© 2016 Fidelis Health Group. All Rights Reserved.

CLIENT BILL OF RIGHTS AND RESPONSIBILITIES

Attn: Privacy Officer

Fidelis Specialty Pharmacy

5275 Arville Street

Suite 156

Las Vegas, NV 89118

(866) 643-3547

(702) 815-0800

(702) 815-0801

Toll Free:

Phone:

Fax:

Specialty pharmacy clients have the right to be notified in writing of their rights and obligations before any medications are dispensed or any treatment is initiated. Specialty pharmacy providers have an obligation to protect and promote the rights of their clients, including the following rights.

Fidelis Specialty Pharmacy

As a Fidelis Specialty Pharmacy Client, You Have the Right to:

 

• Be treated with dignity, courtesy, respect and fairness without discrimination on the basis of race, color, national origin, age, sex, religion, disability, ancestry, familial status, sexual orientation, gender identity or gender expression.

 

• Receive professional, honest and ethical care in accordance to physician orders

 

• Be fully informed of the pharmacy’s services, limitations of services and care, what to do in the event of an emergency, and the process for receiving, reviewing and resolving complaints or concerns.

 

• Receive complete explanations of charges for medications, services and equipment, including eligibility for third-party reimbursement and an explanation of all forms you are requested to sign.

 

• Receive medication and services from qualified personnel and to receive instructions on self care, safe and effective operation of equipment and your responsibilities regarding medications, home care equipment and services, including pain and pain management modalities,

 

• Participate in decisions concerning the nature and purpose of any technical procedure which may be performed and who will perform it, the possible alternatives and/or risks involved and your right to refuse all or part of the services and to be informed of expected consequences of any such action.

 

• Confidentiality of all your records (except as otherwise provided for by law or third-party payer contracts) and to review and even challenge those records and to have your records corrected for accuracy.

 

• Express dissatisfaction, file a complaint, or suggest changes in any service without discrimination, reprisal or unreasonable interruption of services.

 

• Be advised of any change in your plan of care before the change is made.

 

• Participate in the planning of your care and in planning changes to your care, and to be advised that you have the right to do so.

 

• Accept or refuse medical treatment while competent, and to make decisions about care/services to be received should you lose competency.

 

• Request oral consultation from a pharmacist, or speak with a pharmacist about any questions or concerns about your medications or plan of care.

 

• Receive a copy of the Medicare DMEPOS Supplier Standards & “Medicare Prescription Drug Coverage and your Rights” for Medicare recipients of services.

 

• Be informed within a reasonable amount of time of anticipated termination of service or plans for transfer to another pharmacy provider

 

• Be advised that the telephone number for the Nevada State Board of Pharmacy is (775) 850-1440, toll-free (800) 364-2081.

 

• Be assisted and receive special consideration for language barriers to achieve proper understanding of services provided.

 

 

As a Fidelis Specialty Pharmacy Client, You Have the Responsibility to:

 

• Adhere to the plan of treatment or service established by your prescriber.

 

•  Participate in the development of an effective plan for your care.

 

•  Provide medical and personal information necessary to plan and provide services.

 

•  Communicate any information, concerns and/or questions related to pain.

 

•  Be available at the time deliveries are made and to allow staff to enter your residence at reasonable times to provide prescribed/needed care.

 

•  Notify the company if you are going to be unavailable.

 

•  Treat company personnel with respect and dignity, and without discrimination.

 

•  Provide a safe environment if staff is required to provide care and services at your residence.

 

•  Care for and safely use equipment, according to instructions provided, for the purpose it was prescribed and only for you.

 

•  Monitor the quantity of medications and supplies in your home and reorder as required to assure timely delivery of the required items.

 

•  Protect medication and equipment from fire, water, theft or other damage.

 

•  Prevent transfer to, or allow your medication or equipment to be used by any other person, and further agrees not to modify or attempt to make repairs to any kind to equipment.

 

•  Notify the company of any pertinent changes (e.g. discontinuation of medicine/treatment, changes made by your prescriber, hospitalization, insurance coverage changes),

 

•  Notify the company immediately of any address or telephone changes whether temporary or permanent.