Patient Rights

As a patient of this clinic, you have the right to:

Respect, Dignity, and Non‑Discrimination

• Considerate and respectful care. Receive care that respects your personal values, beliefs, cultural and spiritual practices, and preferences.
• Freedom from discrimination. Receive care that is free from discrimination based on age, race, color, ethnicity, national origin, religion, sex, sexual orientation, gender identity, marital status, disability, or source of payment.
• Freedom from abuse and harassment. Be free from verbal, physical, sexual, mental, and financial abuse, neglect, exploitation, or harassment of any kind.
• A safe environment. Receive care in a clean and safe setting that protects your physical and emotional well‑being.

Information and Communication

• Clear information about your care. Receive complete, current, and understandable information about your diagnosis, treatment options, expected outcomes, and prognosis.
• Know your care team. Know the names, roles, and credentials of the providers and staff involved in your care.
• Language and communication assistance. Have access to qualified interpreter services and auxiliary aids at no cost to you if you have limited English proficiency, are deaf or hard of hearing, or have other communication needs.
• Access to your medical record. Inspect, request copies of, and request amendments to your medical record in accordance with applicable law.

Informed Consent and Decision‑Making

• Participate in decisions about your care. Be an active partner in decisions about your treatment plan, including the right to ask questions and obtain a second opinion.
• Informed consent. Receive information about proposed treatments, procedures, medications, risks, benefits, and reasonable alternatives, including the option of no treatment, before giving consent.
• Refuse treatment. Refuse any recommended treatment, medication, or procedure to the extent permitted by law, and be informed of the medical consequences of that refusal.
• Advance directives. Formulate advance directives (such as a living will or healthcare power of attorney) and have your care team honor them to the extent permitted by law.
• Participation in research. Be informed if any aspect of your care involves research, experimental treatment, or clinical trials, and to refuse to participate without affecting your routine care.

Privacy and Confidentiality

• Personal privacy. Have your personal privacy respected during examinations, treatments, conversations, and consultations.
• Confidentiality of your information. Have your medical, financial, and personal information kept confidential in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and other applicable laws.
• Notice of privacy practices. Receive a written Notice of Privacy Practices that explains how your protected health information may be used and disclosed.
• Restrict disclosures. Request restrictions on how your health information is shared and to receive communications about your health by alternative means or at alternative locations when reasonable.

Access and Continuity of Care

• Timely access to care. Receive timely and appropriate care within the scope of our services, including referrals to other providers when needed.
• Continuity of care. Be informed of any continuing healthcare needs after your visit, including follow‑up appointments, medications, and self‑care instructions.
• Transfer of care. Be informed of and participate in decisions about transfers to other providers or facilities when clinically appropriate.
• Pain management. Receive appropriate assessment and management of pain.

Financial Information

• Understandable billing. Receive an itemized explanation of charges for services and reasonable assistance in understanding your bill, insurance coverage, and any financial assistance programs for which you may qualify.
• Estimates upon request. Request a good‑faith estimate of expected charges for scheduled services before they are provided.

Voicing Concerns and Filing Grievances

• Express concerns without fear of reprisal. Voice complaints, concerns, or suggestions about your care without retaliation, discrimination, or compromise of access to care.
• Timely review of grievances. Receive a prompt, fair, and thorough review of any complaint or grievance, and to receive a written response describing the outcome.
• Contact outside agencies. Contact the state health department, accreditation organizations, or other regulatory agencies at any time, whether or not you have used our internal grievance process.

Patient Responsibilities

To help us provide the best possible care, we ask that you accept the following responsibilities:

Provide Accurate Information

• Share your health history. Provide, to the best of your knowledge, accurate and complete information about your medical history, current medications (including over‑the‑counter products and supplements), allergies, and any other matters relating to your health.
• Report changes. Inform your care team promptly of any changes in your condition, symptoms, or response to treatment.
• Update contact and insurance information. Keep your demographic, emergency contact, and insurance information current.

Participate in Your Care

• Ask questions. Ask questions whenever you do not understand information, instructions, or your plan of care.
• Follow your plan of care. Follow the treatment plan agreed upon by you and your provider, including taking medications as prescribed and completing recommended tests, referrals, and follow‑up appointments.
• Accept the consequences of your decisions. Understand and accept the outcomes that may result from refusing treatment or not following the recommended plan of care.

Show Consideration and Respect

• Respect staff, providers, and other patients. Treat clinic staff, providers, and other patients with courtesy and respect. Threatening, abusive, or disruptive behavior is not tolerated and may result in dismissal from the practice.
• Respect clinic property. Care for clinic property and follow safety, infection‑control, and clinic policies.
• Keep appointments. Arrive on time for scheduled appointments or give the clinic as much advance notice as possible when you must cancel or reschedule.

Meet Financial Obligations

• Pay for services. Pay for services received in a timely manner, including copays, deductibles, and any balances not covered by your insurance.
• Communicate about billing concerns. Promptly notify the clinic of any concerns about your bill, financial hardship, or changes to your insurance coverage.

Communicate Concerns

• Speak up. Tell a member of your care team if you do not understand your care, if something does not seem right, or if you have a concern about quality or safety.
• Share your wishes. Provide copies of your advance directives, healthcare power of attorney, or other legal documents that affect your care, and inform staff of any changes.

How to Raise a Concern or File a Grievance

If you have a concern about your care or experience at our clinic, we encourage you to share it with us so we can address it quickly. You may:

1. Speak with the staff member or provider involved in your care.
2. Ask to speak with the executive director.
3. Submit your concern in writing to the clinic’s administrative office, in person or by mail.
4. Contact your state health department or applicable accreditation organization if you believe your concern has not been resolved.

Filing a complaint will not affect your access to care or the quality of care you receive with our organization.