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. 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 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 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. Confidentiality
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. I have received a copy of my patient rights and responsibilities and have had the opportunity to ask any questions regarding them (located on the website)
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.
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.
