Your Rights as a Patient
Clinical Care Rights
- Receive high-quality occupational therapy services without discrimination
- Be treated with dignity, respect, and consideration
- Receive complete information about your evaluation, treatment, and prognosis
- Participate actively in developing your treatment plan
- Refuse treatment after being informed of potential consequences
- Receive services from qualified occupational therapy practitioners
Privacy Rights
- Have your personal and medical information kept confidential
- Access your medical records upon request
- Receive treatment in a private and secure environment
- Choose who may receive information about your care
Financial Rights
- Receive detailed information about service costs
- Be informed about insurance coverage and payment options
- Request itemized billing statements
Your Responsibilities as a Patient
Treatment Participation
- Provide accurate medical history and information
- Follow the agreed-upon treatment plan
- Attend scheduled appointments or provide 24-hour notice for cancellations
- Actively participate in therapy sessions and home exercise programs
- Ask questions when you don't understand something
Safety and Conduct
- Follow facility safety rules and regulations
- Treat staff and other patients with respect
- Use equipment and supplies as instructed
Financial Responsibilities
- Provide current insurance information
- Pay agreed-upon fees in a timely manner
- Inform staff of changes in financial situation
Acknowledgment
I acknowledge that I have read and understand these rights and responsibilities.
Patient Name: _________________
Date: _________________
Signature: _________________