Recipient's Rights Notification/HIPPA​

 

As a recipient of services at our facility, we would like to inform you of your rights as a patient. The information contained in this brochure explains your rights and the process of complaining if you believe your rights have been violated.

 

Your Rights as a Patient

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1. Complaints. We will investigate your complaints.

2. Suggestions. You are invited to suggest changes in any aspect of the services we provide.

3. Civil Rights. Your civil rights are protected by federal and state laws.

4. Treatment. You have the right to take part in formulating your treatment plan.

5. Denial of services. You may refuse services offered to you and be informed of any potential consequences.

6. Record restrictions. You may request restrictions on the use of your protected health information; however, we are not required to agree with the request.

7. Availability of records. You have the right to obtain a copy and/or inspect your protected health information; however we may deny access to certain records in which we will discuss this decision with you.

8. Amendment of records. You have the right to request an amendment in your records; however, this request could be denied. If denied, your request will be kept in the records.

9. Medical/Legal Advice. You may discuss your treatment with your doctor or attorney.

10. Disclosures. You have the right to receive an accounting of disclosures of your protected health information that you have not authorized.

 

Your Rights to Receive Information

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1. Costs of services. We will inform you of how much you will pay.

2. Termination of services. You will be informed as to what behaviors or violations could lead to termination of services at our clinic.

3. Confidentiality. You will be informed of the limits of confidentiality and how your protected health information will be used.

4. Policy changes.

 

Our Ethical Obligation

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1. We dedicate ourselves to serving the best interest of each client.

2. We will not discriminate between clients or professionals based on age, race, creed, disabilities, handicaps, preferences, or other personal concerns.

3. We maintain an objective and professional relationship with each client.

4. We respect the rights and views of other mental health professionals.

5. We will appropriately end services or refer clients to other programs when appropriate.

6. We will evaluate our personal limitations, strengths, biases, and effectiveness on an ongoing basis for the purpose of self-improvement.  We will continually attain further education and training.

7. We hold respect for various institutional and managerial policies, but will help improve such policies if the best interest of the client is served.

 

Patient's Responsibilities

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1. You are responsible for your financial obligations to the clinic as outlined in the Payment Contract for Services.

2. You are responsible for following the policies of the clinic.

3. You are responsible to treat staff and fellow patients in a respectful, cordial manner in which their rights are not violated.

4. You are responsible to provide accurate information about yourself.