Patients' Rights and Responsibilities / Consent to Treatment
Ivanka A. Vassileva, M.D. is dedicated to providing you with the best in health care. Along with technical expertise, we want to provide you with a positive patient experience. We respect your rights as a patient and want you to understand your responsibility as a partner in your care. Consent to Treatment
□ I voluntarily authorize the rendering of such care, including diagnostic procedures and medical treatment, by authorized agents and employees of the office of Ivanka A. Vassileva, M.D., its medical staff and their designees, as may in their professional judgment be deemed necessary or beneficial. I acknowledge that no guarantees have been made as to the effect of such examination or treatment on my condition or the condition of the person for whom I am duly authorized to sign. I understand that I have the right to make decisions concerning my health care or the health care of the person for whom I am duly authorized to make such decisions, including the right to refuse medical and surgical procedures. This consent to treatment may be revoked in writing at any time by the patient or duly
authorized agent. Patients' Rights Ivanka A. Vassileva, M.D. is committed to providing you with respectful care as we meet your health care needs. For this reason, we want you to have a summary of your rights as a patient.
• You have a right to considerate and respectful care.
• You have the right to participate in the development and implementation of your plan of care.
• You will not be denied access to care due to race, creed, color, national origin, sex, age, sexual orientation, disability or source of payment.
• You have the right to information about your diagnosis, condition and treatment, in terms that you can understand.
• You have the right to refuse treatment to the extent permitted by law and to be informed of the possible consequences of the refusal.
• You may consent or refuse to participate in experimental treatment or research.
• You are entitled to be free from all forms of abuse or harassment.
• You have the right to make or have a representative of your choice make informed decisions about your care.
• You have the right to formulate advance directives and have them followed.
• You have the right to appropriate assessment and management of pain.
• You are entitled to be free from any forms of restraint or seclusion as a means of
convenience, discipline, coercion or retaliation.
• Seclusion and restraint for behavior management can only be used in emergency
situations.
• You are entitled to information about rules and regulations affecting your care or
conduct.
• You have the right to know the names and professional titles of your physicians and caregivers.
• You can request a change of provider or second opinion if you choose.
• You have the right to personal privacy and to receive care in a safe environment.
• You have the right to a prompt and reasonable response to any request for services within the capacity of the health care facility.
• You have the right to express concerns or grievances regarding your care to the office.
• The confidentiality of your clinical and personal records will be maintained.
• You have the right to see your medical record within the limits of the law.
• You have the right to an explanation of all items on your bill. Patients'
Responsibilities
This is a summary of your responsibilities as a patient at Ivanka A. Vassileva, M.D.
• It is your responsibility to provide accurate and complete information about all matters pertaining to your health, including medications and past or present medical problems.
• You are responsible for following the instructions and advice of your health care team. If you refuse treatment or do not follow the instructions or advice, you must accept the consequences of your actions.
• It is your responsibility to notify a member of the health care team if you do not
understand information about your care and treatment.
• You are responsible for reporting changes in your condition or symptoms, including pain, to a member of the healthcare team.
• It is your responsibility to act in a considerate and cooperative manner and to respect the rights and property of others.
• You are responsible for following the rules and regulations of the health care facility.
• You are expected to keep your scheduled appointments or to cancel them in advance if at all possible.
• It is your responsibility to pay your bills or make some arrangement with the facility to meet your financial obligations.
Questions or Concerns
You and your family should feel you can always voice your concerns. If you share a concern or complaint, your care will not be affected in any way. The first step is to discuss your concerns with your doctor, nurse or other caregiver. If you have concerns that are not resolved, please contact the office manager or nurse at 580-354-9600.