Patient Rights and Responsibilities

Patient Rights and Responsibilities

SimonMed Imaging is committed to providing quality and cost-effective imaging services. As a patient of SimonMed Imaging, you have certain rights and responsibilities. It is important that you understand them.

You have the Right:

  • To be treated with dignity, courtesy and respect. Not to be discriminated against based on race, national origin, religion, sex, gender, sexual orientation, age, disability, color, ancestry, medical condition, marital status, genetic information, source of payment or diagnosis.
  • A patient will not be subject to abuse, neglect, harassment, exploitation, coercion, manipulation, sexual abuse, sexual assault, retaliation or misappropriation of personal or private property.
  • To receive assistance in a prompt, courteous and responsible manner.
  • To receive assistance from a family member, your representative, or other individual in understanding, protecting, or exercising your rights.
  • To receive treatment that supports and respects your privacy, individuality, choices, strengths and abilities.
  • To confidential handling of all communications and medical information maintained at SimonMed Imaging, as provided by law and medical ethics. Your written permission will always be required for SimonMed Imaging’s release of Private Health Information (PHI) except when:

- Health professionals providing for your care request clinical information.

- SimonMed Imaging is legally obligated to release PHI.

- SimonMed Imaging prepares and releases information in the form of statistical summaries that do not identify individuals.

- Information is necessary to support or facilitate claims payment, utilization management or quality management.

  • To know who is providing medical services and who is responsible for your care at SimonMed Imaging.
  • To be informed by SimonMed Imaging healthcare professionals about your health status, diagnosis, any treatment/services you may receive, alternatives, risks, and prognosis (unless medically inadvisable), in terms you understand. Your health care professional should request your informed consent for all treatment, unless there is an emergency and your life and health are in serious danger.
  • To participate or have the patient’s representative participate in the development of, or decisions concerning, treatment.
  • To know what rules and regulations apply to your conduct.
  • To know if medical treatment is for purposes of experimental research and to participate or refuse to participate in such research or experimental treatment.
  • To review and request amendment(s) to your own medical record according to applicable state law.
  • To refuse treatment/services, except as otherwise provided by law, and be advised of the possible consequences of your decision by SimonMed Imaging health care professionals. We encourage you to discuss your objection with your referring physician before scheduling with SimonMed Imaging. He or she will advise and discuss alternative treatment plans with you, but you will have the final decision regarding your health care.
  • To receive reasonable requested accommodation, auxiliary aids or services, or assistance to access radiological services and equipment based on a disability.
  • To receive a referral to another health care institution if the outpatient treatment center is not authorized or not able to provide necessary physical or behavioral health services needed by the patient.
  • To express a complaint about SimonMed Imaging and/or the quality of care you have received and to receive a response in a timely manner.
  • To initiate the grievance procedure if you are not satisfied with services by contacting the SimonMed Imaging Operations Department at (602) 688-6116, the Arizona Department of Health at (602) 364-3030, or ACR at (703) 648-8900.
  • To be provided with information pertaining to your financial responsibility for all services rendered, including, upon request, prior to treatment, a reasonable estimate of charges for medical care.
  • If you are eligible for Medicare, to know, upon request and in advance of treatment, whether SimonMed Imaging accepts the Medicare assignment rate for your proposed treatment.
  • To be given, upon request, full information and necessary counseling on the availability of known financial resources for your care,
  • To receive a copy of a reasonably clear and understandable itemized bill and, upon request, to have the charges explained.

You have the Responsibility:

  • To provide, to the best of your knowledge, accurate, up-to-date and complete information about present complaints, past illnesses, hospitalizations, medications, allergies and other matters relating to your health to your SimonMed Imaging healthcare provider.
  • To report unexpected changes in your condition to your SimonMed Imaging healthcare provider.
  • To ask questions when you do not understand information or instructions.
  • To express your opinions, concerns or complaints in a constructive manner to the appropriate people within SimonMed Imaging as they arise.
  • To make it known whether or not you understand the care and diagnostic tests to be performed and what is expected of you, and take an active role in your treatment by being informed and prepared, clearly communicating your wants and needs, and adhering to any pre- and post-procedure instructions and the treatment plan given to you by a SimonMed Imaging healthcare provider.
  • To keep scheduled appointments or notify SimonMed Imaging if you will be delayed as soon as reasonably possible; or, if unable to keep scheduled appointments, notify the office 24 hours in advance.
  • To learn how to access information pertaining to your health care coverage.
  • To inform SimonMed Imaging about any living will, medical power of attorney, or other directive that may affect your care.
  • To follow healthcare facility rules and regulations affecting patient care and conduct and behave in a manner that is not disruptive to the delivery of healthcare or to yourself or others.
  • To take full responsibility for your actions and the consequences of your decisions if you refuse treatment or do not follow your SimonMed healthcare provider's instructions.
  • To verify with your insurance company whether SimonMed Imaging participates with their insurance plan and if you have deductibles and/or co-pays.
  • To present your insurance card and proper identification prior to receiving services.
  • To pay all charges, if any, for appointments and non-covered services at the time service is rendered.
  • To accept personal financial responsibility for any charges not covered by your insurance and assure that your financial obligations in connection with your health care are fulfilled as promptly as possible.

If at any time you have questions or concerns regarding your Rights and Responsibilities, please contact the SimonMed Imaging Operations Department at (602) 688-6116.

Why Choose Us

SimonMed Imaging and its affiliates have been serving the community for over 30 years. Our mission is to provide best-in class affordable care through the use of advanced technology. We have patient-focused staff and highly trained medical professionals.

SimonMed has over 75 convenient locations and provides late night and weekend appointments to accommodate patients.

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