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 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.
20 Patient & Visitor Guide