Please review the following information:

1. No person shall be denied primary health care services because of age, sex, race, color, creed, national origin, religion, or sexual preference.

2. No person shall be denied health care services due to his/her inability to pay for services. However, patients may be denied services due to refusal to pay their assigned cost or for violation for the Code of Conduct.


3. The patient has the right to be informed of his/her medical condition and the right to agree to or refuse treatment.


4. The patient has the legal right to confidential treatment of records and disclosures and has the opportunity to authorize or refuse the release of his/her records unless required by law.


5. The patient has the right to be treated with consideration, respect, dignity and recognition of individuality, including privacy and care for personal needs.


6. The patient has the right to be informed in advance of all financial charges for services and, if agreeable to the service, is responsible financially for charges incurred.


7. The patient is responsible for keeping appointments on time, and if unable to keep the appointment, to notify the center in advance.


8. The patient has the right to truthful, accurate information and is responsible for giving truthful information.


9. The patient is expected to abide by the health center’s Code of Conduct. If the patient is abusive or violent towards anyone on the health center premises or connected with the health center, the patient code of conduct will be reviewed between the patient and the provider. If the patient continues with violent, aggressive or disruptive conduct, the health center reserves the right to refuse service to the patient and to contact law enforcement as needed.


10. The patient may voice grievances and recommend changes in policies and services of the center verbally and/or on a written complaint form, first to the Department Supervisor or the Executive Director. Each complaint will be reviewed and investigated. Resolution of the complaint will be addressed to all parties involved and will not become a part of a patient’s permanent record.

11. The patient may express grievances to the Department of Health Services, Licensing and Certification, Redwood Coast District Office, 2170 Northpoint Parkway, Santa Rosa, CA 95407. Phone: (707) 576-6775. Toll Free (866) 784-0703. Fax (707) 576-2037.