PATIENT BILL OF RIGHTS
As a patient you have the RIGHT to:
- Be informed of your rights in writing. To receive a copy of these rights and have them verbally explained to you in terms that you could understand.
- Full and up-to-date information on services and fees for services including related charges and refund policy. To know the names and professional titles of staff responsible for your care.
- Be informed if the facility has authorized other health care and educational institutions to participate in your care.
- Facts and explanations about your diagnosis, prognosis, and treatment (recommended treatment, treatment options, including the option of no treatment, risk(s) of treatment, and expected results) in terms that you understand the “what, why and how “of your complete medical/health condition. If this information would be detrimental to your health, or if you are not capable of understanding the information, the explanation shall be provided to your next of kin, guardian, or legal authorized representative. This release of information to your next of kin, guardian, or legal authorized representative, along with the reason for not informing you directly, shall be documented in your medical record.
- Participate in the planning of your care and treatment, and to refuse medication and treatment. This refusal will be documented in your medical record.
- Participate in experimental research or agree to be included only by giving informed written consent by you, your guardian, or legal representative.
- Voice a complaint or recommend changes in policies and services to agency staff, the governing authority, and/or outside representatives and have it investigated promptly without fear of restraint, interference, coercion, discrimination, or retaliation.
- Be free from any mental or physical abuse including exploitation and use of restraints, unless authorized by a provider for a limited period of time to protect you or others from injury. Drugs and other medications shall not be used to discipline patients, or for convenience of the health center’s personnel.
- Confidential treatment of your information. Obtain a copy of your records, request a change to your record, or have confidential records released only with your written consent unless the information is needed for legally authorized purposes, and receive a list of disclosures upon written request.
- Request restrictions on certain uses and disclosures of your Protected Heath Information (PHI). “Zufall Health is not required to agree to your requested restriction except for certain uses and disclosures to health plans.” (See Zufall rights below).
- Request a copy of the Notice of privacy Practices.
- Be treated with courtesy, consideration, compassion, dignity, and respect for your privacy, including, but not limited to, auditory and visual privacy.
- Not be required to perform work for the facility unless the work is part of your treatment and is performed voluntarily. This work shall be in accordance with local, State, and Federal laws and rules.
- Exercise free will including the right to make independent personal decisions. No religious beliefs or practices shall be imposed on you.
- Not be discriminated against because of age, race, ethnicity, color, religion, sex, national origin, sexual preferences, disability, diagnosis, ability to pay, or source of payment. Not be deprived of any constitutional, civil, or legal rights because of receiving our services including family planning.
- Expect and receive appropriate assessment, management, and treatment of your pain.
- Quality medical care.
- Determine how you would like to be contacted.
As a patient you have the RESPONSIBILITY to:
- Keep appointments. Arrive 10 minutes in advance to complete paperwork and understand that arriving later may result in your appointment being rescheduled.
- Be honest and complete about any information you give us (Remember: all information is confidential and can only be released with your written consent or disclosed under circumstances that are in accordance with state law).
- Be open about all aspects of your health and health care both past and present.
- To participate in medical services which include lab tests and physical exam.
- Comply with the health center’s policy and procedures and follow instructions. If you do not understand please ask us to explain.
- Ask questions. If something is confusing or unclear, let us know; we are here to help you.
- Pay your bill promptly so we can continue to provide quality care at low cost to all patients and provide information to ensure proper processing of insurance and payments.
- Call us immediately if you need help.
- Abide by the rules and regulations of patient conduct and responsibilities.
Zufall Health will uphold the RIGHT to:
- Refuse treatment and services to any patient who is under the influence of drugs or alcohol or otherwise cannot give informed consent for services.
- Accept patients’ request for restriction on the use or disclosure of their PHI to a health plan only if:
- Disclosure is for purpose of carrying out payment or health care operations and is not otherwise required by law; and
- The PHI pertains solely to a health care item or service for which the patient (or person other than the health plan on behalf of the patient) has paid Zufall Health in full.
- Deny the request to amend PHI maintained in the patients’ medical record if Zufall Health determinates that the PHI or record that is the subject of the request:
- Was not created by Zufall Health
- Is not part of the designated record set
- Would not be available for inspection by the individual, or
- Is accurate and complete.