As a patient of Brevard Health Alliance (BHA) medical clinics, you have both rights and responsibilities.

My RIGHTS are:

1. I have the right to be respected and supported.
2. I have the right to be informed about and involved in all aspects of my health care.
3. I have the right to complete confidentiality regarding my medical records.
4. I have the right to care that is considerate and respectful of my personal beliefs and values.
5. I have the right to select or change to any qualified provider that works for BHA.
6. 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:

1. 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.
2. 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.
3. I have the responsibility to attend all scheduled appointments and comply with all treatments, referrals, and follow-up recommendations of my healthcare providers.
4. I have the responsibility to behave appropriately towards all BHA staff members.
5. I have the responsibility to notify my healthcare providers of any changes in my condition that may necessitate a change in my treatment plan.
6. 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.
7. 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.