Patient Rights & Responsibilities

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


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.


  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.


Florida Patient
Rights & Responsibilities

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



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