Patient Privacy and Rights
Your privacy is very important to us. Your records and your health information are confidential. We strictly adhere to the HIPAA (Health Insurance Portability & Accountability Act) regulations. All patient records are stored in a secure database. Only you and your care team can access your health records.
If you want another family member to have access, you must complete a release form which can be found here for adults and here for children.
Rights and Responsibilities
Shoreline Family Health Care believes that every patient in our care should be treated with dignity, respect and compassion. We recognize that all patients have basic rights, and we are committed to honoring these rights. As a trusted member of your care team, we also recognize that responsibilities for good health are shared between providers and patients.
Please take a few moments to familiarize yourself with the ways listed below that will help make your health care experience the best it can be.
As a patient of Shoreline Family Health Care, you are protected by the following guidelines. Click on the links below for downloadable copies. (Please note, Shoreline Family Health Care is operated by Fair Haven Community Health Clinic, Inc and follows all Fair Haven Community Health Clinic, Inc. policies and procedures.)
- Nondiscrimination Statement / Declaracion de No Discriminacion
- Affordable Care Act Grievance Procedure / Ley de Atencion Asequible
- Compliance and Ethics Program
- Language Help
You can also choose direct and confidential communication:
- Corporate Compliance Officer: Robyn Hoffmann, 203.752.5198
- Director of Practice Transformation & Accreditation: Rose Pudlin, 203.752.5111 or email@example.com
- For anonymous reporting, you may call Fair Haven Community Health Clinic, Inc.’s Corporate Compliance Hotline at 203.974.0123.
As a patient of Shoreline Family Health Care, you have the right to:
Access to Care
- Accessible care that is available or medically indicated regardless of race, creed, gender, national origin, cultural or spiritual values, disability, sexual orientation or ability to pay. This includes all scheduled and walk-in patients.
- Obtain, from the providers responsible for coordinating and providing your care, complete and current information about outcomes of care, diagnosis (to the degree known), treatment, alternatives, risks or unanticipated outcomes of care and any known prognosis, so that you can participate in decisions about your care.
- Be involved in making decisions about your care and services, and to include a family member or partner in decision-making about your care, treatment or service decisions to the extent permitted by law and regulations.
- Choose your medical provider, and to know the name and position of the provider(s) who are responsible for your care, treatment or services.
- You have the right to obtain care from other clinicians within the primary care medical home, to seek a second opinion, and to seek specialty care.
- Be given information in terms you can understand. When it is not medically advisable to give you such information, it should be made available to your legal representative.
- Have an interpreter if you don’t speak English or are hearing impaired. Accommodations can be made for patients with hearing, speech, visual and cognitive impairments by requesting these services at the time the appointment is made.
- Receive the necessary information to participate in decisions about your care and to give your informed consent before any treatment or procedure is performed.
- Be free from all forms of abuse or harassment and have access to protective and advocacy services.
- Have care provided in a safe setting. Everyone has a role in making health care safe, including providers, healthcare executives, nurses and technicians. You play a vital role in making your care safe by becoming an active, involved and informed member of your healthcare team. Please make your health care providers aware of any concerns you have.
- Tell someone about your pain and receive a care plan for how to address your pain.
- Expect that your personal privacy, within the law, will be respected and maintained by all staff as demonstrated by the following rights: To be interviewed and examined in surroundings designed to assure reasonable visual and auditory privacy; to request to have another person present during certain parts of a physical examination, treatment or procedure performed by a health professional of any sex; and to expect that any discussion or consultation involving your care will be conducted discreetly.
- Refuse treatment to the extent permitted by law. When refusal of treatment by you or your legal representative prevents the provision of appropriate care in accordance with professional standards, our relationship with you may be terminated upon reasonable notice.
Medical Records Privacy and Access
- Expect that your medical records will be kept confidential and will be released only with your written consent, in cases of medical emergencies, or in response to court-ordered subpoenas. Confidentiality can also be violated if the individual poses a significant threat or harm to self or others.
- Access, request amendment to, and obtain information on disclosures of your health information, in accordance with law and regulations.
- Receive a copy of a reasonably clear and understandable itemized bill and have the charges explained upon request even if they are covered by insurance.
- Receive information about advance directives. Advance directives ensure that your wishes, in written or oral form, are carried out.
As a patient of Shoreline Family Health Care, you are an integral part of the healthcare team. Therefore, you are responsible for:
Participating in the teaching/learning process so that you will acquire and understand the skills and behaviors that promote recovery, maintain or improve function, or manage disease or symptom progression.
Keeping appointments and for notifying Shoreline Family Health Care when you are unable to do so.
Following the treatment plan recommended by the practitioner primarily responsible for your care.
Providing accurate information about your past medical, mental health, and social history including informing us about any other healthcare provider(s) currently participating in your care.
Asking questions if you do not understand the explanation of your diagnosis, treatment, prognosis, or any instructions.
Medical Record Accuracy
Providing the necessary personal information to complete your file, including but not limited to address changes, household information or financial status.
Rules and Regulations
Following any rules and regulations that are posted for your safety.
Not engaging in verbal or physical threats to self and others and not bringing weapons to the care center.
You are responsible for paying any charges billed to you, or for making other arrangements with our staff.
Becoming a partner in your healthcare by complying with medical treatment and instructions.
Respect and consideration
Being considerate of the rights of other patients and staff. This includes not smoking in any form and controlling noise. You are responsible for being respectful of the property of Shoreline Family Health Care. You understand that any abusive or disrespectful behavior could result in your dismissal.
If you have a concern about any aspect of your care at Shoreline Family Health Care, you are urged to let us know so we can resolve it promptly. This reporting will in no way negatively impact future care. To address concerns, please contact the administrator or nurse manager on call. Please ask a patient representative to connect you with any of these individuals.
If you would like to make a complaint to Shoreline Family Health Care, state or an outside agency, you may contact the following:
Fair Haven Community Health Care
(203) 777-7411, x5113 or firstname.lastname@example.org
One Renaissance Blvd.
Oakbrook Terrace, IL 60181
Connecticut Department of Insurance
Agency for Health Care Administration
Consumer Services Unit
You can download a copy here in Spanish or here in English.
Shoreline Family Health Care is operated by Fair Haven Community Health Care, Inc.