-understand manner.
6. When you can’t get what you want, you can ask why and give your alternative wishes.
7. You will not be discriminated against and will be protected from being hurt by anyone.
8. Information (privacy) about your illness and treatment will be protected.
9. Even if you are sick, you can still play and study as far as you can.
10. You can receive treatment and care from trained and skilled staff.
11. You can continue to receive treatment and care even after you are discharged from the hospital.

Patient responsibilities
1.
2.
3.

You are responsible for providing accurate information about your illness.
You are responsible for focusing on treatment and follow hospital rules and instructions.
When you receive a request for paying your medical expenses, you are responsible for promptly
paying the expenses.

Notices from the hospital
1.

2.

3.

4.

5.

KMU hospital uses patients’ personal information in accordancewith the provisions of the Act on the Protection of PersonalInformation. Please see the bulletin board of each ward fordetails.
KMU hospital is a “Designated Cancer Care Hospital” specified
by the Ministry of Health, Labour and Welfare, and we operate
cancer registry in accordance with the requirements.
Please note that we may ask you to move between wards,rooms, and beds during your hospitalization depending on thenature of your treatment and the need for nursing.
At KMU hospital, nurses pertaining to specified medical acts
who have received specialized training perform specified
medical acts on patients under the direction and guidance ofdoctors.
At KMU hospital, in order to provide clinical care more
efficiently by reducing the administrative burden on doctors, wemay have a medical clerk (a doctor’s office assistant) present in
the consultation room.

Requests from the hospital
We at KMU hospital believe that mutual trust between patients andthe medical institution is important in order to provide safe and highquality medical care. Therefore, please note that we may refuse
clinical care or ask you to leave the hospital if you engage in any ofthe acts listed below.
1.
2.
3.
4.
5.

Using abusive language, violence, intimidation, and any otheracts causing trouble to other patients and staff.
Acts of damaging property in the hospital
Coercion and persistent interviewing of staff regarding
document creation, etc.
Smoking on hospital premises
Any other acts that interfere with smooth clinical care
operations (including unauthorized audio/video recording,taking photos, etc.)

Before your admission
On the day of admission, please prepare the following items and come to the Admission Center ( A1 )on the first floor at the designated time. Please note that your admission date may be postponed orchanged depending on the degree of emergency, such as if another emergency patient needs to beadmitted.
Documents you need to bringItems you need to bring□ Consent form for admission*□ Confirmation at the time of admission*□ Food allergy questionnaire *□ Pajamas
If you would like to rent pajamas, pleaseask at the ward at the time of youradmission.
[130 yen per day , changed twice a week(three times a week from July toSeptember )]* The questionnaire is attached at the end of
this pamphlet.

□ Patient ID cardYour patient ID card will be kept in the ward
until you are discharged from the hospital.

□ My Number Card/Insurance
Card/Eligibility Certificate for CeilingAmount Application
Other medical certificates, medical
tickets, etc.
* If you bring your My Number Card with you,
you do not need to present an insurance
card or Eligibility Certificate for CeilingAmount Application.
* If you do not present your insurance card,etc., you will have to pay out of pocket.

□ Your personal seal
□ Admission deposit• You will need to pay a deposit in case ofobstetrics (delivery, etc.) or admission
paid out of pocket, and the balance will
be calculated at the time of discharge.
• Please hold your deposit slip in
safekeeping.
• Credit cards, debit cards, and electronicmoney cannot be used to pay thedeposit.
• We cannot keep any money other thanthe expenses required for admission.

♦ Please take care of the items you bringwith you by yourself. Please takeparticular care when storing yourdentures, hearing aids, glasses, etc., andbring a case to store them.
♦ Things for daily use can be purchased at
the convenience store on the first floor.

* Pajamas are available in two types: aseparate top and bottom type and a gown
type, and there are no pockets.

□ Toothbrush/toothpaste□ Shampoo, body soap , hand soap
□ Chopsticks, spoons, cups (that are hardto break)□ Undergarments, towels, bath towels□ Footwear (non-slip)□ Tissue paper etc.
□ Hairbrush/shaver□ Earphones for TV□ Masks□ Medications, injections, etc. that youcurrently use* If you are bringing your own oral
medications, please bring one-week doses
together with their pharmacy prescription
bags.
* Medications cannot be prescribed by othermedical institutions while you are
hospitalized.

□ Medication notebook□ Diapers (if needed)□ Writing utensils♦ Your doctor or nurse will explain if there
are any special items you need.

Meals
Meals during your admission are managed by a registered dietitian based on your doctor’s instructions,and are provided at the right time and at an appropriate temperature.
●Please consume your meal within 1 hour after the meal isserved.
● If you have any allergies, please inform your doctor or nurse.
Meal time:
Breakfast 8:00-9:00
Lunch 12:00-13:00
Dinner 18:00-19:00
Breakfast:
You can choose from bread, rice, and porridge.
If you would like to make a choice, please ask
the ward staff.
(Some meals do not provide choice.)
Selective meals:
Selective meals (A and B) are available for lunch and dinner from Monday toSaturday, and you can choose meals at least three days after receiving theselective meal form.
Every Monday and Thursday, lunch trays will be served with selective meal
sheets on them, so please choose either A or B and place the sheets in thecollection box located at the nurse’s station by 8:00 the next day. If you do not
submit the selective meal sheet, you will receive meal A.
* For Meal B (separate menu), an additional 20 yen per meal will be charged.
* Persons with food allergies, medical restrictions, or persons who are notserved meals on the day the selective meal sheet is distributed (lunch onMondays and Thursdays) will not be eligible for the selective meals.
* If you change to a non-selective meal after the selective meal sheet has
been collected, the selective meal will not be served even if the sheet has
been submitted.
Where to have meals: In addition to the hospital room, the Day Room can be used as a dining room.
Tea dispenser:
A tea dispenser is available in the Day Room. Please feel free to use it.
Please note that tea delivery service is available only for people who areunable to walk.

Special services
At KMU hospital, we provide the following services to the patients who pay uncovered room charges fora private room.
① Special menu service
Every lunch, the meal of your choice will be delivered to yourhospital room from Nozomi, the restaurant on the 13th floor,
at the same price at the restaurant.
* This service is limited to patients who do not have foodallergies, are served ordinary meals, and have obtained
approval from their doctors.
* Please fill out the application form and submit it to thestaff’s station by 15:00 the day before.
* We request that you make the payment in full at the time ofdischarge.
* This service is not available on Sundays, holidays, and the
2nd and 4th Saturdays of the month.
② Mineral water service
One bottle of KMU brand mineral water will bedelivered to your hospital room every day fromthe day of your admission to the day of yourhospital discharge.

Things to note during your admission
❶❷
❸
❹
❺
❻
❼
❽
❾

❿
⓫
⓬
⓭
⓮
⓯

Please follow the instructions of doctors and nurses regarding consultations and nursing.
When starting or replacing a drip infusion, your name will be checked using your wristband, even if
you are sleeping.
As measures to prevent falls, ① please keep the bed at a low height and ② install bed rails in aposition that prevents you from falling off the bed.
As for footwear, to prevent falls, please use footwear ① that covers your heel and does not come
off when you lift your foot and ②that are easy to take on and off.
Please do not enter other than the designated rooms.
Please do not touch medical equipment.
We will lend you a thermometer upon your admission. Please return it when you leave the hospital.
If it is damaged or lost, you will have to purchase it at the hospital’s convenience store.
To prevent theft, please open the curtains in your hospital room and close the door during the day.
Please place combustible garbage in the trash box in your hospital room. Please place noncombustible garbage in the special trash box in the Day Room. Please do not throw things withblood on them in the trash box and notify the staff.
Please use earphones when listening to TV, radio, music players, etc.
Please write the name of the ward when sending mail to inpatients.
Unless in an emergency, phone calls from outside will only be delivered as messages.
Please note that the service hours are 8:30-21:00.
Continuous parking during the admission period is strictly prohibited. In that case, you will berequired to pay the regular rate.
It is strictly prohibited to give rewards to staff members.
In the event of a fire or earthquake, please follow the instructions of doctors, nurses, and staff
members. Also, please do not use the elevator. Please check the “evacuation route map” in eachward in advance.

Request for infection prevention
Patients have weakened resistance. We ask for your cooperation in preventing infection.
[Implementation of hand washing]① When entering and exiting the hospital room
② Before and after using the toilet③Before and after meals④ When handling body fluids such as phlegm or runny nose
[About masks]
Please make sure to wear a mask when you are in the hospital, when you comeinto contact with other people, and when you leave your hospital bed.
If you have a cough or fever, please wear a mask at all times.
[Do not visit the hospital if you have any of the following symptoms]① Fever ② Runny nose ③ Cough④ Nausea ⑤ Diarrhea⑥ Eye itching and redness in the eyes
[Request in case a staff member is injured by a used needle, etc.]
If a staff member is accidentally injured with a needle, etc., used for you, we may
ask you to sample your blood for an infectious disease testing to determine your condition. The
hospital will cover the cost of the testing and will notify you of the test results if requested.

Confirmation at the time of admission
Patient nameDate of birth

Date:

//

① Before being admitted to KMU hospital this time, have you been hospitalized at another hospital
within the past 3 months?

(Yes・No)

Please fill in the following
only if you answered “Yes”.

② Do you have a discharge certificate issued by the medical institution where you were lasthospitalized?

(Yes・No)If you answered “Yes,” please submit the certificate alongwith this self-declaration form.

③ Please specify the name of the hospital where you were last hospitalized and the date ofadmission and discharge.
(Hospital name)(Admission date)
Date:/ /(Discharge date)
Date:/ /④ Please specify, if possible, the name of the main injury or illness during your admission.
(Name of injury orillness)Please leave this section blank.
IDDepartment
Ward

Consent form for admission
To: Hospital Director, KMU Hospital
I hereby consent to observing the following upon admission to KMU hospital.
If I violate the following, I will not object if I am ordered to leave the hospital.

(1) I will abide by the precautions and rules such as described in the “Admission Information”. I will
not disturb other patients or KMU hospital.
(2) I will pay hospitalization fees and other charges by the specified date without delay.
(3) If it is determined that there is no longer a medical need for hospitalization and treatment at KMU
hospital, I will leave the hospital immediately.
Date:
Furigana
Patient
nameDate of birth
Seal (male/female)

Current
address

Telephone(mobile)Place ofwork

Telephone(place of work)

//

Date:

//I hereby consent to taking joint responsibility for the consent made by the above patient uponadmission to KMU hospital. I will serve as the guarantor of the above patient regarding her/his
hospital admission.

Furigana
Patient
nameDate of birth
Seal (male/female)

Current
address

Telephone(mobile)Place ofwork

Telephone(place of work)
Relationshipwith the patient

Date:

/

/

KMU Hospital

Food allergy questionnaire
Date of birth

Date:

//

Name

<Presence or absence of food allergies> □Yes □No* Please tick the applicable box(es) below only if you have food allergies.
(Exclude likes and dislikes.)
Do not tick the box(es) of foods that you can currently eat without developi
Allergen□ Eggs

Degree of removal□ Complete removal□ A small amount isacceptable.
□ No raw eggs
allowed□ Milk/dairyproducts□ Wheat flour□ Soba(buckwheat)□ Kiwi□ Peach□ Mackerel only
□ Blue-skinnedfish□ Complete removal

Remove only mayonnaise
Do not use any foods that contain even a small amountof milk components (such as lactose in the stock)
Foods that contain up to 5g of dairy products such asbutter, bread, and consommé are used.

□ A small amount isacceptable.
□ Only drinking milk isprohibited□ Complete removal
Don’t use any seasonings□ Seasonings areSeasonings such as soy sauce and miso are used
acceptable□ Complete removal□ Complete removal□ Complete removal
Only use as stock is acceptable
Target fish: Sardines,
Pacific saury, horsemackerel, mackerel□ Nuts (peanuts,cashew nuts,etc.)□ Soybeans

DetailAvoid all foods that contain even small amounts of eggs
Tempura, fried batter, hamburger filler, kamaboko (boiled
fish paste), ham, etc.
A small amount of eggs is contained, up to 5g is used

Only use as stock is acceptable□ Complete removal□ Complete removal□ Seasonings areacceptable

Don’t use any seasonings
Seasonings such as soy sauce, miso, and oil are used

□ Shrimp□ Complete removal□ Crab□ Complete removal* If you are allergic to shrimp and/or crab and also have foods obtained from the habitat of shrimp
and/or crab (e.g. seaweed, sea lettuce, green seaweed, etc.) removed, please write down the foods
that have been removed.
Other (please specify if you have any allergies, symptoms, additional comments, etc. that do not applyto the above)*Please hand the completed form to the ward staff upon admission.

Access・ Three-minute walk from Keihan Railway Hirakatashi Station・ Free shuttle bus service is available from Hirakatashi Station North Exit Bus Terminal (8 a.m. to 4 p.m.)
YodoRiver

Yodogawa
Riverside Park
Hirakata
Performing andVisual Arts Center,
Annex

Dead end

Shuttle bus
stopEscalator

KMU Facultyof Medicine

Elevator
Hirakata Performing
and Visual Arts Center

Parking lot

Rapport Hirakata

KMU
Hospital

Route on foot(To thesecond floor)

Limousine bus
stop for Kansai
AirportRapport Hirakata

KMU
Communicati
on Center

To Kyoto
Kuzuha/Gionshijo

KMU Home Nursing Station
Hirakata
KMU Care Plan Center Hirakata

Paidparking lot

Faculty ofNursing

Route on footKMU Hospital

KMU Tower Hotel

Keihan Railway

North exit
bus loopJijin-Kan

Hirakatashi
StationTo Osaka
Vie.Orner(Aeon Hirakatastore)

To Osaka
Yodoyabashi/Kyobashi

From Shin-Osaka Station (Shinkansen)
Senri-Chuo

Kawaramachi

Minamiibaraki(Osaka Metro Midosuji

To Demachiyanagi
Gion-shijo

Osaka
AirportKyoto

From JR Osaka Station

Shin-Osaka
Shinkansen

To Nagoya(JR Osaka Loop Line)

ShinOsaka(JR)Tambabashi
To KobeUmeda

KMU
Hospital(Kintetsu Kyoto LineExpress)

Kadoma-shi Hirakatashi

Approximately
15 minutes(Keihan Main Line Limited
Express)

Tambabashi
Approximately
10 minutes

Yodoyabashi
Temmabashi

Hirakatashi

Approximately
10 minutes

Kyoto(Shinkansen)

KyobashiNakanoshima(Keihan Main Line LimitedExpress)

Kyobashi

From Kyoto Station (Shinkansen)

ShinOsaka

To Nara area

Hirakatashi
Approximately
19 minutes

From Osaka (Itami) Airport(Osaka Monorail)

Osaka
AirportKeihan Railway
Osaka Metro (Midosuji Line)(Keihan Main LineLocal/Semi-express)

Kadoma-shiApproximately
36 minutes

Hirakatashi
Approximately
20-25 minutes

From Kansai Airport

Osaka Monorail

TennojiHankyu (Kyoto Line)
Kintetsu (Kyoto Line)To NaraKansai Airport(Keihan Main Line LimitedLine)
Express)
ShinYodoyabashi
Hirakatashi
Osaka(Shinkansen) Approximately
Approximately
10 minutes
22 minutes(Limousine bus)
Kansai
AirportHirakatashi
Approximately 1 hour
30 minutes

KMU Hospital
KANSAI MEDICAL UNIVERSITY HOSPITAL

2-3-1, Shin-machi, Hirakata City, Osaka 573-1191
TEL 072(804)0101 FAX 072(804)0131
http://www.kmu.ac.jp/hirakata/