Statement of Patient Rights
These are your patient rights.
1. Patients are treated with respect, consideration, and dignity.
2. Patient rights will be exercised without regard to sex or culture, economic, education or religious background or the source of payment for his or her care.
3. Patients are provided privacy with respect to medical treatment and other decision making.
4. Patient disclosures and records are treated confidentially, and, except as required by law, patients are given the opportunity to approve or refuse their release.
5. Patients are provided, to the degree known, complete information concerning their diagnosis, evaluation, treatment, and prognosis.
6. Patients are given the opportunity to participate in decisions involving their healthcare, except when such participation is contradicted for medical reasons. Patients have the right to consent to or refuse treatment.
7. Information available to both patients and staff: All information relating to Patient Rights and Responsibilities is available to both patients and staff. This information includes the following:
■ Patient rights
■ Patient responsibilities
■ Services available within [insert practice name]
■ Provisions for after hours and emergency care
■ Patient right to refuse to participate in experimental research
■ Patient right to refuse to have an observer present during a procedure
■ Advance directives in accordance with state and federal law and other regulations
■ Credentialing of health care professionals
■ Grievance policies
■ Fees for services
■ Billing and payment policies
8. Patients have the right to change primary or specialty physicians if available and the right to change CRNA provider.
9. Marketing or advertising regarding the competence and capabilities of the organization are not misleading to patients.
10. Patients will be informed if there is a problem with malpractice insurance coverage.
11. Patients have the right to make any complaints or suggestions.
12. Patients have the right to consent or decline to take part in research affecting their care.
13. Patients have the right to an advance directive, such as a Living Will or Health Care Proxy. Those documents express your choices about your future care or name someone to decide if you cannot speak for yourself. If you have a written advance directive, please provide a copy to your family and physician.
14. The patient may expect a reasonable response to any reasonable requests that he or she may make in regard to service and patient care.
EPGI will recognize the special needs of the speech/hearing or visually impaired patients. The primary language, if not English, will be noted in the patient’s record. Any speech or hearing impairment will also be noted. Every effort will be made to get an interpreter if the patient does not bring one. The use of note pads and other communicative methods will be encouraged for any patient who is speech and/or hearing impaired.
15. A patient whom undergoes a procedure within [insert name of practice] can expect to be discharged with the following assurances:
■ The patient’s safety is assured by having a responsible party available to provide transportation home.
■ The procedure was performed safely and accurately by qualified personnel and only according to the physician’s specific instructions and plan of care.
■ The patient may leave the facility, even against the advice of his or her physician.
■ Qualified personnel are available at all times to answer questions.
■ Patients will receive information from his or her physician about his or her illness, his or her course of treatment, and his or her prospects for recovery in terms that he or she can understand.
In general, the patient should be aware of the services available within [insert name of practice] and be willing to follow policies and procedures. The patient agrees to the following personal responsibilities in regard to his/her care provided within [insert name of practice].
1. Patients should provide accurate information about:
■ Current health status, symptoms, and complaints
■ Past history, previous diagnosis from other health care practitioners
■ A list of medications currently being used or prescribed
■ Release of medical records to access data from prior physicians related to providing an updated and current diagnosis
2. Patients are responsible for asking detailed questions if unable to comprehend preparations or physician orders related to new medications or diagnoses.
3. Patients should inform health care providers if they do not intend to follow the recommended treatment plan and interventions and accept personal responsibility for these actions.
4. Patients should be knowledgeable of our efficiency in providing care in a timely manner without evidence of discrimination.
5. Patients are responsible for:
■ Providing current insurance cards, policy numbers, and other information needed by [insert name of practice] for billing
■ Obtaining authorizations for procedures in advance
6. Payment is expected at the time of service unless other arrangements have been made in advance.
7. If the patient is unable to keep an appointment, it is his or her responsibility to cancel in advance.
8. Patients are responsible for cooperating and adjusting to the needs of our practice, other patients, caregivers, and staff of [insert name of practice] so that we can operate in a safe and respectful manner without discrimination. The patient should be respectful of all personal property, including that of [insert name of practice] and other patients.
9. Patients should be aware of how personal lifestyle habits may need to be altered to provide optimal medical care and interventions at the order of the physician and be willing to make these adjustments.
10. Patients are responsible for contacting our answering service available after hours for emergency care or response.
11. Patients are responsible for notifying us if they refuse to have medical students or other observers watch the procedure.
12. Patients with questions about insurance benefits are responsible for checking with their insurance company.