Patient’s Rights & Responsibilities

PATIENT’S RIGHTS

You have the right to:

• Be fully informed in advance about services/care to be provided, including the company representatives that provide care/services, and the frequency of visits as well as any modifications to the service/care plan.
• Be treated, and have your property treated, with dignity, courtesy, and respect, recognizing that each person is a unique individual.
• Be informed both orally and in writing, in advance of care being provided of the charges, including payment for care/services expected from third parties and any charges for which the patient will be responsible.
• Receive information about the scope of services that the organization will provide and specific limitations on those services.
• Participate in the development and revision of the plan of care.
• Refuse care or treatment after the consequences of refusing care or treatment are fully presented.
• Be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property.
• Voice grievances/complaints regarding treatment of care, lack of respect of property, or recommend changes in policy, personnel, or services without restraint, interference, coercion, discrimination, or reprisal.
• Have complaints regarding treatment or care, or lack of respect of property investigated.
• Confidentiality and privacy of all information contained in the patient record and of protected health information.
• Be advised on agency’s policies and procedures regarding the disclosure of clinical records.
• Choose a health care provider.
• Receive appropriate care without discrimination in accordance with physician orders.
• Be informed of any financial benefits when referred to an organization.
• The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.
• Be fully informed of one’s responsibilities.

PATIENT’S RESPONSIBILITIES

You have the responsibility to:

• Adhere to the plan of treatment or service established by your physician.
• Adhere to the company’s policies and procedures.
• To submit any forms that are necessary to participate in the program, to the extent required by law.
• Participate in the development of an effective plan of care/treatment/services.
• Provide, to the best of your knowledge, accurate and complete medical and personal information necessary to plan and provide care/services.
• Provide any necessary forms and documentation needed to participate in patient management programs, to the extent required by law.
• Ask questions about your care, treatment and/or services, or to have clarified any instructions provided by company representatives. Communicate any information, concerns and/or questions related to perceived risks in your services, and unexpected changes in your condition.
• Be available at the time deliveries are made and to allow The Oncology Institute’s representatives to enter your residence at reasonable times to repair or exchange equipment or to provide services.
• Notify the company if you are going to be unavailable.
• Treat company personnel with respect and dignity without discrimination as to color, religion, sex, or national or ethnic origin.
• Provide a safe environment for dispensary representatives to provide services.
• Care for and safely use medications, supplies and/or equipment, according to instructions provided, for the purpose it was prescribed and only for/on the individual for whom it was prescribed.
• Communicate any concerns about your/your caregiver’s/your family member’s ability to follow instructions or use the equipment provided.
• Protect equipment from fire, water, theft, or other damage. You agree not to transfer or allow your equipment to be used by any other person without prior written consent of the company and further agree not to modify or attempt to make repairs of any kind to the equipment. Modifying equipment or attempting equipment repairs releases the company from any liability related to the equipment and its uses, and from any resulting negative customer outcomes.
• Except where contrary to federal or state law, you are responsible for equipment rental and sale charges that your insurance company or companies do not pay. You are responsible for prompt settlement in full of your accounts unless prior arrangements have been approved by company administration.
• The company should be notified of any changes in your physical condition, physician’s prescription, or insurance coverage. Notify the company immediately of any address or telephone changes, whether temporary or permanent.

QUESTIONS OR COMPLAINTS?

If you have any questions about this notice or believe we have not protected your private health information and wish to file a complaint, please contact:

Mark Hueppelsheuser, Compliance Officer
markhueppelsheuser@theoncologyinstitute.com

OR

Office for Civil Rights
U.S. Department of Health & Human Services
200 Independence Avenue SW
Room 509F, HHH Building
Washington, D.C. 20201
(800) 368-1019

If you have any questions or complaints regarding our dispensary, please contact:

Lupe Chavez, Dispensary Manager
pharmacy@theoncologyinstitute.com

OR

ACHC, Credentialing Organization
(855) 937-2242