Patient Responsibility

AS A PATIENT, YOU ARE RESPONSIBLE FOR –

GRIEVANCE PROCEDURES –

AMENDMENT TO CHARGES FOR MEDICAL RECORDS –

AS A PATIENT, YOU ARE RESPONSIBLE FOR:

1. Providing, to the best of your knowledge, accurate and complete information about your present health status, any allergies or sensitivities, medications, including over-the-counter and dietary supplements, and past medical history and reporting any unexpected changes to the appropriate physician.
2. Following and participating in the agreed upon treatment plan recommended by the primary physician involved in your case.
3. Providing an adult to transport you home after surgery and an adult to bring you back the next morning for your follow-up appointment.
4. Being respectful to the healthcare providers and other patients.
5. Indicating whether you clearly understand the proposed treatment plan and what is
expected of you and ask questions when you need further information.
6. Your actions if you refuse treatment, leave the facility against the advice of the physician and/or do not follow the physician’s instructions relating to your care.
7. Providing a copy of your advance directives (power of attorney/living will) if applicable.
8. Responsible for informing us of any insurance changes and will accept personal financial

Responsibility for charges not covered by your insurance.