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Patient Bill of Rights

Example Patient Bill of Rights

You have the right to:

  1. Be treated with dignity, respect and privacy in all phases of your care and treatment.
  2. Expect all communications and records will be kept confidential and only released with your written consent, except as required by law or third party payment contract.
  3. Receive high quality comprehensive family planning and related services provided by qualified personnel.
  4. A clear, concise explanation, in terms easily understood, of all proposed procedures, probable risks and benefits, alternatives and serious side effects.
  5. Be informed about any medical condition and its treatment plan.
  6. Receive all information necessary in order to give informed consent or refusal for any particular drug, device, test, procedure or treatment.
  7. Have input into all phases of the care and treatment provided.
  8. Be provided with education and counseling on all aspects of reproductive health and related concerns.
  9. Be referred for other needed or desired services not available through the agency.
  10. Be informed of all services available through the agency.
  11. Be informed of all relevant clinic policies and procedures, including charges for services and eligibility for third party reimbursement.
  12. Be informed of provisions for off-hour and emergency coverage, including emergency contraception.
  13. Know the names of the agency staff.
  14. Be provided with an interpreter if you do not speak English.
  15. Evaluate the effectiveness of the services.
  16. Voice grievances and recommend service and policy changes to the staff and the governing body.
  17. Have complaints handled efficiently and in a timely fashion.
  18. Expect the agency to behave as a consumer advocate.
  19. Refuse to participate in experimental research.

You have the responsibility to:

 

  1. Keep appointments or notify the agency in advance if you are unable to keep them.
  2. Give truthful and accurate information.
  3. Ask questions about anything you do not understand or are concerned about.
  4. Be aware of the possible side effects of any procedure or treatment, and inform the agency immediately if you suspect any serious side effect or complication.
  5. Understand your chosen method of contraception and use it responsibly according to instructions.
  6. Pay what you honestly can of any fees charged for services provided.
  7. Treat the agency staff with dignity and respect.
  8. Voice grievances or dissatisfaction to the appropriate staff.