Statement of Clients' Rights
Clients have the right to be treated with dignity and respect.
Clients have the right to fair treatment, regardless of their race, religion, gender, sexual orientation, gender identity expression, ethnicity, age, disability, or source of payment.
Clients have the right to have their treatemnt and other member information kept private. Only where permitted by law may records be released without member permission.
Clients have the right to easily access timely care in a timely fashion.
Clients have the right to know about their treatment choices. This is regardless of cost or voerage by the member's benefit plan.
Clients have the right to share in developing their plan of care.
Clients have the right to information in a language they can understand, and if needed, the provision of language services through an interpreter.
Clients have the right to have a clear explanation of their condition and treatment options.
Clients have the right to information about their health care benefit plan, its practitioners, services and role in their treatment process.
Clients have a right to inspect and copy their health information record.
Clients have the right to recieve an accounting of all disclosures of their health information record made for reasons other than payment, treatment, or health care operations.
Clients have the right to information about clincial guidelines used in providing and managing their care.
Clients have the right to ask their provider about their work history and training.
Clients have the right to give input on the Client's Rights and Responsibilities policy.
Clients have the right to know about advocacy and community groups and prevention services.
Clients have a right to freely file a complaint or appeal and learn how to do so.
Clients have the right to know of their rights and responsibilties in the treatment process.
Clients have the right to recieve services that will not jeopardize their employment.
Clients have the right to list certain preferences in a provider.
Statement of Clients' Responsibilties
Clients have the responsibility to treat those giving them care with dignity and respect.
Clients have the responsibility to give providers information they need. This is so providers can deliver the best possible care.
Clients have the responsibility to ask questions about their care. This is to help them understand their care.
Clients have the responsibility to follow the treatment plan. The plan of care is to be afreed upon by the client and the provider.
Clients have the responsibility to follow the agreed upon medication plan.
Clients have the responsibility to tell their provider and primary care physician about medication changes, including medications given to them by others.
Clients have the responsibility to keep their appointments. Clients should call their providers as soon as they know they need to cancel visits.
Clients have the responsibility to let their provider know when the treatment plan is not working for them.
Clients have the responsibility to let their provider know about problems with paying fees.
Clients have the responsibility to report abuse and fraud.
Clients have the responsibility to openly report concerns about the quality of care they recieve.
My signature below shows that I have been informed of my rights and responsibilities, and that I understand this information.