Patient Rights and Responsibilities Sample Clauses

Patient Rights and Responsibilities. A. I understand that pre-existing medical conditions do not disqualify me from enrolling into Evolve and that I have a right to know my treatment options and actively participate in my healthcare decisions. B. I understand that I have the right to a fair, expedient and objective review of any complaint I may have against Evolve and a Practitioner and that I will submit my concerns, suggestions and patient feedback to xxxx@xxx0xx.xxx. C. I understand that in the event of a life-threatening medical condition, I should always call 911 or proceed to the nearest emergency department. I also understand that the costs of urgent care services not rendered by Evolve is not included in Evolve’s monthly membership fees or otherwise. D. I understand that Practitioners are available for telephone consultations in the event of an urgent medical matter, but I will call 911 or proceed to the nearest emergency department if immediate medical attention and/or treatment is required. Patient Name: _ _ Patient Signature: _ __ _Date: _ Signature: _Date: Xxxxxxx X. Xxxxxxxx, MD If the Patient is a minor, the Patient’s parent or legal guardian must sign below indicating the parent or guardian’s acceptance of the above terms and agreement to pay the Membership Fee on behalf of the Patient: Signature of Parent/Guardian: _Date: _ MEDICARE OPT-OUT AND LIST OF PRACTITIONERS‌ I AGREE, UNDERSTAND AND EXPRESSLY ACKNOWLEDGE THE FOLLOWING: • The Practitioners listed below (the “Practitioners”) have all opted out of the Medicare program effective on dates indicated after their names for a period of at least two years. • Neither Evolve nor any Practitioner is involuntarily excluded from participating in Medicare Part B under Sections 1128, 1156, or 1892 or any other section of the Social Security Act. • I accept full responsibility for payment of Evolve’s and Practitioners’ charges for all items and services furnished to me by Evolve. • Medicare fee limitations do not apply to what Evolve and the Practitioners may charge for the items or services they provide to me. • I will not submit a claim (or request that Evolve or any Practitioner submit a claim) to the Medicare program for payment for any items or services provided to me by Evolve or any Practitioner, even if the items or services are covered by Medicare Part B. • Neither Evolve nor any Practitioner will submit a Medicare claim for items or services they furnish to me, and no Medicare reimbursement will be provided for such items or s...

Patient Rights and Responsibilities. I acknowledge that this is a partnership between my FTI therapist and me and, as such, I agree to actively participate in my treatment. I also acknowledge the rights available to me. A list of patient rights and responsibilities is posted in the waiting area. A copy of these rights and responsibilities is available upon request. (initial)

Patient Rights and Responsibilities. I understand I have the right to take part in decisions about the health care and plan for treatment. I have received a copy of the Patient Rights and Responsibilities and my questions have been answered.

Patient Rights and Responsibilities. A. I understand that pre-existing medical conditions do not disqualify me from enrolling into Evolve and that I have a right to know my treatment options and actively participate in my health care decisions. B. I understand that I have the right to a fair, expedient and objective review of any complaint I may have against Evolve and a Practitioner and that I will submit my concerns, suggestions, and patient feedback to xxxx@xxx0xx.xxx. C. I understand that in the event of a life-threatening medical condition, I should always call 911 or proceed to the nearest emergency department. I also understand that the costs of urgent care services not rendered by Evolve are not included in Evolve’s monthly membership fees or otherwise. D. I understand that Practitioners are available for telephone consultations in the event of an urgent medical matter, but I will call 911 or proceed to the nearest emergency department if immediate medical attention and/or treatment is required. Patient Name: _ _ Patient Signature: _ __ _Date: _ Signature: _Date: Xxxxxxx X. Xxxxxxxx, MD Signature of Parent/Guardian: _Date: Please note: Evolve makes every effort to minimize lab costs for our members! Covid PCR lab billing is done by the lab processing your sample and it is not within our ability to control this cost. Our member cost for lab processing of PAP smears is also steeply discounted. PAP alone is $30 for our members (average national price is $88) and PAP with HPV is $87 for our members (average national price is $129). Women’s health can be very expensive if paying out-of-pocket. In addition to the fee for the lab (PAP+HPV=$129), you can expect to pay $65 to $125 for the visit PLUS $90 to $360 for the Pelvic Exam. • CBC (complete blood count) • CMP (comprehensive metabolic panel) • Lipid analysis • TSH/T4 (thyroid stimulating hormone and thyroid hormone) • PSA (prostate specific antigen) for men only

Patient Rights and Responsibilities. A. I understand that pre-existing medical conditions do not disqualify me from enrolling into Evolve and that I have a right to know my treatment options and actively participate in my healthcare decisions. B. I understand that I have the right to a fair, expedient and objective review of any complaint I may have against Evolve and a Practitioner and that I will submit my concerns, suggestions and patient feedback to XXX@xxx0xx.xxx. C. I understand that in the event of a life-threatening medical condition, I should always call 911 or proceed to the nearest emergency department. I also understand that the costs of urgent care services not rendered by Evolve is not included in Evolve’s monthly membership fees or otherwise. D. I understand that Practitioners are available for telephone consultations in the event of an urgent medical matter, but I will call 911 or proceed to the nearest emergency department if immediate medical attention and/or treatment is required.

Patient Rights and Responsibilities. The MCO shall provide to Providers any and all training and technical assistance it deems necessary regarding administrative and clinical procedures and requirements, as well as clinical practices.

Patient Rights and Responsibilities. Patient Rights As a A1KARE HOSPICE AND PALLIATIVE CARE INC. patient, you have the right to: 1. Be informed of your rights and responsibilities in a language and manner, which you understand.

Patient Rights and Responsibilities. I acknowledge that I have received, both verbally and in written format, Lewes Surgery Center’s - Patient’s Rights information. Furthermore, I have had the opportunity to read the notice, ask questions regarding my rights as a patient and understand all information as presented. I am aware that Lewes Surgery Center is a physician owned facility. The physicians listed below have a financial and ownership interest in Lewes Surgery Center. I acknowledge that I have selected to have my procedure performed at the Center after considering both my physician’s financial interest in Lewes Surgery Center and that I understand I retain the choice to have the procedure performed at a different facility. Xxxxxx Xxxxxx, MD; Xxxxx Xxxxxx, DPM; Xxxxxx Xxxxxxx, DO; Xxxxxxxx Xxxxx, MD; Xxxx Xxxxxx, MD; Xxxxxx Xxxxxxxxxx, DPM; Xxxxx Xxxxxxx, MD; Xxxxx Xxxx, MD; Xxxxxx X. Xxxxxxx, DO; Xxxxxx X. Xxxxx, DO. Lewes Surgery Center acknowledges that all patients have the right to participate in their own health care decisions and to make Advance Directives or to execute Powers of Attorney that authorize others to make decisions on their behalf based on the patient’s expressed wishes when the patient is unable to make decisions or unable to communicate decisions. Lewes Surgery Center respects and upholds those rights. However, unlike in an acute care hospital setting, Lewes Surgery Center does not routinely perform “high risk” procedures. While no surgery is without risk, most procedures performed in this facility are considered to be of minimal risk and of an elective nature. You will discuss the specifics of your procedure with your physician who can answer your questions as to its risks, your expected recovery, and care after your surgery.

Patient Rights and Responsibilities. Patients have the right to terminate this agreement at any time and demand the return of all of their property in the caregiver’s possession including marijuana, plants, and supplies, but must give the caregiver 7 days notice of the termination date. The caregiver needs time to make preparations for the safe return of the patients plants and to gather all supplies. The patient will also be responsible to compensate the caregiver for the service already invested in the growth of the plants. Patients have the right to a consistant supply of medical grade cannabis. The caregiver must be able to produce a steady supply for each patient and remain within the quantity guidelines of the Act. The caregiver can not divert any of the patients marijuana or plants without the consent of the patient. The caregiver can not consume any of the patients marijuana or plants without the consent of the patient, and the caregiver must also be a patient. If the caregiver ends up with excess marijuana for a patient, that patient must decide if it should be destroyed, transfered to other patients, or donated to indigent patients. Patients have a right to reasonable access to their caregiver and marijuana. That means the patient should have the caregiver’s contact numbers and information, and be able to talk to the caregiver as necessary to inquire about a transfer, their supply, the progress of their plants, or just a friendly hello. Reasonable access means at an appropriate time of day, when the caregiver would normally be tending the garden, and by yourself as only you and the caregiver are invloved in this relationship and have access to the plants. Patinets have a right to privacy. Caregivers are not allowed to discuss any of thier patients with any other patient or caregiver. The interaction between the patient and caregiver is exclusively their business and all details of this relationship are to be kept private. The patient must make a clear designation showing whether the primary caregiver or the qualifying patient will be allowed under state law to possess the marihuana plants for the qualifying patient's medical use, which shall be determined based solely on the qualifying patient's preference.

Patient Rights and Responsibilities. The LME shall provide to Providers any and all training and technical assistance it deems necessary regarding administrative and clinical procedures and requirements, as well as clinical practices.