Patient’s Rights and Responsibilities
Date of Last Revision: May 31, 2018
In accordance with Federal and California State laws, customers of Clarify Medical have the following Rights and Responsibilities:
Clarify customers have the right to:
- Be fully informed in advance about the product and service Clarify Medical provides. (DRX2-1A)
- Be informed, in advance both orally and in writing of the details of the Clarify device and CarePartner support, of the charges, including payment for the device from third parties and any charges for which you will be responsible. (DRX3-4B)
- Receive information about the scope of services that Clarify Medical will provide and specific limitations on those services. (DRX2-1A)
- Refuse care or treatment after the consequences of refusing care or treatment are fully presented (DRX2-6A)
- Have your property and person treated with respect, consideration, and recognition of your dignity and individuality (DRX2-2B)
- Be able to identify communication from Clarify personnel through proper identification via email, text or telephone. (DRX2-2B)
- Be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of your property. (DRX2-3A)
- Voice grievances/complaints regarding treatment or care or lack of respect of property, or recommend changes in policy, personnel, or care/service without restraint, interference, coercion, discrimination, or reprisal (DRX2-4A)
- Have grievances/complaints regarding your treatment that is (or fails to be) furnished, or lack of respect of property investigated. (DRX2-4A)
- Be advised on the agency’s policies and procedures regarding the disclosure of clinical records (DRX2-5A)
- Choose your healthcare provider (DRX2-2B)
- Receive appropriate support without discrimination in accordance with physician’s orders (DRX2-2B)
- Be fully informed of your responsibilities (DRX2-2B)
- Exercise these rights without regard to sex or cultural, economic, educational or religious background or the source of payment for your care.
- Considerate and respectful care.
- Receive information about your treatment.
- Stop using the Clarify Device if you choose.
- Have all patient rights apply to the person who may have legal responsibility to make decisions regarding medical care on behalf of the patient.
- Voice grievances/complaints regarding treatment or care or lack of respect of your property, or recommend changes in policy, personnel, or care/service without restraint, interference, coercion, discrimination, or reprisal. by calling Clarify Medical, Inc. (916) 443-3299 ext. 6290 or in writing to: (DRX2-4C)
Clarify Medical, Inc.
401 W A street, Suite 950
San Diego, California 92101
- File a complaint with the state Department of Health Services, regardless of whether you use Clarify Medical grievance process by calling (800) 554-0354 or writing to the department at: (DRX2-4C)
California Department of Public Health Services
2000 Evergreen St., Suite 210
Sacramento, CA 95815
- Have all Clarify personnel observe these DRX2-2B
While you are using Clarify Medical’s Device for Treatment, you are responsible for:
- Call 911 in the event of an Emergency.
- Clarify Medical CarePartners will only help you with your treatment, they do not practice medicine. Refer to your physician for medical advice.
- Choosing your doctor and scheduling and attending follow up appointments
- Downloading and Installing the Clarify Medical App on their Android or iOS mobile phone
- Responding to Clarify Medical CarePartners through the App regarding treatment observations, guidance and suggestions
- Understanding that you are responsible for attending follow-up appointments with your doctor as specified by your doctor and if you do not attend follow-up appointments, your Clarify device will no longer work after the treatment duration has expired.
- Using the Clarify Device in accordance with the Patient guide and training provided by Clarify Medical.
- Reporting any unexpected changes in your condition to your doctor.
- Following the treatment plan recommended by your doctor. This includes responsibility for keeping your appointments and for notifying your provider if you are unable to do so.
- Assuring that the financial obligations of your care are fulfilled promptly.
- Following Clarify instructions for proper care, charging, cleaning and operation of the Clarify Device.