Your Rights as a Patient
Access to Care
- Receive care regardless of race, religion, gender, sexual orientation, or disability status
- Access appropriate mental health services based on clinical needs
- Obtain emergency psychiatric care when needed
Privacy and Confidentiality
- Have your medical information kept confidential per HIPAA regulations
- Access your medical records upon written request
- Approve or refuse release of records to any outside party
Treatment Decisions
- Participate actively in treatment planning
- Receive complete information about diagnosis and treatment options
- Accept or refuse treatment (except in emergency situations)
- Receive information about medication effects and side effects
Respect and Dignity
- Be treated with respect and consideration
- Receive care in a safe environment
- Be free from physical restraint or seclusion except when necessary
Your Responsibilities as a Patient
Treatment Participation
- Provide accurate information about your medical history
- Follow the agreed-upon treatment plan
- Attend scheduled appointments
- Take medications as prescribed
Communication
- Inform staff about changes in your condition
- Ask questions when you don't understand something
- Provide feedback about your care
Facility Policies
- Follow clinic rules and regulations
- Respect the rights of other patients and staff
- Meet financial obligations for care
- Provide accurate insurance information
Acknowledgment
I have read and understand my rights and responsibilities as outlined above.
Patient Name: _________________
Date: _________________
Signature: _________________
Provider Name: _________________
Date: _________________
Signature: _________________