PATIENT RIGHTS

Please take a few moments to read this section as it contains information explaining your rights and responsibilities as our patient or as the parent or legally designated representative of one of our patients. If you have additional concerns or questions please feel free to ask us at any time.

• Access to Care—Individuals shall be accorded impartial access to treatment or accommodations as to his or her requests and needs for treatment or service that are within the clinic’s capacity, availability, stated mission and applicable law and regulation, regardless of race, creed, sex, national origin, religion, and disability/handicap.

• Respect and Dignity—Every individual, whether adult, adolescent or newborn, has the right to considerate, respectful care/services at all times and under all circumstances, with recognition of his or her personal dignity and his or her psychosocial, spiritual and cultural variables that influence the perceptions of illness.

• Privacy and Confidentiality—(Please see our Notice of Privacy Practices for additional information concerning your rights to Privacy). The patient or his or her parent or legally designated representative has the right, within the law, to personal and informational privacy, as manifested by the right to:

  • Refuse to talk with or see anyone not officially connected with the clinic/ facility, including visitors or persons officially connected with the clinic/ facility but who are not directly involved in his or her care/services.

  • Wear appropriate personal clothing and religious or other symbolic items, as long as they do not interfere with diagnostic procedures or treatment.

  • Be interviewed and examined in surroundings designed to assure reasonable audiovisual privacy. This includes the right to have a person of one’s own sex present during certain parts of a physical examination, treatment or procedure performed by a health professional of the opposite sex and the right not to remain disrobed any longer than is required for accomplishing the medical purpose for which the patient was asked to disrobe.

  • Expect that any discussion or consultation involving the patient’s case will be conducted discreetly, and that individuals not directly involved in his or her care/services will not be present without his/ her permission.

  • Have the right to review his or her medical records and have the information explained, except when restricted by law.

  • Have the medical records read only by individuals directly involved in the treatment or the monitoring of its quality and by other individuals only on the patient’s or his or her parent or legal designated representative’s written authorization.When the records are released to insurers, that confidentiality is emphasized.

  • Expect all communications and other records pertaining to care/services of the individual, including the source of payment for treatment, to be treated as confidential.

  • Where these rights differ from those listed in our Notice of Privacy Practices, the Notice of Privacy Practices supercedes the rights listed here.

• Personal Safety—The patient, whether adult, adolescent or newborn, has the right to expect reasonable safety insofar as the clinic practices and environment are concerned.

• Identity—The patient or his or her parent or legally designated representative has the right to know the identity and professional status of individuals providing service to the patient.

• Information—The patient or his or her parent or legally designated representative has the right to obtain from the practitioner responsible for coordination of his or her care/services complete and current information concerning his or her diagnosis (to the degree known), treatment and any known prognosis. This information should be communicated in terms the patient or his or her parent or legal designated representative can reasonably be expected to understand. When it is not medically advisable to give such information to the patient, the information should be made available to a legally authorized individual.

• Communication—The patient or his or her parent or legally designated representative has the right of access to people outside the clinic by means of visitors and by verbal and written communication.

• When the patient or his or her parent or legally designated representative does not speak or understand the predominant language of the community, he or she has the right to bring their own interpreter.

• Consent—The patient or his or her parent or legally designated representative has the right to the information necessary to enable him or her, in collaboration with the health care practitioner, to make treatment decisions involving his or her health care/services that reflect his or her wishes. To the degree possible, this should be based on a clear, concise explanation of his or her condition and of all proposed technical side effects, problems related to recuperation, and probability of success. The patient should not be subjected to any procedure without voluntary, competent and understanding consent by the individual or by his or her parent or legal designated representative. Where a medically significant need for care/services or treatment exists, the patient or his or her parent or legal designated representative shall be so informed.

• The patient or his or her parent or legally designated representative has the right to know who is responsible for authorizing and performing the procedures or treatment.

• The patient or his or her parent or legally designated representative shall be informed if the clinic proposes to engage in or perform human experimentation or other research/educational projects affecting his or her care/services or treatment, and the patient has the right to participate in any such activity. If the patient chooses not to take part, he or she shall receive the most effective care/services the clinic otherwise provides.

• Consultation—The patient or his or her parent or legally designated representative has the right to accept medical care/services or to refuse treatment to the extent permitted by law and to be informed of the medical consequences of such refusal. When refusal of treatment by the patient or his or her parent or legal designated representative prevents the provision of appropriate care/services in accordance with ethical and professional standards, the relationship with the patient may be terminated upon reasonable notice.

• Transfer and Continuity of Care—A patient has the right to expect that the clinic/facility will give necessary health services to the best of its ability. Treatment, referral or transfer may be recommended. If transfer is recommended or requested, the patient will be informed of risks, benefits and alternatives. The patient will not be transferred until the other institution agrees to accept such patient.

• Charges—Regardless of the source of payment for the individual’s care/services, the patient or his or her parent or legal designated representative has the right to request and receive an itemized and detailed explanation of his or her total bill for services rendered in the clinic.

• Delineation of Patient’s Rights—The rights of the patient may be delineated on behalf of the patient, to the extent permitted by law, to the patient’s guardian, next of kin or legally authorized responsible person if the patient:

• has been adjudicated incompetent in accordance with the law

• is found by his or her physician to be medically incapable of understanding the proposed treatment or procedure>

• is unable to communicate his or her wishes regarding treatment

• is a minor.

PATIENT RESPONSIBILITIES

In order for our practice to function as smoothly as possible it is your responsibility to abide by the following rules. Failure to abide by our clinic policies can result in dismissal from our practice.

• You are responsibile to provide, to the best of your knowledge, accurate and complete information regarding your child(ren)’s past and present medical condition.

• You are responsible for following the treatment plan recommended by the physician(s).

• You are responsible for your own actions if you refuse to follow the treatment plans of the physician(s).

• If you can not follow through with a treatment plan, you are responsible for informing the physician so that an alternative treatment plan can be developed.

• You are responsible for notifying our physician(s) of any unexpected changes in your child's condition.

• You are responsible for keeping your appointment and providing us with reasonable notification if you will be unable to keep your scheduled appointment.

• You are responsible for knowing what your insurance benefit plan covers and does not cover.  Your benefit plan is a contract between you and your insurance carrier.  Under State and Federal laws you have certain rights of appeal should your insurance carrier inform you of certain benefits and then denies claims based on the information provided to you. These rigts of appeal do not transfer to our office if we act as your agent, representative or as a 'go-between'.

• You are responsible for verifying with your insurance carrier that Dr. Perryman is In-Network for your benefit plan.  If you verify our network status, then you have certain rights of appeal through your contract and State law. These rights of appeal are lost if our office verifies the status.  If we verify network status any verification is non-binding, and we do not assume any liability for mis-information provided by your insurance carrier.  Also, if we verify network status you are expressly agreeing to indemnify and hold Teri Perryman, MD harmless.

• You are responsible for assuring that any financial obligations for services rendered are fulfilled as promptly as possible, unless special arrangements with our office are made in writing.

• You are responsible for being considerate of the rights of other patients and personnel, and for assisting in the control of noise and number of visitors. DUE TO LIMITED WAITING ROOM SPACE WE ASK THAT YOU LIMITED THE NUMBER OF FAMILY MEMBERS THAT ACCOMPANY YOU AND YOUR CHILD(REN).

• You are responsible for respecting the rights of the staff, physicians, patients and property of our practice.

• You are responsible for treating our staff with respect and courtesy. Arguing, yelling, gesturing, verbally or physically assualting our staff will result in immediate termination from our practice.

• Lastly, a patient's health depends not just on his or her care/services but, in the long term, on the decisions he or she and his or her parents or legally designated representative(s) make in daily life. You are responsible for recognizing the effect of lifestyle choices on your personal life and the lives of those around you.