Text Box: STEVEN M BAGAN, M.D. THOMAS I STRINDEN, M.D. SARAH M SWANHOLM, O.D. PATIENT BILL OF RIGHTS & RESPONSIBILITIES The policy of Steven, M. Bagan, MD, Thomas I Strinden, MD, and Sarah M Swanholm, OD, is to care for all patients with dignity, choice and self-determination. Patients’ rights and responsibilities will be protected and promoted without interference or discrimination. AS A PATIENT, YOU HAVE THE RIGHT TO: Receive considerate and responsible care consistent with acceptable professional standards. Receive accurate and current information regarding the current health status, diagnosis, treatment and prognosis in understandable language. This information may also be provided to a legal guardian or representative on your behalf. Be assured of personal privacy including confidentiality of health information Receive care in a safe setting. Be fully informed of charges related to the care provided prior to or at the appointment time, including any charges for services not covered by insurance. Participate in the planning of your medical treatment and to refuse to participate in experimental research. Review your medical records and have them explained to you within a reasonable amount of time. You have the right to refuse the release of your medical records to an outside facility except as otherwise provided by law or third party payment contract. Receive care free from all forms of abuse or harassment. Discuss any issues or concerns with your doctor or appropriate staff member. Contact your state’s Department of Health: North Dakota Department of Health 600 East Boulevard Avenue Bismarck, ND 58505-02200 1-701-328-2352 AS A PATIENT, YOU HAVE THE RESPONSIBILITY TO: Provide accurate and current information regarding your health and report any changes to your doctor. Ask questions until you clearly understand the proposed medical treatment plan in order to make an informed decision. Follow the agreed upon treatment plan. Respect others’ privacy and property.