PATIENT AND CENTER RIGHTS AND RESPONSIBILITIES

Welcome to CommuniCare Health Centers (CCHC). Our goal is to provide quality health care to qualified persons in the community, regardless of their ability to pay for health services. As a patient you have rights and responsibilities. The Center also has rights and responsibilities. We want you to understand these rights and responsibilities so you can help us provide health care services for you. Please read this statement and ask any questions you might have.

Human Rights

1. You have a right to be regarded with respect and dignity regardless of race, religion, sex, national origin, sexual orientation, political affiliation or ability to pay for services.

Payment for Services:

2. You are responsible for giving us accurate information about your present financial status and any changes in your financial status. We need this information to decide how much to charge you and/or so we can bill private insurance, Medicaid, Medicare, or other benefits for which you may be eligible. If your income is less than the federal poverty guidelines, you will be charged a discounted fee.

3. You have a right to receive explanation of our bill. You must pay, or arrange to pay, all agreed fees for health services as provided by our policies.

4. Federal law prohibits us from denying you primary health care services, which are medically necessary, solely because you cannot pay for these health services.

Privacy:

5. You have a right to have your interviews, examinations and treatment in privacy. Your medical records are also private. Only legally authorized persons may see your records, unless you request in writing for us to show them to someone else. A complete discussion of your privacy rights is attached as “Notice of Patient Privacy Practices”. By signing this document you are indicating that you have received this Notice. The Notice details the various rights granted to you under the Health Insurance Portability and Accountability Act.

Health Care:

6. You are responsible for providing us complete and current information about your health or illness, so that we can give you proper health care. You have a right, and are encouraged, to participate in decisions about your treatment.

7. You have a right to information and explanation in the language you normally speak and in words you understand. You have a right to information about your health or illness, treatment plan (including risks) and expected outcome, if known, and information regarding Advance Directives. If you do not wish to receive this information, or if it is not medically advisable to share that information with you, we will provide it to a legally authorized person.

8. You are responsible for appropriate use of our services, which includes following staff’s instructions, making and keeping scheduled appointments, and only requesting a “walk in” appointment when you are ill. We may not be able to see you unless you have an appointment. If you cannot follow the staff’s instructions, please tell us so we can help you.

9. If you are an adult, you have the right to refuse treatment to the extent permitted by law, and to be informed of the risks of refusing such care. You are responsible for the outcome of refusing treatment.

10. You have a right to medical and dental care and treatment that is reasonable for your condition and within our capability. You have a right to be treated or referred to another facility for services that we cannot provide. We do not pay for services that you get somewhere else. Note: CCHC is not an emergency facility.

11. You have a right to receive an appropriate assessment and pain management plan as necessary.

Center Rules:

12. You have a right to receive information on how to appropriately use CCHC and its program sites services. You are responsible for using CCHC and its sites in an appropriate manner. If you have questions about using Center services, please ask us.

13. You are responsible for the supervision of children you bring to the Center. You are responsible for their safety and the protection of other clients and our property. Children cannot be left unattended at any time while in our facility.

14. You have a responsibility to keep your scheduled appointments. Missed appointments cause delay in treating other patients. Missed scheduled appointments will follow our “No Show Procedure.

Complaints:

15. If you are not satisfied with our services, please tell us. We want suggestions so we can improve our services. We will tell you how to file a complaint. If you are not satisfied with how we handle your complaint, you may file a complaint with the Center’s Executive Team. The Team will submit a report to the Board of Directors.

16. We will not punish you for filing a complaint, and will continue to provide services.

Termination:

17. If we decide that we must stop treating you as a patient, you have a right to advance notice that explains the reason for the decision, and you will be given 30 days to attempt to find other health services. We can decide to stop treating you immediately and without notice, if you have created a threat to the safety of the staff and/or other clients. You also have a right to receive a copy of CCHC termination policy. Other reasons for which we may stop seeing you include but not limited to: A) Failure to obey rules, B) Persistent failure to keep scheduled appointments, C) Intentional failure to report accurate information concerning your health, D) Intentional failure to follow the health care program, such as instructions about taking, medications, personal health practices, or follow-up appointments, as recommended by your provider and/or E) Creating a threat to the safety of the staff and/or other clients F) Intentional failure to report accurately your financial status, G) A patient's abusive, inappropriate, or violent behavior toward others (staff or other patients) or the Center facilities that interferes with the Center's ability to deliver services reasonably to the patients. CCHC maintains ZERO TOLERANCE of abuse, harassment, or violence of any kind. A person who causes or threatens to cause abuse, harassment or violence of any kind is subject to immediate termination as a patient of the Center and/or removal from the Center premises. The center will not give a 30-day termination notice in these situations.

18. If CCHC has given you notice of termination, then you have the right to appeal the decision to the Center’s Executive Team. The Team will submit a report to the Board of Directors.

Patient rights & responsibilities/ Revised 2-28-03/2-28-06

For the Spanish version of this document, please click here