Patient Rights and Responsibilities

As a patient, I have a RIGHT to:

  1. Be fully informed of my rights and responsibilities
  2. Receive an explanation of my diagnosis, benefits of treatment, alternatives of treatment, explanation of expected recuperation, and an explanation if treatment is not pursued
  3. Receive an explanation of services provided by the practice, the days and hours of service, and provisions for emergency care including emergency phone numbers
  4. Participate in development of a plan of treatment
  5. Make known Advance Directives or a Living Will, if I wish
  6. Freely withdraw my previous consent for treatment
  7. Obtain full financial explanation prior to treatment
  8. Receive professional care without discrimination based on race, creed, color, religion, national origin, sexual identity or preference, handicap, or age
  9. Be treated with courtesy, dignity, and respect, and receive protection of my personal privacy by all office staff
  10. Express grievances without fear of retaliation or discrimination
  11. Have confidential treatment of information relating to my condition, medical records, and other personal and financial data
  12. Access to my personal records and obtain copies upon written request

              As a Patient, I have the RESPONSIBILITY to:

  1. Disclose accurate and complete information with regard to my physical condition, hospitalizations, medications, allergies, medical history, and related items
  2. Assist in maintaining a safe, peaceful, and efficient office environment
  3. Provide timely new/changed information related to my health insurance to the business office
  4. Be prepared to meet my co-pay during my office visit
  5. Contact the office when unable to keep a scheduled appointment, acknowledging that repeated last minute cancellations may result in a fee or in dismissal from the practice
  6. Cooperate in the planned care and treatment developed for me
  7. Request more detailed explanations for any aspect of service I don’t understand
  8. Inform my physician or staff of any changes in my condition or any new medical problems or concerns
  9. Communicate in a timely manner any change in my address or phone number which might hinder contact by the office
  10. Treat the physician and staff with courtesy, dignity, and respect
  11. Make certain I keep myself informed of any changes in office hours, visit requirements, office policies,  or any other office-specific information by checking the practice website prior to each and every upcoming visit
  12. Listen to completely, or read fully, any appointment reminder message I may receive, to ensure timely arrival and appropriate preparation for my visit
  13. Arrive at the requested time for my visit, as late arrivals will require rescheduling and may result in a fee


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© Virginia Chiantella MD