Patient Rights and Responsibilities
- Confidential treatment of all information about your care except as required by state law.
- Privacy during any interview, exam, or treatment.
- Refusal to be examined, observed, or treated by students or staff without affecting your access to care.
- Refusal to serve as a research subject.
- Access to your health record as prescribed by law and the Center’s policy.
- Privacy respecting the source of payment for care and detailed explanation of all charges.
- Assistance and information about any health center bills or costs for services, or financial assistance and free health care if you are eligible.
- Information about the relationship, if any, between the Center or its providers and any other health care facility or educational institution.
- A friend, relative, or advocate who can act on your behalf during your health center visits.
- Lifesaving treatment, even if you don’t have insurance or cannot pay.
- Information about all the ways breast cancer can be treated (if you have breast cancer).
- Assistance and information about emergency contraception (if you are a female rape victim).
- Full information about Health Center services and policies.
- Be treated with respect and dignity.
- Courteous, convenient communication.
- Information about the name and qualifications of the persons involved with your care.
- Convenient appointment times, prompt attention, and an explanation if you are kept waiting.
- Consultation from another provider, if desired.
- Freedom to choose your provider or facility to the extent we are able to accommodate that choice.
- Ability to take part in all decisions regarding your care, with explanations for examinations and tests.
- Evaluation and effective management of pain, including information about options for pain relief.
- An interpreter at no cost to you.
- Prompt response to any reasonable requests.
- Provide an accurate and complete health history.
- Your provider may base many of his/her
- recommendations on this information.
- Inform Family Health Center if health care instructions provided are not clear or easily understood.
- Bring necessary personal and health coverage
- information to every visit.
- Help Family Health Center to meet financial obligations by keeping health insurance up to date and by paying charges and co-payments promptly.
- Treat Family Health Center staff, other patients/
- visitors, facilities and their property with respect and dignity.
- Follow the rules and regulations of the Health Center.
Regjistrimi Pacientve te Rinj (New Patient Registration)
Formulari per te Dhenat Personale Shendetesore (Intake Form)
Autorizim Trajtimi (Consent to Treat)
Autorizim per Trajtim Mjekesor Telefonik (Telehealth Consent to Treat)
Shkarko Fotografine e Problemit tuaj Mjekesor (Upload a Picture of your Medical Problem)
Registro Para Novos Pacientes (New Patient Registration)
Formulário de Inscrição (Registro) (Intake Form)
Consentimento Para Tratar (Consent to Treat)
Consentimento da Telesaúde Para Tratar (Telehealth Consent to Treat)
Envie a Sua Foto do Problem Medico (Upload a Picture of your Medical Problem)
Registro Para Pacientes Nuevos (New Patient Registration)
Formulario de Admisión (Intake Form)
Consentimiento Para Tratar (Consent to Treat)
Consentimiento Para tratamiento de Telesalud (Telehealth Consent to Treat)
Agregue su Foto de su Problema Médico (Upload a Picture of your Medical Problem)
Vietnamese (Tiếng Việt)
Đơn Đăng ký bệnh nhân mới (New Patient Registration)
Đơn tiền sử y khoa bệnh nhân (Intake Form)
Đơn Đồng ý điều trị (Consent to Treat)
Đơn Đồng ý điều trị qua trực tuyến (Telehealth Consent to Treat)
Đơn Đăng hình về bệnh trạng của quý vị (Upload a Picture of your Medical Problem)
Nouvelle inscription de patient (New Patient Registration)
Formulaire d’admission (Intake Form)
Consentement à traiter (Consent to Treat)
Consentement à traiter par télésanté (Telehealth Consent to Treat)
Problem Télécharger une photo de votre problème de sante (Upload a Picture of your Medical Problem)