Order Forms

Notice of Patient Rights

Our patients have the right to:

  • Medical care and services without discrimination based upon race, color, religion, gender, sexual preference and orientation, national origin, age, source of payment, disability, marital status or diagnosis.
  • Care that is considerate and respectful of his or her personal values and beliefs and the right to express those values and beliefs which do not harm others or interfere with medical therapy.
  • Know the name and professional status of the physician, who has primary responsibility for his or her care, as well as other physicians and non-physicians involved in providing care.
  • Be informed about his or her responsibilities related to his or her care, treatment, and services.
  • Receive information in a manner tailored to the patient’s age, language, and ability to understand. This information is to be relevant, current, and easily understood concerning diagnosis, treatment, and prognosis.
  • Receive communication if the patient has vision, speech, hearing, or cognitive impairments in a manner that meets the patient’s needs, including provided interpretation and translation services, if necessary.
  • Participate in making decisions about his or her care, treatment, and services, including the right to have his or her own physician promptly notified of any changes in condition or treatment.
  • Refuse care, treatment, or services and be respected for this decision.
  • Give or withhold informed consent to produce or use recordings, films, or other images of the patient for purposes other than his or her care.
  • Be informed of the risks, benefits, alternatives, and procedures to be followed if experimental treatment or research is being proposed; the patient has the right to refuse to participate in such treatment or research without limiting his or her access to care and services.
  • Receive respect for his or her rights during research, investigation, and clinical trials.
  • Formulate advanced directives and have the medical staff comply with these directives.
  • Be free from neglect, exploitation, coercion, manipulation, misappropriation, seclusion, restraint, retaliation; and verbal, mental, physical, and sexual abuse.
  • File a complaint and expect prompt referral to appropriate administrative personnel for resolution. The patient also has the right to file a complaint with state and federal advocacy and licensing groups, as well as accreditation agencies.
  • Confidentiality regarding his or her care, including the right to receive care in privacy, and any clinical records of care.
  • Access information contained in his or her records within a reasonable period.
  • Be informed of unexpected as well as expected outcomes resulting from the care provided.
  • To receive a referral to another health care institution if the provider is not authorized or unable to provide services needed by the patient.
  • Obtain knowledge of any professional and/or business relationships that may exist between individuals, other organizations or health care services, or educational institutions involved in his/her care.
  • Request and receive a detailed explanation of their medical bill and to receive information and counseling on the availability of known financial resources for health care.
    Access, request amendments to, and obtain information on all disclosures of health information made by the organization.

WHERE TO FILE A COMPLAINT OR GRIEVANCE

If you are concerned that your rights may have been violated, please contact us using the following information.

Pure Infusion – Attn: Director of Compliance
75 W Towne Ridge Parkway, Tower 2 Suite 500
Sandy, Utah 84070
Phone: 801-921-6305
Email: [email protected]

If you wish to remain anonymous, please call our Compliance Hotline at 1-801-823-0120.

You may also file a complaint with the U.S. Department of Health and Human Services Office of Civil Rights via phone, fax, mail, or through their portal at ocrportal.hhs.gov.

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