Patient Rights Responsibilities in Broadway at AFC Urgent Care

Patients Bill of Rights

• A patient has the right to be treated with courtesy and respect, with appreciation of his or her individual dignity, and with protection of his or her need for privacy.
• A patient has the right to a prompt and reasonable response to questions and requests.
• A patient has the right to know what rules and regulations apply to his or her conduct.
• A patient has the right to be given by the health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.
• A patient has the right to refuse any treatment, except as otherwise provided by law.
• A patient has the right to be given, upon request, full information and necessary counseling on the availability of known financial resources for his or her urgent care.
• A patient has the right to receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
• A patient has the right to receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
• A patient has the right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion, physical handicap, or source of payment.
• A patient has the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
• A patient is responsible for reporting unexpected changes in his or her condition to the health care provider.
• A patient is responsible for his or her actions if he or she refuses treatment or does not follow the health care provider’s instructions.
• A patient is responsible for assuring that the financial obligation for his or her health care are fulfilled as promptly as possible.
• A patient is responsible for following health care facility rules and regulations affecting patient care and conduct.
• A patient is responsible for providing to the health care provider, to the best of his or her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.
• A patient has the right to express grievances regarding any violation of his or her rights, as stated in law, through the grievance procedure of the health care provider which served him or her and to the appropriate state licensing agency.
• Patients are provided, to the degree known, complete information concerning their diagnosis, evaluation, treatment and prognosis. When it is medically inadvisable to give such information to a patient the information is provided to a person designated by the patient or to a legally authorized person.
• Patients are given the opportunity to participate in decisions involving their healthcare, except when such participation is contraindicated for medical reasons.

Statement of Patient’s Rights

• Know the names of your healthcare providers.
• Be involved in the planning of your care and treatment, including pain management, in collaboration with your physician and treatment team.
• Information to enable you to make treatment decisions that reflect your wishes.
• Accept medical care or to refuse treatment to the extent permitted by law and to be informed of the medical consequences of such refusal.
• Have all records concerning your care or illness to be treated confidentially, with personal privacy respected. You have the right to access information contained in your clinical records within a reasonable time period and in accordance with federal HIPPA policies and procedures.
• Receive prompt and reasonable responses to your requests for service.
• Considerate, safe and respectful care; and to be free from abuse or harassment.
• Have impartial access to care regardless of race, creed, sex, sexual orientation, age, national origin, physical disability, or source of payment.
• Request a consultation or second opinion from another physician.
• Review your urgent care bill and receive an explanation of the charges.
• Express a compliment and/or concern pertaining to your care or treatment. Your compliments/concerns may be directed to Medical Director, physician, medical staff, Center Administrator or be given to opportunity to complete a
• Patient Satisfaction Survey in person or anonymously.

Statement of Patient’s Responsibilities

You have the responsibility of/for:

• Providing accurate and complete information about your illness and medical history including present complaints, past illnesses and hospitalization, medications, and other matters related to your health.
• Knowing and following urgent care center rules and regulations; i.e. smoking and use of electrical equipment.
• Following your physician’s prescribed plan of treatment, care and services.
• Notifying your physician or medical assistant if you do not understand your diagnosis, treatment, or prognosis.
• Any consequences and other adverse outcomes if you refuse treatments or do not follow physician’s prescribed treatment plan.
• Being considerate of other patients’ rights, privacy, and property, and in assisting with noise control and the number of visitors you receive.
• Fulfilling your financial obligations associated with your health care.
• Advising your medical assistant or physician of any concern, dissatisfaction, or safety issues you may have in regard to your care while visiting our urgent care center.
• Safeguarding any valuables or personal belongings.
• Cooperating with your Health Care Team to maintain your and your family’s safety, e.g. calling for assistance when needed or as instructed.
• Be knowledgeable of your medical insurance benefits plan and your obligations regarding deductibles, co-payments, pre-authorization requirements, etc.