Rights & Responsibilities

At Waco Family Medicine you have rights and responsibilities as a patient. Waco Family Medicine also has rights and responsibilities as a healthcare provider. Please take a moment to become familiar with these rights and responsibilities.

A. Human Rights

You have a right to be treated with respect regardless of race, color, marital status, religion, sex, gender, gender identity, sexual orientation, national origin, ancestry, physical or mental handicap or disability, age or other grounds as applicable to federal, state and local laws or regulations.

B. Payment for Services

1. You are responsible for giving staff accurate information about your present financial status and any changes in your financial status. The staffs need this information to decide how much to charge you and/or so they can bill private insurance, Medicaid, Medicare, or other benefits for which you may be eligible. If your income is less than the federal poverty guidelines, we will help determine your eligibility to receive a discounted fee schedule.
2. You have a right to receive explanations of your Waco Family Medicine bill. You must pay, or arrange to pay, all agreed fees for medical services, with the exception of dental services, which are provided on a prepaid basis. For any unpaid balance you may have, please contact our billing department for a payment plan.
3. Federal law prohibits Waco Family Medicine from denying you primary health care services which are medically necessary solely because you cannot pay for these services. Waco Family Medicine may require a Co-Pay or a Nominal Fee from our patients. If you cannot afford this required payment, we would be happy to assist you to determine potential eligibility for programs that may reduce your required fee.

C. Privacy

You have a right to have your interviews, examinations and treatment in privacy. Your medical records are also private. Only legally authorized persons may see your medical records unless you request in writing for us to show them to, or copy them for, someone else. In certain instances, Waco Family Medicine may be required to report to the Texas Department of State Health Services regarding your health condition or illness status. The Privacy and Confidentiality in Delivery of Services Policy sets forth the ways in which your medical records may be used or disclosed by Waco Family Medicine and the rights granted to you under the Health Insurance Portability and Accountability Act (“HIPAA”). This document is available to you upon request.

D. Health Care

1. You are responsible for providing Waco Family Medicine with complete and current information about your health or illness, so that we can give you proper health care. You have a right, and are encouraged, to participate in decisions about your treatment.
2. You have a right to information and explanations in the language you normally speak and in words that you understand. You have a right to information about your health or illness, treatment plan, including the nature of your treatment; its expected benefits; its inherent risks and hazards (and the consequences of refusing treatment); the reasonable alternatives, if any
   (and their risks and benefits); and the expected outcome, if known. This information is called obtaining your informed consent.
3. You have the right to receive information regarding “Advance Directives.” If you do not wish to receive this information, or if it is not medically advisable to share that information with you, we will provide it to your legally authorized representative.
4. You are responsible for appropriate use of Waco Family Medicine services, which includes following staff instructions, making and keeping scheduled appointments, and requesting a “walk in” appointment only when you are ill. Waco Family Medicine professionals may not be able to see you unless you have an appointment. If you are unable to follow instructions from the staff, please tell them so
   they can help you.
5. If you are an adult, you have a right to refuse treatment or procedures to the extent permitted by applicable laws and regulations. In this regard, you have the right to be informed of the risks, hazards, and consequences of your refusing such treatment or procedures. Your receipt of this information is necessary so that your refusal will be “informed.” You are responsible for the consequences and outcome of refusing recommended treatment or procedures. If you refuse treatment or procedures that your healthcare providers believe is in your best interest, you may be asked to sign a Refusal to Permit Medical Treatment or Services / Against Medical Advice Release Form.
6. You have a right to health care and treatment that is reasonable for your condition and within our capability, however, Waco Family Medicine is not an emergency care facility. You have a right to be transferred or referred to another facility for services that Waco Family Medicine cannot provide. Waco Family Medicine does not pay for services that you receive from another healthcare provider or any required transportation service.

E. Waco Family Medicine Medical Home Responsibilities

1. The practice is responsible for coordinating your care across different settings.
2. The care team will provide you access to evidence-based care, patient/family education and self-management goals.
3. The front office staff at your clinic will help transfer your medical records. You will be required to sign a release of information form.
4. You will receive a written clinical summary at each visit.

F. Patient Responsibilities

1. You have a right to receive information on how to use Waco Family Medicine’s services appropriately. You are responsible for using Waco Family Medicine’s services in an appropriate manner. If you have any questions, please ask us.
2. You are responsible for the supervision of children you bring with you to Waco Family Medicine. You are responsible for your children’s safety and the protection of other patients and our property.
3. You have a responsibility to keep your scheduled appointments. Missed scheduled appointments cause delay in treating other patients. If you do not keep scheduled appointments you may be subject to disciplinary action pursuant to Waco Family Medicine’s policies and procedures.

G. Complaints

1. If you are not satisfied with our services, please tell us. We want suggestions so we can improve our services. Staff will tell you how to file a complaint. If you are not satisfied with how the staff handles your complaint, you may file a complaint in writing to Waco Family Medicine’s Board of Directors.
2. If you make a complaint, no representative of Waco Family Medicine will punish, discriminate or retaliate against you for filing a complaint, and Waco Family Medicine will continue to provide you services.

H. Termination

If Waco Family Medicine decides that we must stop treating you as a patient, you have a right to advance written notice that explains the reason for the decision, and you will be given thirty (30) days to find other health care services. However, Waco Family Medicine can decide to stop treating you immediately if you have created a threat to the safety of the staff and/or other patients. You have a right to receive a copy of Waco Family Medicine’s Patient Dismissal Policy.

Reasons for which we may stop seeing you include:

1. Failure to obey Waco Family Medicine’s rules and policies;
2. Intentional failure to accurately report your financial status;
3. Intentional failure to report accurate information concerning your health or illness;
4. Intentional deception of care team regarding medications and obtaining care outside Waco Family Medicine;
5. Verbal abuse of or inappropriate behavior toward our staff or creating a significant disturbance and/or
6. Creating a threat to the safety of the staff and/or other patients.

I. Appeals

If Waco Family Medicine has given you notice of termination of the patient and health center relationship, you have the right to appeal the decision to the grievance committee in writing. Unless you have a medical emergency, we will not continue to see you as a patient while you are appealing the decision.