Patient Rights  |  Patient Responsibilities  |  Concerns  |  Utilization Management Service and Coverage

Patient Rights

All patients of Camino Medical Group have the right to:

• Considerate and respectful care.
  
• Know the names and titles of all who provide their care.
  
• Information regarding their diagnosis, evaluation, treatment and prospects for recovery in terms they can understand.
  
• Information about any proposed treatment or procedure in order to give informed consent, understanding the risks and advantages of each.
  
• Participate actively in decisions involving their health care.
  
• Request or refuse treatment, to the extent permitted by law. However, patients do not have the right to demand inappropriate or medically unnecessary treatment or services.
  
• Access and obtain copies of their medical records.
  
• Receive notice of privacy practices.
  
• Request amendment of personal health information.
  
• Request restrictions on the use and disclosure of protected health information.
  
• Request an accounting of disclosures of their protected health information, as required by HIPAA.
  
• File a privacy complaint.
  
• Agree or object to use and disclosure of confidential protected health information. Information about their health, including medical records, shall not be made available without their written permission to anyone except those directly concerned with the care, except as required by law.
  
• Know if their physician proposes to involve them in clinical experimental research, and to refuse participation in such research projects.
  
• Examine and receive an explanation of their bill for service, regardless of the source of payment.
  
• Voice concerns and make suggestions regarding the organization or the care provided.
  
• Change primary care or specialty physicians if other qualified physicians are available.
  
• Information about the services offered by the medical group and the qualifications of its providers.
  
• Have their rights extended to the person who has legal responsibility to make decisions regarding medical care on their behalf.

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Patient Responsibilities

• Patients have the responsibility to provide accurate and complete information about present symptoms, past illnesses, hospitalizations, medications, and other matters related to their health. They have the responsibility to report unexpected changes in condition to the responsible practitioner. Patients are also responsible for reporting whether they clearly understand a contemplated course of action and what is expected of them.
  
• Patients have the responsibility to engage in behaviors which promote their own health, such as good nutrition, appropriate physical activity, and health risk avoidance, and to seek periodic health screening evaluations as recommended by their care provider.
  
• Patients are responsible for following the treatment plan agreed upon with the health care providers responsible for their care. Patients are responsible for keeping appointments, and when unable to do so, for notifying the provider's receptionist as far in advance as possible.
  
• Patients are responsible for cooperating with medical group policies and procedures regarding patient care and conduct.
  
• Patients are responsible for ensuring that the financial obligations of their medical care are fulfilled as promptly as possible.
  
• Patients have the responsibility to treat all providers and staff and other patients with courtesy and respect.

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Concerns

If you are having a problem with CMG services that front-line staff are unable to resolve, always ask to speak to a supervisor or manager of the department involved. If your problem is not resolved to your satisfaction, you may contact our Quality Improvement Department at 650-934-7202 or 650-934-7203.

If you are having a problem with your medical care or doctor that cannot be resolved, please check with your health plan. Most HMOs require that you file your concern with them first. They will then work with the clinic to resolve your issue. Otherwise, you may contact the CMG Quality Improvement Department at 650-934-7202 or 650-934-7203. The CMG Quality Improvement Department is open from 8 a.m. to 5 p.m. and all calls will be returned within 24 hours, excluding weekends.
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Utilization Management Service and Coverage

Managed Care Ensures Appropriate Utilization Management Service and Coverage

In accordance with National Committee on Quality Assurance (NCQA) standards:

• Palo Alto Medical Foundation (PAMF) employees and Palo Alto Foundation Medical Group (PAFMG) physicians who make utilization related decisions, and those who supervise them, ensure decisions are based only on appropriateness of care and service. Economic profiling is not used.
  
• PAFMG does not specifically reward practitioners or other individuals conducting utilization review for issuing denials of coverage or service or encourage decisions that result in underutilization.
  
• Compensation plans for individuals who provide utilization review services do not contain direct or indirect incentives, financial or other, for these individuals to make inappropriate review decisions.
  
• Members have the right to independent, external review of final determinations.
  
• Members or their legal guardians may designate, in writing, a representative to act on their behalf.
  
• Members, practitioners and the public have the right to request clinical criteria, including requests for emerging and current technologies, devices, medical procedures, and techniques, or to discuss denial decisions and/or UM issues with appropriate practitioners.

Members, practitioners and the public should direct all requests either in writing or by telephone to:

Palo Alto Medical Foundation Managed Care Department
2350 West El Camino Real
Mountain View, CA 9494040
408-523-3133
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