As a patient of Brevard Health Alliance (BHA) medical clinics, you have both rights and responsibilities.
My RIGHTS are:
- I have the right to be respected and supported.
- I have the right to be informed about and involved in all aspects of my health care.
- I have the right to complete confidentiality regarding my medical records.
- I have the right to care that is considerate and respectful of my personal beliefs and values.
- I have the right to select or change to any qualified provider that works for BHA.
- I have the right to an estimate of my charges. Requests must be made three (3) days in advance of an appointment. For more information, please click here.
My RESPONSIBILITIES are:
- I have the responsibility to report all of my significant health-related conditions that may be relevant to the ability of BHA providers to provide effective patient care.
- I have the responsibility to truthfully and accurately report earning, assets, and the insurance status (including Medicaid or Medicare eligibility) of everyone living in my household.
- I have the responsibility to attend all scheduled appointments and comply with all treatments, referrals, and follow-up recommendations of my healthcare providers.
- I have the responsibility to behave appropriately towards all BHA staff members.
- I have the responsibility to notify my healthcare providers of any changes in my condition that may necessitate a change in my treatment plan.
- I have the responsibility to contact the clinic at least 1 (one) week prior to running out of medication which is provided through the assistance of BHA. Please do not “walk in” for medication refills.
- I have the responsibility to supply the required documentation needed to receive medication assistance.
I have read and fully understand all of my rights and responsibilities and agree to comply with the requirements of BHA.
Patient Rights & Responsibilities Form
This is a downloadable copy of the content that is written above.
Florida Patient Rights & Responsibilities
This is a downloadable copy of the Rights and Responsibilities of the patient according to the State of Florida.