The Patient/Patient Designated Representative has the Right to:

• You have the right to receive considerate, respectful and compassionate care in a safe setting regardless of your age, gender, race, national origin, religion, sexual orientation, gender identity or disabilities.
• You have the right to receive care in a safe environment free from all forms of abuse, neglect, or mistreatment.
• You have the right to be called by your proper name and to be in an environment that maintains dignity and adds to a positive self-image.
• You have the right to know the names of staff and all health care team members directing and/or providing your care.
• You have the right to be told by your doctor about your diagnosis and possible prognosis, the benefits and risks of treatment, and the expected outcome of treatment, including unexpected outcomes. You have the right to give written informed consent before any non-emergency procedure begins.
• You have the right to have your pain assessed and to be involved in decisions about treating your pain.
• You can expect full consideration of your privacy and confidentiality in care discussions, exams, and treatments. You may ask for a chaperon during any type of exam.
• To a dignified and respectful manner that supports and respects cultural values and religious beliefs and provides for personal privacy to the extent possible during the course of treatment.
• You have the right to communication that you can understand. The clinic will provide interpreters as needed at no cost. Information given will be appropriate to your age, understanding, and language. If you have vision, speech, hearing, and/or other impairments, you will receive additional aids to ensure your care needs are met.
• To refuse drug, test, procedure, or treatment and to be informed of the risks and benefits of this action.
• To receive, upon request: prior to initiation of care or treatment, the estimated average charge for non-emergent care, the entity’s general billing procedures, and to an itemized bill that identifies treatment and services by date.
• To register complaints with the health clinic and the Department of Health Services (DHS) and to be informed of the procedures for registering complaints including contact information.
• To be accepted for care and services when the health clinic can meet their identified and reasonable anticipated care, treatment, and service needs.
• You can expect that all communication and records about your care are confidential, unless disclosure is permitted by law. You have the right to see or get a copy of your medical records. You may add information to your medical record by contacting the Medical Records Department. You have the right to request a list of people to whom your personal health information was disclosed.
• The right to participate in end-of-life decisions and to formulate advance directives and have the health clinic comply with such directives.
• To know about your patient/patient designated representative rights and responsibilities prior to the beginning of treatment or admission, where possible.
• Effective communication.
• You have the right to voice your concerns about the care you receive. If you have a problem or complaint, you may talk with your doctor, nurse, or department supervisor. You may also contact the Administration-Patient Relations Department at 970-200-1643.
  

The Patient/Patient Designated Representative is Responsible for:

• You are expected to provide complete and accurate information, including your full name, address, home telephone number, date of birth, Social Security number, insurance carrier and employer when it is required.
• You are expected to provide complete and accurate information about your health and medical history, including present condition, past illnesses, hospital stays, medicines, vitamins, herbal products, and any other matters that pertain to your health, including perceived safety risks.
• Actively participate in decisions concerning your health care.
• To ask questions when you do not understand information or instructions.
• Follow your provider’s instructions once you have agreed to the recommended care.
• Accept the consequences of your actions if you choose not to follow your provider’s recommendations, which may include discharging you from the practice if your refusal prevents us from providing care according to ethical and professional standards.
• The patient will be considerate of the rights of other patients and clinic personnel and will be respectful of other persons and clinic property. Children brought to the clinic shall be supervised at all times.
• The patient will communicate their needs to Clinic staff in a respectful, non-threatening manner. Verbal abuse or slander will not be tolerated and can result in loss of clinic privileges.
• You are expected to provide complete and accurate information about your health insurance coverage and to pay your bills in a timely manner.
• You have the responsibility to keep appointments, be on time, and call your health care provider if you cannot keep your appointments.