YOUR PATIENT RIGHTS
Welcome to our Latitude Family Clinic. We respect our patients’ dignity and your God-given inalienable right to choose your own path and destiny.
This document will explain your patient rights and responsibilities.
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, personal beliefs or choices or any other basis prohibited by federal, state, or local law
CONSIDERATE AND RESPECTFUL CARE
- Fair, high-quality, safe, and professional care
- Consideration, respect, and recognition of you and your individuality
- Safe environment
- A support person(s) may be with you for any part of an exam, treatment or procedure.
- Private and discreet consultation, exam, and care.
- 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, caregivers, and support system can be expected to understand
- Take part and be active in your care and treatment plan
- Participate in and be ultimately responsible for decisions in your care.
- 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 o 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
- 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
- Refuse treatment
- 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.
- A prompt and reasonable response to questions and requests for service
- Talk to and join in decision making with your provider about:
- conflict resolutions
- withholding resuscitative services
- foregoing or withdrawing life-sustaining care
- Know that if your health care provider believes your refusal to accept treatment prevents you from getting the right care, we will NOT end the relationship as we believe the right to choose your own healthcare is ultimately your right and your decision. This means that you accept full responsibility for the outcome and the provider may ask you to sign an acknowledgment confirming your understanding of the recommended treatment and your understanding of the potential adverse outcomes with declining recommended treatment.
PAYMENT AND ADMINISTRATIVE
- A reasonable estimate of your health care charges before treatment
- To pay for services at the time of service with a credit card, debit card, personal check, or cash.
- Receive information about available financial resources
- To be free from any requirement to purchase drugs, or rent or purchase medical supplies or equipment from any particular source and also to receive patient choice in these types of decisions
- Know that the Practice, Provider(s) and other team members do NOT accept Medicare, the government’s health insurance for those aged 65+ or disabled or Medicaid or any other type of Medical Insurance
- 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
- Discuss complaints, issues, or problems regarding discrimination in access to services with your provider and/or the Practice management team. You can file a grievance in person or by mail, fax, or email at address: 2831 Ringling Blvd, Suite F220, Sarasota FL 34237, fax (941) 303-8619, email: email@example.com or phone (941) 253-2530.
- Have a fair review of alleged patient rights violations
YOUR PATIENT RESPONSIBILITIES
You are an important and active member of your care plan. You have certain responsibilities to yourself and to your care team.
In the spirit of shared trust and respect, we ask you to:
- Give true and complete information about your:
- Health status
- Medical history
- Other matters about your health
- Contact information, family members and caregivers and other needed information
- Let us know:
- Any risks about your care
- Changes in your care, illness, or injury
- Safety concerns
- Violation of your patient rights
- If you understand your care plan and what we expect from you
- If you don’t understand your care plan or its information
- If you have or need to ask questions
- Keep appointments and, if you cannot make your appointments, let us know at a minimum 24 hours before your appointment
- Pay your health care bills at time of service or prior to service
- Be responsible for your actions if you refuse care or don’t follow the provider’s orders
- Follow practice procedures, rules and regulations
- Treat the Health Care Provider and our healthcare staff with respect and consideration
- Accept that you, as well as we, may end our relationship at any time and for any reason. We will give you 30 days’ notice in writing.