Patient Rights & Responsibilities

We improve the health status of the medically underserved by providing extraordinary service.

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As a patient of The Brevard Health Alliance (BHA) medical clinics, I have both rights and responsibilities.

My RIGHTS are:

  1. I have the right to be respected and supported.
  2. I have the right to be informed about and involved in all aspects of my health care.
  3. I have the right to complete confidentiality regarding my medical records.
  4. I have the right to care that is considerate and respectful of my personal beliefs and values.
  5. I have the right to select or change to any qualified provider that works for BHA.

My RESPONSIBILITIES are:

  1. I have the responsibility to report all of my significant health-related conditions that may be relevant to the ability of BHA providers to provide effective patient care.
  2. I have the responsibility to truthfully and accurately report earning, assets, and the insurance status (including Medicaid or Medicare eligibility) of everyone living in my household.
  3. I have the responsibility to attend all scheduled appointments and comply with all treatments, referrals, and follow-up recommendations of my healthcare providers.
  4. I have the responsibility to behave appropriately towards all BHA staff members.
  5. I have the responsibility to notify my healthcare providers of any changes in my condition that may necessitate a change in my treatment plan.
  6. I have the responsibility to contact the clinic at least 1 (one) week prior to running out of medication which is provided through the assistance of BHA. Please do not “walk in” for medication refills.
  7. I have the responsibility to supply the required documentation needed to receive medication assistance.

I have read and fully understand all of my rights and responsibilities and agree to comply with the requirements of BHA.

Patient Rights &
Responsibilities Form

This is a downloadable copy of the content that is written above.

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Florida Patient
Rights & Responsibilities

This the Rights and Responsibilities of the patient according to the state of Florida.

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CONTACT US

If this is a medical emergency please do not use this form to reach out to us, and instead please call 911.
This form is for general inquires only. It can take up to 72 hours to respond to questions submitted here.

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