RESOURCES
Patient RESPONSIBILITIES: 1. You are expected to provide complete and accurate information, including your full name, address, home telephone number, date of birth, Social Security number, insurance carrier and employer, when it is required. 2. You should provide the health care facility or your doctor / dentist with a copy of your advance directive if you have one.
3. You are expected to provide complete and accurate information about your health and medical history, including present condition, past illnesses, hospital stays, medicines, vitamins, herbal products, and any other matters that pertain to your health, including perceived safety risks.
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 law and does not discriminate based on race, color, religion, ethnic or national origin, genetic information, age, disability, religion, veteran’ s status or sex( consistent with the scope of sex discrimination described at 45 CFR $§ 92.10( 1)( i)). UAB Medicine does not exclude people or treat them less favorably because of race, color, national origin, age, disability, or sex.
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, other formats).
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 reasonable modifications, appropriate auxiliary aids and services, or language assistance services, contact UAB Guest Services at 205-934-2273.
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 the UAB Medicine Civil Rights / ADA Coordinator in person or by mail, fax, or email using the following contact information:
P. O. Box 55746 Birmingham, AL 35255 Phone: 205.731.9863 Fax: 205-801-8468 Email: UABMedCivilRightsCoord @ uabmc. edu
If you need help filing a grievance, the UAB Medicine Civil Rights / ADA 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, available at https:// 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. 202011 Phone: 800-368-1019, 800-537-7697( TDD)
* Complaint forms are available at hhs. gov / ocr / office / file / index. html.
20 Patient & Visitor Guide