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As a patient at Psychiatric and Addiction Services, you have the following
rights:
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Being treated by all medical providers and staff with
respect and dignity while maintaining all information confidential
unless a written consent form is provided by the client or client's
guardian. |
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You will not be denied treatment based on your race,
creed, religion, political affiliation, gender or sexual orientation. |
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You have the right to terminate treatment at any time. |
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You will be informed of alternative forms of treatment
if you request it. |
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You will participate in the development of your treatment
plan. |
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Your account will be handled with honest and precise
billing practices that comply with all local, state, federal, and
/ or insurance company regulations. |
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You have the right to report complaints to management
(Medical Director, Practice Administrator, or Office Manager.) |
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You are advised that mental health / substance abuse
providers are mandated by law to report suspected child abuse or neglect,
in addition to any serious threats to harm yourself or others to the
appropriate state or local authorities. |
As a patient at Psychiatric and Addiction Services, you have the following
responsibilities:
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Attend all scheduled appointments or give
at least 24-hours notice for cancellations (if we do not receive 24-hours
notice, your account will be charged for the full session). |
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Provide your complete medical history to
your treatment provider. |
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Discuss any life decisions with your treatment
provider before taking any action. |
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Be open and honest when speaking with your
treatment provider. |
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Deal realistically with your problems or
issues; accepting that there will be ups and downs in treatment. |
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Respect the confidentiality of other clients
with whom you may come into contact with in the office. |
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Complete any assignments that treatment
providers ask of you. |
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Practice good financial mangement - as
most insurance have a deductible and co-pay, it is important to understand
your insurance benefits; especially mental health / substance abuse
benefits since they are usually different from your other medical
benefits. Please be prepared to pay your co-pay prior to each visit.
Financial plans with flexible terms are available; ask our staff how
you can participate. If your balance is delinquent (more than 30 days)
and no financial plan has been agreed to, excess fees may be charged
to your account (i.e. collection costs and / or reasonable attorney
fees). |
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STOP Patient Rights and Responsibilities
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To be treated with dignity and respect. |
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To be free from: Abuse, Neglect, Exploitation, and Restraint or seclusion, of any form, used as a means of coercion, discipline, convenience, or retaliation. |
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To provide a safe, sanitary, and humane living environment that provides privacy and promotes dignity. |
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To receive treatment services free of discrimination based on the patient’s race, religion, ethnic origin, age, disabling or a medical condition, and ability to pay for the services.. |
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To privacy in treatment, including the right not to be fingerprinted, photographed, or recorded without consent, except for: Photographing for identification and administrative purposes, as provided R03-602, or video recordings used for security purposes that are maintained only on a temporary basis. |
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To receive assistance from a family member, designated representative, or other individual in understanding, protecting, or exercising the patient's rights. |
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To confidential, uncensored, private communication that includes letters, telephone calls, and personal visits with: an attorney, personal physician, clergy, Department of Social and Rehabilitation Services Staff, or other individuals unless restriction of such communication is clinically indicated and is documented in the patient record. |
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To practice individual religious beliefs including the opportunity for religious worship and fellowship as outlined in program policy. |
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To be free from coercion in engaging in or refraining from individual religious or spiritual activity, practice, or belief. |
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To receive an individualized treatment plan that includes the following: patient participation in the development of the plan and periodic review and revision of the patient’s written treatment plan. |
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To refuse treatment or withdraw consent to treatment unless such treatment is ordered by a court or is necessary to save the patient’s life or physical health. |
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To receive a referral to another program if the licensee is unable to provide a treatment service that the patient requests or that is indicated in the patient’s assessment or treatment plan. |
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To have the patient’s information and records kept confidential and released according to R03-602. |
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To be treated in the least restrictive environment consistent with the patient’s clinical condition and legal status. |
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To consent in writing, refuse to consent, or withdraw written consent to participate in research, experimentation, or a clinical trial that is not a professionally recognized treatment without affecting the services available to the patient. |
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To exercise the licensee’s grievance procedures. |
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To receive a response to a grievance in a timely and impartial manner. |
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To be free from retaliation for submitting a grievance to a licensee, the Department of Social and Rehabilitation Services, or another entity. |
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To receive one’s own information regarding: medical and psychiatric conditions, prescribed medications including the risks, benefits, and side effects, whether medication compliance is a condition of treatment, and discharge plans for medications. |
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To obtain a copy of the patient’s clinical record at the patient’s own expense. |
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To be informed at the time of admission and before receiving treatment services, except for a treatment service provided to a patient experiencing a crisis situation, of the: fees the patient is required to pay and refund policies and procedures. |
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To receive treatment recommendations and referrals, if applicable, when the patient is to be discharged or transferred. |
Patient Grievance Form || Download Copy of Patient Rights
As a patient at Psychiatric and Addiction Services, you have the following responsibilities:
| - |
Attend all scheduled appointments or give at least 24-hours notice for cancellations (if we do not receive 24-hours notice, your account will be charged for the full session). |
| - |
Provide your complete medical history to your treatment provider. |
| - |
Discuss any life decisions with your treatment provider before taking any action. |
| - |
Be open and honest when speaking with your treatment provider. |
| - |
Deal realistically with your problems or issues; accepting that there will be ups and downs in treatment. |
| - |
Respect the confidentiality of other patients with whom you may come into contact with in the office. |
| - |
Complete any assignments that treatment providers ask of you. |
| - |
Practice good financial management – as most insurance have a deductible and co-pay, it is important to understand your insurance benefits; especially mental health/substance abuse benefits since they are usually different from your other medical benefits. Please be prepared to pay your co-pay prior to each visit. Financial plans with flexible terms are available; ask our staff how you can participate. If your balance is delinquent (more than 30 days) and no financial plan has been agreed to, excess fees may be charged to your account (i.e. collection costs and/or reasonable attorney fees). |
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