Patient Bill Of Rights

  3501 Del Prado Blvd. S, Suite 303 Cape Coral, FL 33904

  239-317-0265

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Patient Bill Of Rights

  1. The patient has the right to considerate and respectful care provided without discrimination as to race, color, ethnicity, creed, sex, sexual orientation, age or national origin.
  2. The patient has the right to obtain from his/her health care provider complete current information concerning his/her diagnosis, treatment and prognosis in terms the patient can be reasonably expected to understand. Patients are able to come into the office and obtain a summary of care up to three days after their visit.
  3. The patient has the right to be an active participant in any plan of care developed for him/her.
  4. The patient has the right to receive from his/her physician information necessary to give informed consent prior to the start of any procedure and/or treatment. Where medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information (and) to know the name of the person responsible for the procedures and/or treatment.
  5. The patient has the right to be informed of services available, to select among available providers and/or services and the right to communicate with those providers.
  6. The patient has the right to refuse treatment to the extent permitted by law, and to be informed of the medical consequences of his/her action.
  7. The patient has the right to every consideration of his/her privacy concerning his/her own medical care program. We may transfer your PHI to other treating health care providers electronically. We may also transmit your information to your insurance carrier electronically.
  8. The patient has the right to expect that all communications including electronic data and records pertaining to him/her should be treated as confidential.
  9. The patient has the right to expect that within its capacity a health care provider must make reasonable response to the request of a patient for services.
  10. The patient has the right to access necessary professional services 24 hours a day, 7 days a week.
  11. The patient has the right to know the name and qualifications of any person involved in his/her care.
  12. The patient has the right to obtain information as to any relationship of his/her health care provider to other health care and educational institutions in so far as his/her care is concerned, and any professional relationships among individuals, by name, who are treating him/her.
  13. The patient has the right to be advised if the health care provider proposes to engage in or perform human experimentation affecting his/her care of treatment and has the right to refuse to participate.
  14. The patient has the right to be fully informed of provider policies and charges for services prior to receiving care.
  15. The patient has the right to examine and receive an explanation of his/her bill regardless of source of payment.
  16. The patient has the right to know that health care provider rules and regulations affect his/her conduct as a patient.
  17. The patient has the right to have access to his/her health care records through a release of information in writing.
  18. A patient denied service for any reasons shall have the right to receive a written explanation regarding denial and information regarding community resources upon request.
  19. The patient has the right to voice grievances and suggest changes in service or staff without fear of reprisal or discrimination.
  20. The patient has the right to be free from verbal, physical and psychological abuse and to be treated with dignity.
Physician’s Signature: _________________________________ Date:____07/08/2020_____
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