Patient Rights and Responsibilities Agreement

Vascular Surgery Department

Vascular Surgery

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Last updated: Mar 24, 2025

Your Rights as a Vascular Surgery Patient

Medical Care Rights

  • Receive high-quality vascular care without discrimination
  • Be fully informed about your diagnosis, treatment options, and prognosis
  • Participate actively in decisions regarding your care
  • Obtain a second medical opinion when desired
  • Access your medical records as permitted by law
  • Have your pain assessed and managed appropriately

Privacy and Dignity Rights

  • Have your personal privacy and dignity respected
  • Confidential handling of all medical records and communications
  • Receive care in a safe, clean environment
  • Be free from all forms of abuse or harassment

Communication Rights

  • Receive clear explanations about procedures and treatments
  • Know the names and roles of your healthcare providers
  • Have access to language interpretation services if needed
  • Voice concerns without fear of discrimination

Your Responsibilities as a Patient

Treatment Cooperation

  • Provide accurate, complete medical history
  • Follow the agreed-upon treatment plan
  • Attend scheduled appointments or provide notice of cancellation
  • Inform providers of any changes in your condition

Financial Responsibilities

  • Provide accurate insurance and billing information
  • Meet financial obligations for care received
  • Understand your insurance coverage and limitations

Facility and Staff Respect

  • Treat healthcare providers and staff with respect
  • Follow facility rules and regulations
  • Respect the rights of other patients
  • Maintain a safe, quiet environment

Acknowledgment

I have read and understand my rights and responsibilities as a vascular surgery patient.

Patient Name: _________________________

Signature: ____________________________

Date: ________________________________

Witness: ______________________________

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