PATIENT BILL OF RIGHTS AND RESPONSIBILITIES
We believe that all pharmacy patients receiving services from AccuServ Pharmacy ® should be informed of their rights. Therefore, you are entitled to:
- Choose a health care provider.
- Be fully informed in advance about service/care to be provided.
- Participate in the development and periodic revision of the plan of service/care.
- Informed consent and the right to decline participation, revoke consent or disenroll at any point in time.
- Be informed, both orally and in writing, in advance of service/care being provided, of the charges, including payment for service/care expected from third parties and any charges for which the patient will be responsible.
- Have one’s property and person treated with respect, consideration, and recognition of patient dignity and individuality.
- Voice grievances/complaints regarding treatment or care, lack of respect of property or recommend changes in policy, staff, or service/care without restraint, interference, coercion, discrimination, or reprisal.
- Have grievances/complaints regarding treatment or care that is (or fails to be) furnished, or lackof respect of property investigated.
- Receive appropriate service/care without discrimination.
- Be informed of any financial benefits when referred to an organization.
- Be fully informed of one’s responsibilities.
- The right to know about philosophy and characteristics of the patient management program. [The right to have personal health information shared with the patient management program only in accordance with state and federal law.
- The right to identify the staff member of the program and their job title, and to speak with a supervisor of the staff member if requested.
- The right to receive information about the patient management program.
- The right to receive administrative information regarding changes in or termination of the patient management program
- The responsibility to submit any forms that are necessary to participate in the program, to the extent required by law.
- The responsibility to give accurate clinical and contact information and to notify the patient management program of changes in this information.
- The responsibility to notify their treating provider of their participation in the patient management program, if applicable.
We believe that all patients receiving services from AccuServ Pharmacy ® should be informed of their rights.Therefore, you are entitled to:
- Be informed, orally and in writing, in advance of the product being provided, of the charges, including payment expected from third parties and any charges for which the patient will be responsible
- Receive information about the products that the organization will provide and specific limitations on those services
- Have one’s property and person treated with respect, consideration, and recognition of patient dignity and individuality
- Be able to identify delivery personnel through proper identification
- 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 or care, lack of respect of property, or recommend changes in policy, personnel, or service without restraint, interference, coercion, discrimination, or reprisal
- Have grievances/complaints regarding products that are (or fail to be) furnished, or lack of respect of property investigated
- Confidentiality and privacy of all information contained in the patient record and of Protected Health Information (PHI)
- Be advised on organization’s policies and procedures regarding the disclosure of clinical records
- Receive appropriate product without discrimination in accordance with physician orders, if applicable
- Be informed of any financial benefits when referred to an organization
- Be fully informed of one’s responsibilities
- Patient agrees to use the equipment and supplies for the purposes so indicated and in compliance with the physician’s prescription.
- Patient agrees to request payment of authorized Medicare, Medicaid, or other private insurance benefits are paid directly to the pharmacy for any services furnished.
- Patient agrees to accept all financial responsibility for medical equipment and supplies furnished by the pharmacy.
- Patient agrees that the pharmacy shall not insure or be responsible to the patient for any personal injury or property damage related to any equipment; including that caused by use or improper functioning of the equipment; the act or omission of any other third party, or by any criminal act or activity, war, riot, insurrection, fire or act of God.
- Patient understands that the pharmacy retains the right to refuse delivery of service to any patient at any time.
- Patient agrees that any legal fees resulting from a disagreement between the parties shall be borne by the unsuccessful party in any legal action taken.