Patient Rights & Responsibilities


patient_rights_intro3

Your Rights As Our Patient


ACCESS | Appointments are provided within a reasonable time.

RESPECT |  Care is provided in a manner that respects your individuality and dignity.

PRIVACY | All physical exams, interviews and discussion about your health will occur privately and your medical 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 | Consent for treatment will be requested by our staff 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 within 10 days of your written request for records, as applicable.

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.

responsible_intro

Your Responsibilities As Our Patient


RESPECT | Follow rules including the consideration of the rights of other patients and staff. Please assist with the control of noise and observe the no-smoking policy.

INFORM | Please give full and honest information. This includes complete health records or a complete medical history, information on any medication you take and any other providers that you see outside of Chapa-De.

REPORT CHANGES |  Report any changes in your condition, symptoms and allergies.

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.

REPORT EMERGENCIES |  Please notify your healthcare provider within 24 hours if you suffer an emergency.

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.

before_visit_intro

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.

register

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:

confidential

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 (Auburn)

Release of Information Form (Grass Valley)

Personal Representative Forms