We welcome you as a patient to the Samuel U. Rodgers Health Center. It is the policy of Sam Rodgers to inform and notify patients of their rights and responsibilities regarding our health care services.

With your cooperation, we want to help you enjoy the best health possible.

Patient Rights: (Our Responsibility to You)

1. 1. You have the right to refuse treatment.
   2. You have the right to be fully informed of all rules and regulations governing Sam Rodgers’ activities.
   3. You have the right to be informed of all available services at the Sam Rodgers.
   4. You have the right to an explanation about charges for services including third-party payment.
   5. You are entitled to information concerning your medical condition and plan for treatment.
   6. You may refuse to participate in any experimental research.
   7. You have the right to submit complaints and recommend policy changes to Sam Rodgers’ staff and governing body.
   8. You will be informed of the procedure to follow in case of an emergency when Sam Rodgers is closed.
   9. Your records are confidential. You have the right to refuse the release of your medical information except as required by third-party payment contracts.
   10. At all times you are to be treated with respect, consideration, and dignity, including privacy in treatment and personal needs.

Patient Responsibilities: (Your Responsibilities as a Patient)

1. 1. You are responsible for keeping your appointments, or notifying Sam Rodgers 24 hours in advance when unable to do so.
   2. You are obligated to give truthful information.
   3. You are expected to abide by all rules and regulations with regard to patient conduct and responsibilities.
   4. You are responsible for taking medications and treatments as prescribed by your doctor.
   5. You are responsible for paying fees and co-pays according to insurance and sliding fee scales.

For more information, or if you have questions, call (816) 474.4920.