Lock & Key Wellness
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Patient's Bill of Rights & Responsibilities

Please review your rights and responsibilities as a patient at Lock & Key Wellness, then acknowledge below.

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Pursuant to Section 381.026, Florida Statutes. You have the right to request all signed documents.

A patient has the right to:

  • Be treated with courtesy and respect, with appreciation of his or her dignity, and with protection of privacy. Receive a prompt and reasonable response to questions and requests.
  • Know who is providing medical services and is responsible for his or her care.
  • Know what patient support services are available, including if an interpreter is available if the patient does not speak English.
  • Know what rules and regulations apply to his or her conduct.
  • Be given by the health care provider information such as diagnosis, planned course of treatment, alternatives, risks, and prognosis.
  • Refuse any treatment, except as otherwise provided by law.
  • Be given full information and necessary counseling on the availability of known financial resources for care.
  • Know whether the health care provider or facility accepts the Medicare assignment rate, if the patient is covered by Medicare.
  • Receive prior to treatment, a reasonable estimate of charges for medical care.
  • Receive a copy of an understandable itemized bill and, if requested, to have the charges explained.
  • Receive medical treatment or accommodations, regardless of race, national origin, religion, handicap, or source of payment.
  • Receive treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
  • Know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in such research.
  • Express complaints regarding any violation of his or her rights.

A patient is responsible for:

  • Giving the health care provider accurate information about present complaints, past illnesses, hospitalizations, medications, and any other information about his or her health.
  • Reporting unexpected changes in his or her condition to the health care provider.
  • Reporting to the health care provider whether he or she understands a planned course of action and what is expected of him or her.
  • Following the treatment plan recommended by the health care provider.
  • Keeping appointments and, when unable to do so, notifying the health care provider or facility.
  • His or her actions if treatment is refused or if the patient does not follow the health care provider's instructions.
  • Making sure financial responsibilities are carried out.
  • Following health care facility conduct rules and regulations.

Agency for Health Care Administration — www.FloridaHealthFinder.gov. If you have questions or concerns, please contact the office at (656) 227-9547.

Acknowledgment & signature