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| Patient Rights / Responsibilities | |
Patient Rights
It is the philosophy of Sussex County Medical Associates to ensure that patients are informed of their rights and responsibilities. It is also our desire to treat our patients and their families with respect as we provide the health care services they need and request. Medical Care: Every patient has the right
to be informed of specific details about procedures, treatments and cost in order to make
informed decisions. Communication and Information:
A patient has the right to be informed of the names and functions of all healthcare
professionals providing care, and to be supplied with an interpreter, if necessary. A
patient should always be treated with courtesy, consideration and respect. Medical Records: A patient may have
access to his or her medical records. A
patient’s medical records will be transferred to another provider upon written/signed
request. Privacy and Confidentiality: Physical
privacy will be ensured during any exam, test or treatment.
Personnel will avoid speaking about a patient’s condition in a public area and
only discuss it on a need-to-know basis. Questions and Complaints: A
patient’s question or grievance should be given to the Office Manager. Patient Responsibilities I, the patient, understand the following responsibilities: Assignment: I request that payment
of authorized Medicare, Blue Shield, HMO’s and/or commercial benefits be made to
Sussex County Medical Associates for any services furnished to me. I also understand that I am financially
responsible for all copays, coinsurance, deductibles and/or services that are denied or
not covered by my insurance carrier. Administrative Charge: I understand that I will be
charged an
administrative charge of $25.00 for any copay that is not paid at the time of service and
must be billed for. Release: I grant permission for release of medical and/or
insurance information from Sussex County Medical Associates to any third party payers
and/or agents for the purpose of any concurrent or retrospective review which may be
required for processing any claim for payment. I also grant permission to Sussex
County Medical Associates to release medical information to other treating specialists.
Such release may include information which may be considered a communicable or venereal
disease which include, but not be limited to, diseases such as hepatitis, syphilis,
gonorrhea and the human immunodeficiency virus, also known as acquired immune deficiency
syndrome (AIDS). Also included in such release may be information regarding alcohol and
drug abuse and psychiatric illness. Your medical records are the property
of Sussex County Medical Associates and requires signed permission from you (18 years and
older) prior to their release to anyone other then your provider of medical benefits or
treating specialists as described above. Conduct: I agree to treat doctors, all providers and their staff
with respect. Cancellations: I
understand that it is my responsibility to give at least 24 hours notice. |
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