You have the right:
- To receive care that is respectful, recognizes dignity and is private to the extent possible.
- To receive care that takes into consideration your psychosocial, spiritual, and cultural values.
- To receive care free of neglect; exploitation and verbal, mental, physical or sexual abuse.
- To be given information in the language you understand or to have information interpreted.
- To receive an explanation of your diagnosis, treatment, and prognosis in terms you can understand.
- To receive the necessary information to participate in decisions about your care and to give your informed consent before any diagnostic or therapeutic procedure is performed.
- To refuse treatment, except as prohibited by law, and to be informed of the consequences of your decision.
- To participate in the consideration of ethical issues that may arise in your care.
- To expect your medical records will be kept confidential and released only with your written consent, in cases of medical emergency, or in response to court orders. (Confidentiality can be breached if you pose a significant threat of harm to self or others.)
- To know the names and positions of people involved in your care by official name tag or personal introduction.
- To ask and receive an explanation of our charges, even if they are covered by insurance.
- To review your medical records created and maintained by us regarding your care and treatment.
- To receive prompt and effective pain management and to be informed of available measures to treat pain.
- To have your guardian, next of kin, or legally authorized responsible person exercise your rights for you if you have been medically or legally determined to be unable to participate yourself.
- To receive care that reflects and respects your advance directives or your rights to advance directives.
- To submit complaints or offer suggestions to improve our services. If your concerns remain unanswered you have the right to notify the Joint Commission at patientsafetyreport@jointcommission.org. or call 1-800-994-6610
- To obtain care from other clinicians of the patient’s choosing within the primary care medical home.
- To seek a second opinion from a clinician of the patient’s choosing.
- To seek specialty care.
- To choose your preferred method of communication with the practice such as portal messages, email, text messages, voicemail, etc.
You have the responsibility:
- To provide us accurate and complete information about your present complaints and your past health history, including current medications.
- To provide us with accurate demographic information such as address and phone numbers and to keep the information current.
- To ask questions if you do not understand the explanation of your diagnosis, treatment, or any instructions.
- To participate in self-management activities such as weight control, exercise and medication compliance.
- To follow posted rules and regulations.
- To be considerate of other patients, physicians, and facility personnel.
- To arrive on time for appointments. If you arrive late you may need to reschedule your appointment.
- To call in advance of your appointment to cancel and/or reschedule.
- To provide us with at least a 48 hour notice when you need prescription medications.
- To inform the staff that communication accommodations such as translation, sign language, etc. are required.
- To provide us with the necessary information for insurance processing and to be prompt in payment of bills.
Rev. 4/18
