A. The patient is responsible for payment of all medical services rendered to the patient and/or patient’s dependent(s).
B. The patient is responsible to give complete and accurate information, to the best of their knowledge about his/her medical history, including past illnesses, hospitalizations, family history, any medications, including over-the-counter products and dietary supplements, and any allergies or sensitivities regarding the patient and/or patient’s dependent(s) at the request of the physician. All psychological as well as medical matters related to present health need to be shared with the physician.
C. Once patients and physicians agree upon the goals of therapy and a treatment plan, patients have a responsibility to cooperate with that treatment plan and to keep their agreed-upon appointments. Compliance with physician instructions is often essential to public and individual safety. Patients also have a responsibility to disclose whether previously agreed upon treatments are being followed and to indicate when they would like to reconsider the treatment plan.
D. The patient is responsible for filing insurance claims for procedures deemed medically necessary for their own reimbursement of medical costs. Accept personal financial responsibility for any charges not covered by his/her insurance.
E. A 48 notice for cancellation is required. Failure to do so will result in a $50.00 fee or loss of a treatment from your package.
F. Be respectful of all health care professionals and staff, as well as other patients.
G. Patients should discuss end-of-life decisions with their physicians and make their wishes known. Such a discussion might also include writing an advance directive.
H. Patients should not initiate or participate in fraudulent health care and should report illegal or unethical behavior by physicians and other providers to the appropriate medical societies, licensing boards, or law enforcement authorities.
I. Provide a responsible adult to transport him/her home from the facility and remain with him/her for twenty-four (24) hours if patient is receiving general anesthesia or IV sedation.
Revised: 06/03/2015
