Your Rights as a Patient
Medical Care Rights
- Receive high-quality medical care regardless of race, religion, gender, or economic status
- Access complete information about your diagnosis, treatment, and prognosis
- Participate in all decisions regarding your surgical care
- Obtain a second opinion before proceeding with surgery
- Review your medical records and receive copies upon request
Privacy and Dignity Rights
- Have your privacy protected during examinations and procedures
- Receive care in a safe, clean environment
- Be treated with respect and dignity at all times
- Have your cultural and religious beliefs respected
Communication Rights
- Receive clear explanations about your condition and treatment options
- Ask questions and receive timely answers
- Access language interpretation services if needed
- Be informed about the credentials of your healthcare providers
Your Responsibilities as a Patient
Medical Information
- Provide accurate and complete medical history
- Inform healthcare providers about current medications and supplements
- Report any changes in your condition promptly
- Disclose any allergies or previous adverse reactions
Treatment Compliance
- Follow pre-operative instructions carefully
- Adhere to post-operative care guidelines
- Attend all scheduled follow-up appointments
- Take prescribed medications as directed
Financial Responsibilities
- Provide accurate insurance and billing information
- Meet financial obligations for services received
- Understand your insurance coverage and benefits
- Discuss any financial concerns with our billing department
Acknowledgment
I acknowledge that I have read and understand my rights and responsibilities as a colorectal surgery patient.
Patient Name: _________________
Date: _________________
Signature: _________________