|
Dr.
B.L. Limmer |
|
             
|
|
Notice of Patient
Responsibilities This
form is meant to inform you, the patient, as well as your family
that in addition to rights, you have responsibilities while
undergoing medical care. If there are any questions regarding the
contents of this form please notify any staff member. Keep
Your Health Care Providers Accurately Informed
You
(or your parent or legally designated representative) have the
responsibility to provide, to the best of your knowledge, accurate
and complete information about present complaints, past illnesses,
hospitalizations, medications and other matters relating to your
health, including unexpected changes in your condition. Follow
Your Treatment Plan You
(or your parent or legally designated representative) are
responsible for following the treatment plan recommended by the
physician. This may
include following the instructions of health care personnel as they
carry out the coordinated plan of care/services and implement the
physician’s orders and as they enforce the applicable practice
rules and regulations. Keep
Your Appointments
You
(or your parent or legally designated representative) are
responsible for keeping appointments and, when unable to do so for
any reason, for notifying this practice.
Be
Responsible for any Decision You Make Not to Follow Your Treatment
Plan You
(or your parent or legally designated representative) are
responsible for your actions if the physician’s instructions are
not followed. If you
cannot follow through with the prescribed treatment plan, you are
responsible for informing the physician.
Be
Responsible For Your Financial Obligations You
(or your parent or legally designated representative) are
responsible for assuring that the financial obligations of health
care/services are fulfilled as promptly as possible, and for
providing information for insurance. Comply
with Rules of this Facility Regarding Patient Care and Conduct of
our Visitors You
(or your parent or legally designated representative) are
responsible for following practice rules and regulations affecting
patient care/services and conduct. Be
Considerate of Others
Be
Responsible for Your Own Lifestyle Choices
Your
health depends not just on your care/services but in the long term,
on the decisions you make in daily life.
You are responsible for recognizing the effect of lifestyle
of your personal life. Notice of Patient Rights This
form is meant to inform you, the patient, as well as your family
that you have rights and responsibilities while undergoing medical
care. If there are any questions regarding the contents of this form
please notify any staff member. Access to Care
Patients
shall be provided impartial access to treatment or accommodations as
to their requests and needs for treatment or service that are within
this practice’s capacity, availability, stated mission, and
applicable law and regulation.
This is regardless of race, creed, sex, national origin,
religion, disability/handicap or source of payment of care/services. Respect and Dignity
Every patient, whether
adult, adolescent, or newborn, has the right to considerate,
respectful care/services at all times and under all circumstances,
with recognition of his or her personal dignity and his or her
psychosocial, spiritual, and cultural variables that influence the
perceptions of illness.
Privacy
and Confidentiality
The
patient or his or her parent or legally designated representative
has the right, within the law, to personal and informational
privacy, as manifested by the right to: ·
Wear
appropriate personal clothing and religious or other symbolic items,
as long as they do not interfere with diagnostic procedures or
treatment. ·
Be
interviewed and examined in surroundings designed to assure
reasonable audiovisual privacy.
This includes the right to have a person of one’s own sex
present during certain parts of a physical examination, treatment,
or during a procedure performed by a health professional of the
opposite sex. This also
includes the right not to remain disrobed any longer than is
required for accomplishing the medical purpose for which the patient
was asked to disrobe. ·
Expect
that any discussion or consultation involving the patient’s
case—whether he or she is an adult, adolescent, or newborn—will
be conducted discreetly, and that individuals not directly involved
in care/services will not be present without the patient’s
permission. ·
Have
the right to review his or her medical records and have the
information explained, except when restricted by law. ·
Have
the medical records read only by individuals directly involved in
the treatment or the monitoring of its quality and by other
individuals only on the patient’s or his or her parent or legal
designated representative’s written authorization.
When the records are released to insurers, that
confidentiality is emphasized. ·
Expect
all communications and other records pertaining to care/services of
the individual, including the source of payment for treatment, to be
treated as confidential. ·
Request
a transfer to another treatment room if another patient or visitor
is unreasonably disturbing him. Personal
Safety
The
patient, whether adult, adolescent or newborn, has the right to
expect reasonable safety insofar as the clinic practices and
environment are concerned. Identity
The
patient or his or her parent or legally designated representative
has the right to know the identity and professional status of
individuals providing service to the patient, and to know which
physician or other practitioner is primarily responsible for his or
her care/services. This
includes the right to know of the existence of any professional
relationship among individuals who are treating him or her, as well
as the relationship of the practice to any other health
care/services or educational institution involved in his or her
care/services. Participation by patients in clinical training
programs or research should be voluntary. Information The patient or his or
her parent or legally designated representative has the right to
obtain from the practitioner responsible for coordination of his or
her care/services complete and current information concerning his or
her diagnosis (to the degree known), treatment and any known
prognosis. This
information should be communicated in terms the patient or his or
her parent or legal designated representative can reasonably be
expected to understand. When
it is not medically advisable to give such information to the
patient, the information should be made available to a legally
authorized individual. Communication
The
patient or his or her parent or legally designated representative
has the right of access to people outside the clinic by means of
visitors and by verbal and written communication.
When the patient or his or her parent or legally designated
representative does not speak or understand the predominant language
of the community, he or she should have access to an interpreter.
This is particularly true where language barriers are a
continuing problem. Consent
The
patient or his or her parent or legally designated representative
has the right to the information necessary to enable him or her, in
collaboration with the health care practitioner, to make treatment
decisions involving his or her health care/services. ·
To
the degree possible, this should be based on a clear, concise
explanation of his or her condition and of all proposed technical
side effects, problems related to recuperation, and probability of
success. ·
The
patient should not be subjected to any procedure without voluntary,
competent, and understanding consent by the individual or by his or
her parent or legal designated representative.
Where a medically significant need for care/services or
treatment exists, the patient or his or her parent or legal
designated representative shall be so informed. ·
The
patient or his or her parent or legally designated representative
has the right to know who is responsible for authorizing and
performing the procedures or treatment. ·
The
patient or his or her parent or legally designated representative
shall be informed if the clinic proposes to engage in or perform
human experimentation or other research or educational projects
affecting his or her care/services or treatment, and the patient has
the right to participate in any such activity.
If the patient chooses not to take part, he or she shall
receive the most effective care/services the clinic otherwise
provides. Consultation
The patient or his or
her parent or legally designated representative has the right to
accept medical care/services or to refuse treatment to the extent
permitted by law and to be informed of the medical consequences of
such refusal. When
refusal of treatment by the patient or his or her parent or legal
designated representative prevents the provision of appropriate
care/services in accordance with ethical and professional standards,
the relationship with the patient may be terminated upon reasonable
notice. Transfer
and Continuity of Care
A
patient has the right to expect that the clinic/facility will give
necessary health services to the best of its ability.
Treatment, referral or transfer may be recommended. If
transfer is recommended or requested, the patient will be informed
of risks, benefits and alternatives. The patient will not be
transferred until the other institution agrees to accept such
patient. Charges
Regardless
of the source of payment for the individual’s care/services, the
patient or his or her parent or legal designated representative has
the right to request and receive an itemized and detailed
explanation of his or her total bill for services rendered in the
clinic. The patient has the right to timely notice prior to
termination of his or her eligibility for reimbursement by any
third-party payer for the cost of his or her care/services Rules
and Regulations
The
patient or his or her parent or legally designated representative
should be informed of the clinic rules and regulations applicable to
his or her conduct as a patient. Patients are entitled to
information about the mechanism for the initiation, review and
resolution of patient complaints. Delineation
of Patient’s Rights The
rights of the patient may be delineated on behalf of the patient, to
the extent permitted by law, to the patient’s guardian, next of
kin or legally authorized responsible person if the patient: ·
Has
been adjudicated incompetent in accordance with the law ·
Is
found to be medically incapable of understanding the proposed
treatment or procedure ·
Is
unable to communicate his or her
wishes regarding treatment ·
Is
a minor
14615
San Pedro Avenue Suite
210, One Medical Park San
Antonio, Texas 78232 NOTICE
OF PRIVACY PRACTICES As Required by the Privacy Regulations Created
as a Result of the Health Insurance Portability and Accountability
Act of 1996 (HIPAA) THIS
NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF
THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS
TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION. PLEASE
REVIEW THIS NOTICE CAREFULLY. 1.
We have a legal, ethical, and moral obligation to protect
your confidentiality. Any
information about you and/or your family will be held strictly
confidential by all employees.
No discussions about you outside of the patient care
framework will be allowed, and any conversation between staff
members that pertains to delivering you quality care will be held in
a confidential and professional manner. 2. In order to provide quality care to you, as well as operate this office in an efficient manner, we will need to access your private health care information for purposes of treatment, payment and operations [such as quality assurance]. In using this information this office will comply with all state and federal laws pertaining to your privacy rights, including the Privacy and Security protections provided to you by the Health Insurance Portability and Accountability Act [HIPAA]. 3.
Specifically, we will need to disclose your private
information under the following circumstances: a)
Sharing Information
for Purpose of Treatment: We
will share information with all members of your treatment team, both
within this office and with other providers [personal and
institutional] in order to provide you with quality care and the
educational/wellness program specified in your insurance plan. b)
Sharing information
for Purpose of Payment: We
will share all necessary information with your insurer[s], payer[s],
governmental entities [such as Medicare, etc.] and their
representatives [including, but not limited to benefit determination
and utilization review] as well as our representatives involved in
the billing process [including, but not limited to claims
representatives, data warehouses, and billing companies]. c)
Sharing
of Information for Purpose of Operations:
We will share all information necessary for ongoing
operations of this office, including [but not limited to]
credentialing processes, peer review, accreditations and compliance
with all federal and state laws. 4.
Your consent for use and disclosure of information as
described may be revoked in writing at anytime.
Please notify the office/Privacy Officer if you ever decide
to revoke your consent. 5.
Your specific authorization will be required for release of
information not included above. Your authorization will need to be
in writing and it will be specific to the disclosure requested.
Incidences which may require authorization under the HIPAA
regulations include [but are not limited to] some marketing
purposes, the disclosure of any psychotherapy records in our
possession and disclosure for fundraising by any entity. 6.
Your consent will give us authorization to fax or leave
messages on your answering machine/service, regarding appointment
reminder calls, test results, or other messages relating to your
care in this office. It will also give us authorization to send
postcards reminding you to schedule an appointment. 7.
This office will not release any information other than those
incidents described above, unless disclosure is required by law, a
court, a legal process or government agencies. Please contact the Privacy Officer if you have any questions regarding this policy or how our office will use your Individual Identifiable Health Information [IIHI]. [Tina Boyd at (210)496-9929, 14615 San Pedro Suite 210, One Medical Park Building San Antonio, Texas 78232 or Bexar County Medical Society at (210) 301-4391, 202 W. French Plc. San Antonio, Texas 78212]. © 2002 Micro-Transplants.com - All Rights Reserved |
 |
|
|
|
|
|
|
| Dr. B.L. Limmer has more
than 33 years experience in hair restoration. In that time, he
has transplanted hair for thousands of patients and has published
numerous articles on the subject. He is recognized as one of
the premier hair transplant surgeons world wide.
His son, Dr. Bradley Limmer, has been involved in the development of follicular unit micrografting since 1991. He has been extensively trained in this technique by Dr. B.L. Limmer and actively performing hair transplantation surgery for the past 8 years. |
|
