Empowering Your Health Journey

Connect Medical Clinic is committed to providing respectful care while meeting your needs. For this reason, we offer the following summary of your rights as a patient:

• You have a right to considerate and respectful care. 
• Patients have the right to clear and timely information regarding the costs of services, including a Good Faith Estimate when requested, to support informed decision-making and comply with federal and state regulations.
• You have the right to participate in developing your plan of care. 
• You will not be denied access to care due to race, creed, color, national origin, sex, age, sexual orientation, or disability. 
• You have the right to information about your diagnosis, condition, and treatment in terms that you can understand. 
• You are entitled to be free from all forms of abuse or harassment. 
• You have the right to make or have a representative of your choice make informed decisions about your care. 
• You are entitled to be free from any forms of restraint or seclusion as a means of convenience, discipline, coercion, or retaliation. 
• You are entitled to information about the rules and regulations that affect your care or conduct. 
• You have the right to know the names and professional titles of Connect Medical Clinic’s Medical Director and Healthcare Professionals.
• You have the right to change providers if or when other qualified providers are available.  
• You have the right to personal privacy and to receive care in a safe environment. 
• You have the right to be informed about our participation in health information exchange, ask questions about how your information is shared and protected, and request information about available participation options, including opting out where applicable
• You have the right to a prompt and reasonable response to any request for services within the capacity of Connect Medical Clinic’s scope of services. 
• You have the right to express concerns or grievances regarding your care to Connect Medical Clinic’s personnel. 
• You have the right to voice concerns or grievances without fear of retaliation or impact on your care. You may receive physical copies of these forms from the front desk personnel.

• Suggestion Form

• Complaint Form

• Grievance Form

• You have the right to the confidentiality of your medical and personal records.
• You have the right to see your medical record within the limits of the law. 
• You have the right to receive information about your care and your rights in a language you understand, including access to interpretation services when needed.
• You have the right to refuse treatment to the extent permitted by law and to be informed of the consequences of refusal.
• Your Privacy Rights (HIPAA)
• You can ask for a copy of your medical record.*
• You can ask us to correct your medical record.
• You can ask for confidential communication.
• You can ask for limits on sharing certain situations.
• You can request a list of certain disclosures.

If you have questions about your privacy rights, you can request a copy of our Notice of Privacy Practices or contact our Privacy Officer, Audrey Lenz, LPN, at 701-483-9353 ext. 114

 

Patient Responsibilities 

This is a summary of your responsibilities as a patient of Connect Medical Clinic:

• It is your responsibility to provide accurate and complete information about all matters pertaining to your health, including medications and past or present medical problems. 
• Patients are responsible for providing accurate and complete health information and for communicating with clinic staff regarding any questions or concerns about the use or sharing of their health information.
• You are responsible for following the instructions and advice of Connect Medical Clinic’s Care Team. 

• It is your responsibility to notify a member of Connect Medical Clinic’s Care Team if you do not understand information about your care and treatment. 
• You are responsible for reporting changes in your condition or symptoms, including pain, to a Connect Medical Clinic’s Care Team member. 
• You are responsible for acting considerately and cooperatively and for respecting the rights and property of others. 
• You are responsible for complying with Connect Medical Clinic's rules and regulations.
• You are expected to keep your scheduled appointments or, if possible, cancel them in advance. 
• Connect Medical Clinic is an outpatient facility and does not implement advance directives on site. However, patients are welcome to provide a copy of their advance directive, which will be maintained in their medical record. Emergency services will be contacted as needed.

Our Commitment to You

We are committed to protecting the privacy and security of your health information, informing you about health information exchange practices, and honoring applicable participation preferences.

You and your family should feel that you can always voice your concerns. The first step is to discuss your concerns with the healthcare professional on duty. If your concerns are not resolved, please contact Tara Zettel, CEO, at (701) 483-9353. 

If you remain concerned after contacting the CEO, you may contact the 

North Dakota Department of Health at (701) 328-2372 or AAAHC at 847.853.6060.

 

*Connect Medical Clinic does not charge for routine patient requests to access or obtain copies of their own medical records. For large-volume record requests that require mailing, the Clinic may charge postage fees on a case-by-case basis, consistent with HIPAA requirements.