651 Helen Keller Boulevard
/ Tuscaloosa, AL 35404 / 205 556-2323 or 800 225-6882
W.
Ronald McIlwain, D.M.D.
J. Terry Carlson, D.M.D., M.D.
James J. Link, D.D.S.
S. Craig Fairburn, D.M.D., M.D.
• Pre-Op Instructions •Post-Op Instructions •
PATIENT RIGHTS: As a patient you have the right to:
1. Considerate and respectful care.
2. Exercise these rights without regard to age, race, disability, sex, cultural, economic, education, religious background, or source of payment for care given.
3. Knowledge of the name of the physician and professional staff who have primary responsibility for coordinating the patient's care and the name and professional relationships of other physicians and non- physicians who will participate in care.
4. Receive information from the physician about the illness, course of treatment, and prospects for recovery in terms that the patient can understand.
5. Receive as much information about any proposed treatment or procedure as needed in order to give informed consent or to refuse this course of treatment. Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved in this treatment, alternate course of treatment or non-treatment and the risks involved in each, and to know the name of the person who will carry out the procedure or treatment.
6. Participate actively in decisions regarding medical care. To the extent permitted by law, this includes the right to refuse treatment.
7. To know that you can express a complaint regarding your care or any violation of your rights and that your doing so will not adversely affect the quality of care provided.
8. Be made aware of methods of expressing complaints or grievances.
9. Be free of all forms of abuse or harassment.
10. Change physicians if desired, either within the practice or another physician of the patient's choice.
11. Full consideration of privacy concerning the medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discreetly. The patient has the right to be advised as to the reason for the presence of any individual.
12. Confidential treatment of all communications and records pertaining to patient's care. The patient's written permission shall be obtained before medical records can be made available to anyone not directly concerned with patient's care.
13. Access information contained in your medical records within a reasonable time frame in accordance with state/federal laws and regulations.
14. Reasonable responses to any reasonable requests made for service.
15. Leave the practice even against the advice of the attending physician.
16. Reasonable continuity of care and to know in advance the time and location of appointments as well as the physician providing the care.
17. Be advised if a physician proposes to engage in or perform human experimentation affecting the care or treatment. The patient has the right to refuse to participate in such research projects or clinical trials.
PATIENT RESPONSIBILITIES: As a Patient, you have the responsibility to:
1. Provide accurate and complete information about past illnesses, hospitalizations, and other matters related to your health status.
2. Report any unexpected changes in your condition to your healthcare provider.
3. Follow the practice's rules and regulations affecting patient care and conduct while a patient in the practice.
4. Inform your healthcare provider of your advance directives.
5. Make it known whether course of treatment and what is expected of the patient is clearly understood.
6. Follow the treatment plan established by the physician, including the instructions of nurses and other health professionals as they carry out the physician's orders.
