Patient Rights & Responsibilities
Your Rights As Our Patient
ACCESS | Appointments are provided within a reasonable time. You will be treated without discrimination as to race, color, age, sexual orientation or preference, gender, national origin, political beliefs or disabilities.
RESPECT | Care is provided in a culturally appropriate manner that respects your individuality and dignity. Interpretation services will be provided, if needed.
PRIVACY | All physical exams, interviews and discussions about your health will occur privately and your health records will be handled confidentially.
CARE TEAM | You have the right to know the names and professional status of the staff who are providing your care. You have the right to change your provider if another qualified provider is available.
CONSENT | You have the right to participate in decisions about your care and give your consent before any procedure is performed. The procedure and its value, risks and other options for treatment will be explained.
REFUSAL OF TREATMENT | You have the right to refuse any care recommended.
ACCESS TO RECORDS | You may review or receive a copy of your health records after submitting a written request.
BILLS | You have a right to an explanation of all charges and sliding fee scale adjustments.
FEEDBACK | You have the right to file a complaint and it will not impact your access to services or the quality of your care.
Your Responsibilities As Our Patient
RESPECT | Follow rules including the consideration of the rights of other patients and staff. Do not insult, intimidate, threaten or yell at staff, other patients or visitors.
OBSERVE RULES | Weapons, smoking, video recording, and animals (other than a service animal) are not allowed in the buildings.
INFORM | Please provide complete health records or a complete health history, medication list and allergies and any changes in these areas. Please inform us of emergencies within 24 hours.
FOLLOW INSTRUCTIONS | Follow your healthcare provider’s instructions. If you have questions, please ask.
BE ON TIME | Arrive for your appointment on time. If you need to miss an appointment, please call 24 hours in advance.
SHOW IDENTIFICATION AND INSURANCE CARD | Show picture identification and your insurance card (including your Medi-Cal ID card) at each visit.
PAY BILLS | Please pay your co-payments and bills promptly.
FINANCIAL SCREENING | Provide Indian Verification to receive clinic care at no cost or income documents to determine eligibility for reduced fees.
Preparing For Your Visit
All new patients must register before their first appointment, please see How to Register. New patients should arrive at the reception desk in the department you are visiting 30 minutes before your first appointment to complete the new patient registration process. Established patients should arrive 15 minutes before your appointment time.
You will need to bring the following items to all of your appointments:
- Photo ID
- All insurance cards (Medi-Cal, Medicare or other medical, prescription or dental insurance).
- A list of medication you are taking or bring the medications with you.
- The patient services representative making your appointment will also inform you of any records or information you need to bring with you.
- When bringing children in for immunization, always bring their immunization record with you.
For most appointments a patient services representative will contact you three days prior to your appointment to collect additional information that will assist your care team in preparing for your visit. You will also receive a reminder phone call the day prior to your appointment.
If you need to cancel or reschedule an appointment please call us. When patients do not cancel their appointment, they deny other patients the opportunity to book that visit. We keep track of the number of “no-show” appointments a patient accumulates and patients who repeatedly miss their appointments may lose the privilege of making appointments at our community health centers.
New Patient Information / How To Register
All new patients must register before their first appointment. New patients should arrive at the reception desk in the department you are visiting 30 minutes before your first appointment to complete the new patient registration process.
You will need to bring the following items to all of your appointments:
- Photo ID
- All insurance cards (Medi-Cal, Medicare or other medical, prescription or dental insurance).
- A list of medication you are taking or bring the medications with you.
- The patient services representative making your appointment will also inform you of any records or information you need to bring with you.
- When bringing children in for immunization, always bring their immunization record with you.
For your first appointment, please also bring (if applicable);
- Proof of American Indian or Alaska Native Ancestry
- IRS Tax Return Transcript or Letter of Non-Filing Status (If applying for sliding fee scale)
- Birth Certificate (for minors under age 18)
- Proof of Legal Guardianship (for minors under age 18)
To expedite the registration process we also encourage you to print and complete the following forms and bring them with you:
Confidentiality
Chapa-De is committed to protecting the confidentiality and privacy of health records and information. We want you to be informed about your rights to privacy as a patient. As a part of these standards, Chapa-De provides you the following “Notice of Privacy Practices” about how your Protected Health Information (PHI) may be used and disclosed in our healthcare practices as well as how you may access this information.
To request copies of health records or information please contact our Health Information Department at 530-887-2840 in Auburn or 530-477-1720 in Grass Valley. They may ask you to submit one of the following printable forms:
Release of Information Form (English)
Release of Information Form (Spanish)