• Impartial access to medical treatment or care, regardless of race, color, national origin, age, disability, religion, sex, gender identity or sexual orientation.
• Respectful treatment and personal dignity at all times.
• Personal and informational privacy and confidentiality.
• Personal safety in the care environment.
• Know the identity and professional status of individuals providing healthcare and to know their primary care physician.
• Complete, current information about their diagnosis, treatment, and prognosis to the degree known, in terms that can reasonably be expected to be understood.
• Go outside this office for a second opinion.
• Reasonable informed consent and participation in decisions involving their healthcare.
• Refuse to participate in experimental research.
• Consult with a specialist at their own request and expense.
• Be informed of continuing healthcare requirements, of the need for transfer to another facility, or alternatives to transfer.
• Know which services incur a charge, the amount of that charge, and to initiate a formal review of unresolved billing questions.
• Full information regarding the grievance and care evaluation process, including information, review, and resolution of patient complaints.
• Provide accurate and complete healthcare information to the best of their ability.
• Follow the treatment plan recommended by the primary clinician and other caregivers.
• Understand and assume consequences of refusing treatment or not complying with therapy.
• Keep appointments or notify of cancellations in a timely manner.
• Provide feedback to clinicians about the quality of care received and our policies.
• Be considerate and respectful of the rights and property of other patients and our staff.
• Fulfill financial obligations for healthcare promptly.
USA Health Ambulatory Division complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, religion, sex, gender identity, or sexual orientation.
• Free aids and services to people with disabilities to communicate effectively with us, including: qualified sign language interpreters, written information in other formats such as large print, audio, and accessible electronic formats.
• Free language services to people whose primary language is not English, including qualified interpreters, information written in other languages.
If you need these services, please inform your physician’s office.
If you believe that USA Health Ambulatory Division has failed to provide these services or discriminated in any, you can file a grievance with:
Rebekah Bailey, Director of USA Health Ambulatory Compliance, 1504 Springhill Ave, Mobile AL 36604, Phone #: (251) 471- 7836, Fax #: (251) 471- 7886 email: email@example.com. You can file a grievance in person or by mail, fax, or email.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
© 2017 USA Health System