Notice of Patient Rights and Responsibilities (California)

Pure Infusion® is committed to providing safe, respectful, and high-quality care. This Notice describes the rights and responsibilities of every patient receiving care at a Pure Infusion clinic, consistent with California law — including the California Health and Safety Code, Title 22 of the California Code of Regulations, the Unruh Civil Rights Act (California Civil Code Section 51), and applicable federal requirements — as well as the policies of this facility.

A copy of this Notice is available to every patient and representative upon request and is posted in patient care areas. Please ask a staff member if you would like this Notice in an alternate language or format.

YOUR RIGHTS AS A PATIENT

As a patient of Pure Infusion, you have the right to:

1. Considerate, respectful care that recognizes your personal dignity, values, and beliefs, and to be free from abuse, neglect, harassment, and retaliation.
2. Receive care without discrimination on the basis of race, color, religion, ancestry, national origin, disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, sexual orientation, citizenship, primary language, immigration status, age, or source of payment.
3. Know the name and professional role of the licensed practitioner responsible for coordinating your care, and the names of others who will be involved in your treatment.
4. Receive information about your diagnosis, treatment options, and prognosis in terms you can understand, and to have your questions answered.
5. Participate actively in decisions about your care, including the right to give informed consent before treatment begins and, to the extent permitted by law, the right to refuse treatment and to be told the likely medical consequences of that refusal.
6. Appropriate assessment and management of pain.
7. Be informed of any continuing care needs following treatment, and to have a friend, family member, or representative included in that discussion with your authorization.
8. Privacy during examinations, treatment, and discussion of your care, and confidentiality of your health information and records as required by HIPAA, the California Confidentiality of Medical Information Act, and other applicable laws.
9. Free interpreter and language assistance services, and to receive vital documents in your preferred language where required by law.
10. Communication assistance appropriate to any sensory, speech, or cognitive impairment.
11. Designate a support person or personal representative to be involved in your care, consistent with your consent and applicable privacy law.
12. Receive information about the costs of your care and your expected financial responsibility, and to review your bill and receive an explanation of charges.
13. Voice a concern, grievance, or complaint about your care without fear of discrimination or reprisal, and to be told how to do so — including how to file a complaint with Pure Infusion and with the California Department of Public Health.
14. Review and, consistent with law, obtain copies of your medical records, and request correction of information you believe is inaccurate.

YOUR RESPONSIBILITIES AS A PATIENT

To help us provide safe and effective care, we ask that you:

1. Provide accurate and complete information about your health history, medications, allergies, and current condition, to the best of your knowledge.
2. Ask questions when you do not understand your diagnosis, treatment plan, or instructions.
3. Follow the treatment plan you have agreed to, and tell your care team promptly if you are unable or unwilling to follow it.
4. Keep scheduled appointments and notify the clinic as far in advance as possible if you need to cancel or reschedule.
5. Inform staff promptly of any changes in your condition, including new symptoms or reactions during treatment.
6. Treat clinic staff, other patients, and visitors with courtesy and respect.
7. Provide current insurance and billing information and fulfill your financial obligations for services received.
8. Follow clinic safety and infection-control policies.

HOW TO VOICE A CONCERN OR FILE A COMPLAINT

If you have a concern about your care, please speak with your care team or clinic manager so we can address it promptly. You may also contact Pure Infusion’s Compliance Department at (801) 921-6305 or [email protected].

You also have the right to file a complaint directly with the California Department of Public Health, Licensing and Certification Program, without first raising the concern with Pure Infusion, and without fear that doing so will affect your care:

California Department of Public Health — Centralized Complaint Hotline: 1-800-236-9747
Website: cdph.ca.gov

Concerns involving suspected discrimination may also be directed to the U.S. Department of Health and Human Services, Office for Civil Rights, or the California Civil Rights Department.

NOTICE OF PRIVACY PRACTICES

This Notice addresses your rights and responsibilities as a patient. A separate Notice of Privacy Practices describes in detail how your health information may be used and disclosed, and how you can access it. Ask a staff member for a copy or request one at https://pureinfusion.com/about/legal-privacy-notices/.