YOUR RIGHTS AND RESPONSIBILITIES AS A PATIENT
AS A PATIENT, GUARDIAN OR OTHER DESIGNATED LEGAL REPRESENTATIVE, YOU HAVE THE RIGHT:
ACCESS TO CARE
• To receive considerate and respectful care without discrimination
based on race, ethnicity, religion, culture, language, physical or
mental disability, socioeconomic status, sex, sexual orientation and
gender identity or expression; and with recognition of all state-
sanctioned marriages and spouses for purposes of compliance with
the Conditions of Participation, regardless of any laws to the
contrary of the state or locality where the facility is located.
• To expect competent care.
• To consult with a specialist at your own request and expense.
PERSONAL PRIVACY/VISITATION
• To have your personal dignity and privacy respected.
• To personal and informational privacy within the law.
• To appoint a designated legal representative who will participate in
your care and make decisions on your behalf should you be unable
or unwilling to do so.
• To have a support person present during your care, provided it
does not infringe on the rights and safety of others or interfere
with care processes if you have a disability as defined by the
Americans with Disabilities Act (ADA).
• To receive visitors of your choosing and withdraw or deny your
consent to receive such visitors at any time.
• To communicate by phone and/or in writing with those who
cannot visit.
SECURITY
• To receive care in a safe setting and to be free from all forms
of abuse or harassment.
• Be free from restraints of any form that are not medically
necessary.
CONCERNS, COMPLAINTS AND GRIEVANCES
• To receive information about the practice/clinic’s mechanism
for the initiation, review and resolution of patient complaints/
grievances, through written material or public postings.
• To voice complaints and recommend changes without being
subject to coercion, discrimination, reprisal, or unreasonable
interruption of care.
• To report a grievance relating to patient care and be informed as
to the organization’s resolution of such, including a written
notification by the organization’s representative listing the steps
taken to investigate, the results of the process, and the date the
process was completed.
• To file a complaint or grievance involving Gallardo's Clinic:
Call the Practice Manager at 706-529-3009 or visit
https://www.gallardosclinic.com to submit an online message.
Contact the Georgia Department of Community Health by
calling toll-free at 800-878-6442 or submit online at
https://dch.georgia.gov/divisionsoffices/hfrd/facility-licensure/
hfrd-file-complaint
PAIN MANAGEMENT
• To have pain assessed and managed appropriately.
• To participate in the development and implementation of the plan
for pain management.
AS A PATIENT, GUARDIAN OR OTHER LEGAL DESIGNATED REPRESENTATIVE, IT IS YOUR RESPONSIBILITY:
To provide accurate and complete information about your health,
including present complaints, past illnesses, hospitalizations and
medications.
• To inform us of changes in your condition or symptoms,
including pain.
• To ask questions about any part of your care or treatment you do
not understand.
• To speak up about your concerns to any employee as soon as
possible.
• To follow treatment plans recommended by the physician and/or
advanced practice professional primarily responsible for your
care.
• To understand that if you refuse treatment or do not follow the
physician’s instructions, you must accept the consequences.
• To pay your bills or make arrangements to meet the financial
obligations arising from your health care as promptly as possible.
ACCESS TO INFORMATION
• To know the facility/clinic’s rules regulating your care and
conduct.
• To have your physician and/or family member(s) and/or a
representative of your choice notified of any referrals
scheduled.
• To know the names and professional titles of your caregivers
and to know which physician or other provider is primarily
responsible for your care.
• To know that Gallardo's Clinic is a teaching facility and that
some of your caregivers may be in training.
• To ask your caregivers if they are in training.
• To obtain complete and current information about your
diagnosis (to the degree known).
To understand your treatment and prognosis, as well as any
continuing health care requirements following checkout.
• To request a referral to a specialist when applicable.
• To be involved in the development, implementation and revision
of your treatment plan/home-care plan, when applicable.
• To make informed decisions regarding your care, including the
right to request or refuse treatment.
• To make advance directives for end of life care and have
medical providers who will follow them.
To access information contained in your medical records within
a reasonable time frame and without unnecessary barriers.
• To receive an itemized and detailed explanation of your
total bill for services rendered, regardless of the source of
payment.
• To say yes or no to experimental treatments, to be advised when
a physician is considering you to be part of a medical research
program or donor program, and to refuse or withdraw at any
time without consequence to your care.
• To access a financial navigator for assistance with financial
questions and/or financial aid.
COMMUNICATION
• To receive information, you can understand.
• To access an interpreter and/or translation service at no charge.
• To be informed about and in agreement with the need to transfer to
another facility and to be accepted at the receiving facility prior to
that transfer.
To follow our rules regulating your care and conduct.
• To keep your scheduled appointments or let us know if you are
unable to keep them.
• To respect the rights and property of others.
• To treat organizational personnel with respect and consideration,
providing a safe environment in which care is given and avoiding
abusive behavior which could result in dismissal from a physician
practice/clinic.
• To respect our request that all Gallardos Clinic facilities remain
smoke and vape free.
• To provide a current copy of your advance directive if you have
one.
• To follow ADA regulations if a service animal accompanies you
in our facility.