PATIENTS’ BILL OF RIGHTS AND RESPONSIBILITIES

Policy Statement

It is the policy of Caring Hands Children’s Clinic to protect the rights of patients and to inform them of their rights, as well as their responsibilities. Just as we strive to honor your basic rights, we expect reasonable and responsible behavior from our patients, their parents, guardians and friends.

Patient/Parent/Guardian Rights

The following list of patient rights is not intended to be all inclusive. Every patient has the right to:

• Be treated with dignity and respect
• Privacy and confidentiality concerning their medical care - the patient has the right to be advised as to the identity and professional status of any individual directly involved or observing their care
• Expect that all communications, patient disclosures, and records are confidential and except when required by law, be given the opportunity to approve or refuse their release
• Have their questions, concerns or complaints addressed in good faith
• Complete information concerning diagnosis, treatment, evaluation, and prognosis from their physician in terms they can understand. When it is medically inadvisable to give such information to the patient, the information is provided to a person designated by the patient, parent or legally authorized person.
• Make choices and decisions regarding their medical care to the extent permitted by law - this includes the right to refuse treatment
• Change providers if other qualified providers are available
• Consult with a specialist at the patients’ request and expense
• Receive, on request, information about fees and charges, and receive an explanation of their bill, regardless of source of payment
• Receive, on request, and at a reasonable fee a copy of their medical record
• Have an advance directive concerning treatment or designation of a surrogate decision maker
• Exercise these rights without regard to race, color, creed, religion, national origin, disability, economic, educational or religious background

Patient/Parent/Guardian Responsibilities

In addition to these rights, a patient/parent/guardian has certain responsibilities as well. These responsibilities are presented in the spirit of mutual trust and respect.

The patient/parent/guardian has the responsibility to:

• Provide accurate and complete information concerning his/her present complaints, past medical history, and other matters relating to his/her health
• Make it known whether he/she clearly comprehends the course of his/her medical treatment and what is expected of him/her
• Follow the treatment plan established by his/her provider, including the instructions of nurses and other health professionals, as they carry out the provider's orders
• Keep appointments and notify Caring Hands Children’s Clinic when unable to do so
• Accept responsibility for his/her actions should he/she refuse recommended treatment/immunizations or not follow his/her provider's orders
• Assure that financial obligations of his/her care are fulfilled as promptly as possible
• Assure that financial obligations of his/her care are fulfilled as promptly as possible
• Be considerate of the rights and property of other patients and facility personnel
• Show behavior that is respectful and considerate to other patients, families, visitors, and personnel of Caring Hands Children’s Clinic.

If you have any comments or concerns regarding services provided at Caring Hands Children’s Clinic, please contact our Administrator at 601-587-4304, or write Caring Hands Children’s Clinic, Attn: Administrator, P.O. Box 1400, Monticello, MS 39654.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.