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Rights and Expectations
The long-term physician-patient relationship is, in many ways, becoming devalued in our society. However, I believe that it continues to hold great potential for maintaining health and being an important resource in difficult times. An effective relationship relies on trust and realistic expectations.
Your Rights, My Commitments
My commitments to you are spread across this website. As a patient of the practice, your rights include: - Respectful communication at all times.
- Access to effective care when you need it.
- Complete privacy within the confines of the law. Details are in the form below.
If you feel your rights are not being honored, please let me know.
My Expectations, Your Responsibilities
For the relationship to work, patients have responsibilities, too. I expect patients to: - Be respectful in communication and action at all times.
- Arrive for appointments on time, and cancel as soon as possible if necessary.
- Pay for care and cooperate with obtaining insurance payment as expected.
- Take responsiblity for your own health.
Failure to be responsible in these ways may result in dismissal from the practice.
Ending the Relationship
Even when everyone does their best, some relationships simply are not meant to be, for various reasons. If you feel the need to move your care elsewhere, I will support your decision and provide records at your request. There is a release form available below. Likewise, there may be times I will feel the need to end a relationship because I am unable to be of further help.
Forms
Notice of Privacy Practices. This form is required by the federal HIPAA law and is always available to you here or in the office.
Consent for Care. This is a consolidated consent form that must be completed to become a patient of the practice. It allows me to receive payments from your insurance company, acknowledges that you have been given the above privacy notice, and specifies how I may contact you. You may print and bring it, completed, to your first visit.
Release of Information - Incoming. You may complete and return this form to the office to request records from another organization.
Release of Information - Outgoing. You may complete and return this form to the office to request that records be sent out.
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