THE PATIENT BILL OF RIGHTS AND RESPONSIBILITIES

The goal of Rivers Family Medicine is to provide all patients with high quality health care in a manner that clearly recognizes an individual’s needs and rights. We also recognize that in order to accomplish this goal effectively, the patient and the health care provider must work together to develop and maintain optimum health. ¬†As a result, the following patient rights and responsibilities were written.

AS A PATIENT YOU HAVE THE RIGHT:

  • To receive considerate care that is respectful of your personal beliefs and cultural and spiritual values.
  • To have all things explained to you in terms that you can understand and to have any questions answered concerning your diagnosis, prognosis, and treatment.
  • To appropriate assessment and management of your symptoms, including pain.
  • To know the contents of your medical records through interpretation by the provider.
  • To know who it is that is interviewing and examining you.
  • To have explained to you ways that you can prevent your medical problem from recurring.
  • To refuse to be examined or treated by health practitioners and to be informed of the consequence of such decisions.
  • To be assured of the confidential treatment of disclosures and records and to have the opportunity to approve or refuse the release of such information except when release of specific information is requiredby law or is necessary to safeguard you or the community.
  • To participate in the consideration of ethical issues that arise in the provision of your care.

AS A PATIENT YOU HAVE THE RESPONSIBILITY:

  • To provide Rivers Family Medicine with information about your current symptoms, including pain.
  • To provide Rivers Family Medicine with information about past illnesses, hospitalizations and medications.
  • To ask questions if you do not understand the directions or treatment being given by a provider.
  • To keep appointments or telephone the office at least 24 hours ahead if you need to cancel.
  • To be respectful of others and others’ property while in our facility.
  • To keep an up to date list of all medications and to contact the office if there are any changes.
  • To monitor prescription refill status and to initiate the refill process with a minimum of one week of medication remaining.
  • To treat all staff members with common courtesy whether in office or through other means of communication.

FINANCIAL POLICIES

  • As a courtesy, we will file your primary and secondary insurance. It is your responsibility to make sure that your insurance company has your most recent address and contact information.

  • We are required to make a copy of your insurance cards for verification purposes.
  • We will collect your deductible, co-payment and non-covered service fees at the time of service. Payment methods are: cash, check, MasterCard, and Visa.
  • There is a $25 charge on all returned checks and a $25 charge for scheduled appointments canceled without 24 hour prior notice or failure to show up for a scheduled appointment.
  • Your insurance will send you an Explanation of Benefits that explains what they have paid to our office. This is a record that you MUST keep on file. If you do not agree with their payment, please contact the insurance company directly.
  • If payment is not received within 30 days of the filing date with your insurance, you will be notified that payment is due.
  • If you are sent outside of the office for additional testing such as lab work or imaging, that facility will file your insurance for you. If you have questions regarding billing or claim payment, call the facility directly. We do not have information regarding billing from outside of this office.
  • There will be a minimum of a $25 charge for completion of all forms. This is not billable to your insurance. Payment due prior to release of forms.