635 Main Street

Green Bay, WI  54301

Phone (920) 437-0206

Fax (920) 437-0276

PATIENT BILL OF RIGHTS

The Patient has the responsibility to:

Provide information regarding medical history, allergies, medication usage and other pertinent matters related to health status.

Take responsibility for requesting additional information or clarification about health status, treatment, or financial responsibilities when the information or instructions are not clearly understood.

Pay all outstanding financial charges.

The Patient has the right to:

Make decisions prior to and during the course of treatment and to refuse a recommended treatment to the extent permitted by law and to be informed of the medical consequences of this action.  In case of such refusal, you are entitled to other appropriate care and services that the pharmacy provides or to receive services from another provider. 

Be informed, both orally and in writing, in advance of service provided, of the charges, including payment for service expected from third parties and any charges for which the patient will be responsible.

Considerate and respectful care from your pharmacists, nurses and other pharmacy staff that does not discriminate against you and is in accordance with your physician’s orders.

Have your property and person treated with respect, consideration, and recognition of patient dignity and individuality.

Be able to identify staff members through visible proper identification.

Be informed of pharmacy policies and practices that relate to patient service, treatment and responsibilities.

Be informed of available resources for resolving disputes, grievances and conflicts (Refer to Notice of Privacy Practice, Streu’s Pharmacy Complaint/Adverse Event Form).

Report and have investigated grievances/complaints regarding treatment or service, lack of respect of property and may recommend changes in policy, staff or service without restraint, interference, coercion, discrimination or reprisal.

A choice of healthcare providers who can give you high quality healthcare when you need it.

Talk privately with staff and to have your health care information protected.  You also have the right to read and copy your own medical information.

Expect that the pharmacy will emphasize the confidentiality of your health information when it releases it to any other parties entitled to review information in these records (Refer to Notice of Privacy Practice).

Accurate and easily understood information about your health plan, the pharmacy and pharmacy staff. 

Have help provided if you speak another language, have a physical or mental disability, or have difficulty understanding the information, so you can make informed health care decisions.

Be informed of pharmacy service limitations and be informed of any financial benefits when referred to another service provider.

10/13/08