YOUR PATIENT RIGHTS
Welcome to our Practice. We respect our patients' dignity and pride.
This document will explain your patient rights and responsibilities. It is part of your patient registration and is an important part of your health care plan. If you have any questions, please contact the Practice/Clinic leadership.
Our commitment to you, our patient, includes the following rights. We comply with applicable Federal civil rights laws and affirm that we will deliver high-quality health care to every patient without regard to:
age, gender, disability, race, color, ancestry, citizenship, religion, pregnancy, sexual orientation, gender identity or expression, national origin, health condition, marital status, veteran status, payment source or ability, or any other basis prohibited by federal, state, or local law
Considerate and Respectful Care
Fair, high-quality, safe and professional care
Care regardless of color, race, religion, creed, etc.
Consideration, respect, and recognition of you and your individuality
Treatment privacy
Safe environment
Ask for (except in emergencies) a person of the same sex to be available for any part of an exam, treatment or procedures performed by a person of the opposite sex
Not be undressed any longer than needed for the exam, test, procedure, or other reason
Private and discreet consultation, exam, and care. See Notice of Privacy Practices (NOPP) for the full list of privacy and security of health information/medical record rights
To wear appropriate personal clothing and religious or other symbolic items, as long as they do not interfere with your treatment or diagnostic procedures
Health Status and Care
Be informed of your health status in terms and/or language that you, your family, and caregivers can be expected to understand
Take part and be active in your care and treatment plan
Participate in decisions in your care, unless your providers or others believe it is harmful to you
Know, be told, and understand:
the names, roles, and qualifications of your health care experts that provide your care
your follow-up care
risks, benefits and side effects of all medicines and treatment procedures for your diagnoses
innovative or experimental medicines and treatment procedures of diagnosis offered
alternative treatment options offered
your procedure and to “give informed consent” before it begins
possible outcomes of your care and treatment
the assessment and management of your pain
When and if the Practice recommends other health care institutions:
to participate in your care
to know who these other health care places are and what they will do
to refuse their care
Get help from the provider and others for follow-up care, if available
To change providers or get a second opinion, including specialists at your request and expense
Decision Making and Notification
Choose a person to be your health care representative or decision-maker
Exclude those you do not want help from or to join in your care or decisions
Ask for, but not have the right to demand, services the Practice does not think are needed or appropriate
Refuse treatment as applicable by Kentucky law
Be included in experimental research only with your written consent
Refuse experimental research including new drug and medical device investigations
Receive the information necessary to approve a treatment or procedure
Give consent to a procedure or treatment
Access to Services
Receive free services of a translator, interpreter, or other necessary services or devices to help you communicate with the Practice in a timely manner (i.e. qualified interpreters, written information in other format or languages, etc.)
Bring a service animal except where prohibited pursuant to Practice policy
Have access to our facility buildings and grounds in compliance with The Americans with Disabilities Act, a law that stops discrimination against people with disabilities. The ADA policy is available upon request
Prompt and reasonable response to questions and requests for service
If you need any of the above services, contact the Practice management team
Ethical Decision
Talk to and join in with your provider about:
conflict resolutions
withholding resuscitative services
foregoing or withdrawing life sustaining care
investigational study or clinical trials
Know that if your health care expert decides your refusal to accept treatment prevents you from getting the right care (as stated by its ethical and professional standards), it can end the relationship.
Payment and Administrative
Review your health care bill regardless of your ability to pay it or the payment source
Receive information about available financial resources
If uninsured or declared self-pay, to receive, before the provision of a planned nonemergency medical service, a reasonable estimate of charges for such service and information regarding any discount or charity policies for which the uninsured person may be eligible.
Know if the Practice, providers and other team members accept Medicare, the government's health insurance for those aged 65+ or disabled or Medicaid.
Know and understand the Medicare and Medicaid charges for your services and treatment provided
Receive if you ask, with explanation, a reasonable estimate of your health care charges before treatment
To be free from any requirement to purchase drugs, or rent or purchase medical supplies or equipment from any particular source (specifically in accordance with the provisions of the CA Section 1320 of the Health and Safety Code) and also to receive patient choice in these type of decisions
Protective Service
Receive available protective and advocacy services
Receive, as offered by state law:
care and treatment for mental illness or development disability
all legal and civil rights as a citizen
Understand and expect emergency procedures without unneeded delay within Practice scope
Get needed information to approve a treatment or procedure
Be given the Practice's policies and procedures for:
Initiation, review, resolution of patient complaints, including the address and phone number to file complaints
Discuss complaints, issues, or problems regarding discrimination in access to services with your provider and/or the Practice management team.
File a complaint with the Ethics Line (1-800-994-6610), the Department of Health and Human Services*, Office of Civil Rights* or others with your concerns about patient abuse, neglect, misuse of your property at the Practice, other unresolved complaints, patient safety, and quality concerns
Have a fair review of alleged patient right violations
*Contact information for HHS or OCR: US. Department U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html or https://ocrportal.hhs.gov/ocr/portal/lobby.jsfPatient