Courteous & Respectful Treatment
You have a right to be treated with dignity and respect. You should expect:
- Staff shall introduce themselves and explain the care they will provide.
- Staff shall be courteous to you and your visitors.
- Your care shall not be affected by race, color, religion, sex, age, national origin or disability.
- Your cultural and religious beliefs shall be respected and accommodated, as appropriate.
- Communication assistance, including interpretation services, shall be provided free of charge.
- You have a responsibility to treat clinic staff with dignity and respect. You have a responsibility to make your needs and expectations known.
- You have a responsibility to follow clinic policies that you are informed of.
- This clinic and its premises are “Tobacco Free” out of
- consideration and the health of the patients and staff.
- Clinic hours are by appointment only.
- If you feel you are not being treated appropriately, please let staff know or have them contact the Operations Director. The Operations Director facilitates the flow of services and promotes communication between patients, families, and clinic staff.
- You have a right to be seen by your health care professional. You should expect to be seen in an efficient manner.
- Be honest with staff when scheduling appointments so they can assign the appropriate amount of time needed for your visit.
- You have a responsibility to keep your appointments and to arrive on time. Being on time for your appointments and making sure you call in advance to cancel when you cannot be here will help greatly reduce the amount of time you must wait to be seen.
- Arrive on time. We have reserved this time especially for you. Arriving late means you are actually being seen at a time reserved for someone else. If you are more than 10 minutes late for your appointment, we may need to reschedule.
- Make note of the appointment time and date and be prepared to keep the appointment. Our office staff may call to confirm the appointment 24-48 hours in advance as a courtesy reminder.
- Call to cancel your appointment if you discover you cannot keep the appointment. Cancellations should be called in as far in advance as possible, and must be called in at least 24 hours before the scheduled appointment. When you let us know you are not coming, we can fill that time with a patient we might otherwise have to turn away.
- If you fail to cancel your appointment at least 24 hours in advance, a no-show charge may be assessed to your account.
- If you fail two times in 12 months to come in for a scheduled appointment, you may be dismissed from the practice.
Privacy & Confidentiality
- You have a right to privacy during the provision of care, discussions regarding your care and treatment, and to the confidential handling of your medical record. You should expect:
- To have the exam room door closed during care and treatment.
- To have your identity as a clinic patient protected, if requested or required by law.
- Only authorized individuals will have access to your medical records.
- Your medical records will not be released to individuals outside of Physicians’ Clinic of Iowa affiliates without your written consent, except as governed by law.
- You have a responsibility to respect the privacy of others. You have a responsibility to retrieve medical records from outside offices for your patient chart, if needed.
- You are responsible to let staff know how and where to contact you regarding lab test results, appointments, etc.
- Medical records are often requested for various reasons; allowing 7-10 business days for medical records to be copied is appropriate for accurate dispersal of information.
- Maintain a quiet atmosphere by avoiding loud talking and by going only where directed within the clinic.
- Cell phone usage should be used in a manner agreeable to others and consistent with clinic policy.
- You have a right to make decisions regarding your care, including the right to refuse treatment. You have the right to change providers, if other qualified providers are available. You also have the right to formulate an Advance Directive to assure that your wishes will be carried out if you are unable to make decisions for yourself. You should expect:
- An explanation of your condition, the risks, the benefits of the proposed treatment and alternative treatments
- There is a financial counselor available to help give direction regarding your insurance and to help with understanding your statements and balances within the clinic.
- Your healthcare provider and clinic staff shall comply with your Advance Directive to the extent permitted by law.
- You and/or your significant other may access appropriate consultation regarding ethical issues arising in your care.
- You have a responsibility to make informed decisions. You have a responsibility to contact your health insurance to understand what will and will not be covered regarding your care.
- Ask as many questions as you need to fully understand your condition and treatment options.
- Consents should only be signed when you are comfortable that you have received sufficient information and your questions have been answered.
- Inform your clinic staff if you have an Advance Directive and provide the most recent copy.
- Comply with your healthcare insurance agreement up to and including payment for co-payment due at time of service. Be aware of your insurance coverage changes and provide the most up-to-date information to our staff. Your signature is required to acknowledge that information is up to date. Balances that are left unpaid due to inaccurate information will be the patient’s responsibility.
- If eligible, comply with the Medicare rules.
Prescriptions & Treatment
- You have a right to be fully informed regarding your care and treatment and to participate in the planning and implementation of your care and treatment. You should expect:
- To receive adequate information to make treatment plan decisions.
- To have a family member or representative present during treatment, if requested.
- To have your changed prescription or renewals ready after 48 hours.
- To understand the Controlled Medications Policy should you be prescribed a narcotic or controlled medication.
- You have a responsibility to provide complete and accurate information to your physician and clinic staff and to follow your treatment plan. Canceling or rescheduling appointments may lead to not having medications updated or renewed—be sure to keep your appointment.
- Bring with you to each appointment a current list of medications.
- When you need a refill on your prescription, and there are no changes in your prescription, contact your pharmacy. The pharmacy will review your most current refill, dosage and directions and fax a request to our office. This way we can be sure the correct medication, dosage and directions are dispensed.
- Allow 48 hours for all refill requests
- Request your refill or prescription change at least 48 hours before you are out of medication.
- Mail order prescription forms are to be completed and sent by the patient.
- Controlled medications or narcotics will not be refilled after normal business hours, weekends, holidays or before it’s time for the next refill.
- Keep your appointments with your healthcare provider as per their recommendation.
Payment for Services
- You have a right to understand the charges for the services you have received. You should expect:
- To receive timely billing for our services.
- An explanation to any billing questions you may have. We have Financial Counselors on staff who are available to help.
- To have your insurance claim submitted for you–given you have provided accurate and updated information to submit your claim.
- All payments received will be applied to the oldest balance first to prevent your account from being sent to our collection agency.
- You are responsible for the charges incurred for the services you receive. We will submit claims to your insurance carrier.
- Be prepared to pay the co-payment or co-insurance amount at the time of service. We accept cash, check, MasterCard, Visa, and Discover.
- As the contract holder, you are responsible for responding to additional requests by your insurance company to process the claim(s). The balance of the claim is your responsibility.
- Services provided by your physician deemed not medically necessary by your carrier will be your responsibility to pay.
- Balances due after insurance processes the claim are your responsibility and must be paid within 90 days or have an established payment plan to avoid your account being referred to our collection agency.
- If you have past due balances or accounts placed with a collection agency, you may be required to make regular payments before being treated by Physicians’ Clinic of Iowa. You will also be expected to pay for the current visit.
- You have a right to receive care in a safe and secure environment with access to protective services, when appropriate. You can expect:
- To be seen by a licensed, qualified, and competent staff member.
- Freedom from all forms of abuse—verbal, physical, psychological/emotional, and sexual.
- Freedom to report any hazards you may experience or notice within the clinic or premises.
- You have a responsibility to adhere to clinic policies that you are informed of.
- Personal items should be with you at all times. The clinic staff is not responsible for your belongings.
- Report any hazards, suspicious activity or problems that affect the safety of your visit.
Comments & Concerns
- You have the right to voice concerns/grievances and to recommend changes in policies and services by contacting 319-247-3010 or email@example.com. You should expect:
- A timely response to all questions and concerns.
- A thorough investigation of the situation and implementation of corrective action, as appropriate.
- A follow up call or knowledge of the situation being resolved.
- No coercion, discrimination, or reprisal when sharing concerns.
- You have a responsibility to address any concerns regarding your care. You have a responsibility to report concerns in a manner that is appropriate and not abusive.