Patient RESPONSIBILITIES , continued :
4 . You are expected to ask questions when you do not understand information or instructions . If you believe you can ’ t follow through with your treatment plan , you are responsible for telling your doctor / dentist . You are responsible for outcomes if you do not follow the care , treatment , and services plan .
5 . You are expected to actively participate in your pain management plan and to keep your doctors / dentist and nurses informed of the effectiveness of your treatment . 6 . Please leave valuables at home and only bring necessary items . 7 . You are expected to treat all staff , other patients and visitors with courtesy and respect ; abide by all UAB rules and safety regulations ; and be mindful of noise levels , privacy and number of visitors . 8 . You are expected to provide complete and accurate information about your health insurance coverage and to pay your bills in a timely manner . 9 . You are expected to keep appointments , be on time for appointments , and to call your health care provider if you cannot keep your appointments .
* This information is available for the sight-impaired and in Spanish .
NONDISCRIMINATION AND LANGUAGE ACCESSIBILITY NOTICE
UAB Medicine complies with applicable federal civil rights laws and does not discriminate on the basis of race , color , national origin , age , disability , or sex . UAB Medicine does not exclude people or treat them differently because of age , gender , race , religion , culture , language , disabilities , socioeconomic status , sexual orientation , or gender identity or expression .
UAB Medicine provides free aids and services to people with disabilities to communicate effectively with us , such as :
• Qualified sign language interpreters
• Written information in other formats ( large print , audio , accessible electronic formats , etc .)
We also provide free language services to people whose primary language is not English , such as :
• Qualified interpreters
• Information written in other languages
If you need any of these services , please let the person scheduling your appointment know about the assistance you need , or contact Guest Services to request assistance from a patient advocate by dialing * 55 from an in-house phone or 205.934 . CARE ( 2273 ).
If you believe that UAB Medicine has failed to provide these services or discriminated in another way on the basis of race , color , national origin , age , disability , or sex , you can file a grievance with UAB Medicine ’ s Civil Rights Coordinator :
500 22nd Street South , Suite 504 Birmingham , AL 35233 Phone : 205.731.9863 Fax : 205.731.9253 Email : UABMedCivilRightsCoord @ uabmc . edu
You can file a grievance in person or by mail , fax , or email . If you need help filing a grievance , UAB Medicine ’ s Civil Rights Coordinator is available to help you . You can also file a civil rights complaint with the U . S . Department of Health and Human Services , Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal , located online at ocrportal . hhs . gov / ocr / portal / lobby . jsf , or by mail or phone at :
U . S . Department of Health and Human Services 200 Independence Avenue , SW Room 509F , HHH Building Washington , D . C . 20201 1.800.368.1019 , TDD : 1.800.537.7697
* Complaint forms are available at hhs . gov / ocr / office / file / index . html .
18 Patient & Visitor Guide