Jump to Content

Available Forms

Patient Rights and Responsibilities English

You have the right to receive considerate and respectful care through

Maintaining your personal privacy and comfort, providing a safe and secure setting to receive care, free from all forms of abuse or harassment.

Confidential handling of all communications and records pertaining to care. Medical records are only available to persons directly involved in your care and except to the extent allowed by law, are not released without your written permission.

Being informed of the services available in this health center and the names and credentials of the personnel providing your care.

Changing your provider if other qualified providers are available.

You have the right to actively participate in your healthcare by

Receiving information about your health status, the course of treatment in terms that you can understand.

Reviewing your medical chart with the treating provider and to receive a thorough explanation of treatment, results of tests and procedures.

Receiving information regarding rules and policies that apply to your conduct while a patient.

Access to information contained in your medical records within a reasonable time frame (except in certain circumstances regulated by law).

Participating in the planning of your care and treatment options, including the option of no treatment. You have the right to refuse medication and treatment.

Being provided, to the degree known, an explanation of your complete medical/health condition, diagnosis, prognosis and recommended treatment, including the risk(s) of treatment or no treatment, alternatives and expected result(s).

Receiving an explanation of your bill regardless of the source of payment including available methods of payment and if you are uninsured information regarding our financial assistance program.

You have the right of resolution of issues, complaints, or grievances

As a patient, you have rights to not be discriminated against because of age, race, religion, gender, sexual orientation, color, nationality, language, marital status, citizenship, veteran status, physical, mental, or intellectual disability, cultural, economic, educational background or the source of payment for services.

You have the right to necessary interpretation services related to language and/or disability but need to inform staff of this accommodation need timely.

You have the right to make suggestions, recommended changes in policies and services, voice grievances or make complaints to or about facility personnel without risk of reprisal. You may voice grievances or recommend changes directly with a supervisor, manager or your physician, on the patient satisfaction survey or by submitting a complaint form to the Health Center Manager. If you are not satisfied with the complaint resolution, you have the right to escalate your complaint through a grievance process with the Health Center Manager. These forms can be obtained from any health center staff. You may contact the Compliance Officer at 775.870.4312 to verbalize your complaint(s), as well.

Each patient, and/or their designated representative, receiving services in this health center shall have the following responsibilities

To provide complete and accurate information to the best of your ability regarding your health, health complaints, past illnesses, hospitalizations, medications and allergies/sensitivities and other matters relating to your health care.

To follow the treatment plan (including discharge instructions and follow-up appointments) prescribed by your provider and to notify your provider of any decision to not follow your treatment plan.

Ask your provider if you do not understand your treatment plan.

To read all permits and/or consents that you sign and to ask the staff or provider for clarification or help for anything you do not understand.

To inform us if you have a durable power of attorney, an advance directive, a living will or any other directive and to provide a copy for our records.

To provide accurate proof of your financial situation and accept financial responsibility for any charges not covered by your insurance or incurred based on our sliding fee scale; paying timely.

To keep your appointments; if you cannot keep an appointment, let us know as soon as possible so another patient may have that appointment.

Maintain respectful communications and interactions with your Community Health Alliance healthcare team members.

Conduct yourself appropriately within Community Health Alliance facilities; you may not verbally or physically abuse personnel or property or make verbal threats or use threatening (hostile/aggressive) language.

Use appropriate words without vulgar or threatening language.

Refrain from coming to appointments intoxicated.

* Required field