Your Rights as a Patient
Access to Care
- Receive care regardless of race, religion, gender, or national origin
- Access appropriate endocrine care based on clinical needs
- Obtain emergency care when medically necessary
Quality of Care
- Receive respectful treatment from qualified healthcare professionals
- Participate actively in treatment decisions
- Access your medical records and test results
- Receive clear explanations about your endocrine condition and treatment options
Privacy and Confidentiality
- Have your medical information kept confidential
- Private consultations and examinations
- Control who has access to your health information
Financial Information
- Receive clear information about treatment costs
- Understanding insurance coverage and payment options
- Request itemized billing statements
Your Responsibilities as a Patient
Providing Information
- Supply accurate medical history
- Report changes in health status promptly
- Inform about current medications and supplements
- Update contact and insurance information
Treatment Compliance
- Follow prescribed treatment plans
- Take medications as directed
- Monitor blood sugar or other markers as instructed
- Attend scheduled appointments
Communication
- Ask questions when instructions are unclear
- Inform staff of concerns or problems
- Provide feedback about care received
- Notify the office if unable to keep appointments
Financial Obligations
- Pay bills promptly
- Provide current insurance information
- Meet copayment requirements
- Discuss payment concerns proactively
Acknowledgment
I acknowledge that I have read and understand my rights and responsibilities as a patient at [Practice Name].
Patient Name: _________________
Signature: ____________________
Date: ________________________