Giving Kids a Healthy Start
In-Depth Pediatric Care
As a patient of Childrens Clinic, you are entitled to privacy, courteous and respectful quality health care based on your individual needs. You are entitled to these rights regardless of your gender, race, cultural, economic, educational or religious background, or the source of payment for your care.
We encourage you to participate in decisions regarding your treatment. You have a right to clear, unbiased information concerning your diagnosis, treatment, risks, recovery and alternate care. Based on this information, you can refuse, consent or change your treatment. You have the right to create advance directives which dictate your preferences for treatment. If you do not have any advance directives, your treatment will be guided by our policies and procedures.
We guarantee that all of your medical, financial and personal information will be treated confidentially. You are entitled to your medical information after you leave Childrens. You have the right to understand all of your charges on your Childrens Clinic bill.
As a patient, you have the responsibility to provide your doctor and other members of the medical staff your true medical history and insurance information. While you are visiting Childrens Clinic, you must comply with the rules and regulations and adhere to your treatment plan selected by you and your doctor. You have the responsibility to fulfill your financial obligations of your health care. While you are in our care, you must respect the rights of other patients and clinic personnel, and respect the property of other people and the clinic.
The CHILDRENS CLINIC Notice of Privacy Practices provides information about the privacy right of our patients; and how we may use and disclose protected health information (PHI) about our patients. Federal regulation requires that we give our patients or their authorized representative the opportunity to review our Notice before signing this acknowledgment.
If you have any questions about your rights or our privacy practices please send a letter to the following address. A response will be sent within seven (7) business days.
PO Box 509
Madison, GA 30650