Bill of Rights

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 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.