Full information about my rights and responsibilities as a patient in an Ambulatory Center;
Receive an explanation of my diagnosis, benefits of treatment, alternatives, recuperation, risks and an explanation of consequences if treatment is not pursued;
An explanation of all rules, regulations and services provided by the Center, the days and hours of service and provisions for possible emergency care, including telephone numbers;
Choose the type of Medical Plan which is best suited to my particular situation and work with the physician members within my healthcare plan;
Participate in development of a plan of care including Advance Directives and have my own copies;
Refuse participation in any protocol or aspect of care including investigational studies, and freely withdraw my previously given consent for further treatment;
Disclosure of any teaching programs, research or experimental programs in which the facility is participating;
Full financial explanation and payment schedules prior to beginning treatment;
Receive professional care without discrimination, regardless of race, creed, color, religion, national origin, sexual preference, handicap, sex or age;
Be treated with courtesy, dignity and respect of my personal privacy by all employees of the Center;
Be free of physical/mental abuse and/or neglect by all employees of the Ambulatory Center;
Complain or file grievance with the Center Patient Representative without fear of retaliation or discrimination;
Confidential treatment of my condition, medical record and financial information;
Access to my personal records and obtain copies upon written request; and,
Assistance and consideration in the management of pain.
As a Patient, I have the RESPONSIBILITY to:
Disclose accurate and complete information related to physical condition, hospitalizations, medications, allergies, medical history and related items;
Participate in developing a Plan of Care, Advance Directives and Living Will;
Assist in maintaining a safe, peaceful and efficient ambulatory environment;
Provide new/changed information related to my health insurance to the business office and be prepared to meet my agreed co-pay during my office visit.
Contact the Center when unable to keep a scheduled appointment;
Cooperate in the planned care and treatment developed for me;
Request more detailed explanations for any aspect of service I don’t understand;
Inform my physicians and nurses of any changes in my condition or any new problems or concerns;
Communicate any temporary or permanent change in my address or telephone number which might hinder contact by the Ambulatory Center staff;
Relate my levels of discomfort and/or pain and perceived changes in my pain management to my physician.
Inform my physician or nurse when I am going to need a prescription refill before my supply is gone.