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Patient Non-Discrimination Policy

 

Circle Care Center will not discriminate against anyone needing services offered by this institution on the basis of race, color, creed, religion, sex, sexual orientation, gender identity, gender expression, national origin, qualified handicap, or age.

 

Below is your Patient Bill of Rights and Consent to Treat. By continuing to receive care at Circle Care Center, you acknowledge that you have received and reviewed this information.

 

Patient Rights and Consent to Treat

 

Patients have the right to expect their healthcare professional to:

  1. Be professionally competent and adhere to acceptable standards of medical practice.
  2. Treat them with dignity and respect, consistent with professional standards for all patients, regardless of manner of payment, race, sex, age, nationality, religion, disability, or other protected characteristics.
  3. Explain the Patient Management Program and act in their best interest when making medication and/or treatment decisions, including the patient’s right to decline participation, revoke consent, or discontinue care at any time.
  4. Coordinate therapies with the patient and, when appropriate, the patient’s family or other healthcare providers.
  5. Serve as their advocate for accurate and appropriate treatment and make reasonable efforts to recommend alternative treatment options.
  6. Maintain medical records in a confidential manner, use them to support quality care, and make them available for review upon request in accordance with applicable law.
  7. Provide counseling and education appropriate to the patient’s physical, psychological, and intellectual status.
  8. Have their prescriptions dispensed and pharmacy services provided at the pharmacy of their choice in an atmosphere that allows for confidential communication and in an environment that is private, properly lit, well-ventilated, and clean.
  9. Have their drug therapy monitored for safety and effectiveness, including reasonable efforts to prevent adverse reactions, contraindications, or inappropriate dosing.
  10. Be supported in adherence to prescribed therapies, with appropriate interventions when needed.

Consent to Treat

 

I voluntarily consent to receive medical care, treatment, and related services from Circle Care Center and its providers, staff, and designees. This may include, but is not limited to, evaluation, diagnosis, laboratory testing, medication management, and other routine healthcare services.

 

I understand that:

  • I have the right to ask questions about my care and to receive information necessary to make informed decisions.
  • I have the right to refuse any treatment or service and may withdraw my consent at any time, to the extent permitted by law.
  • Refusal of treatment may result in changes to my care plan or outcomes, which have been explained to me as appropriate.

 

If, for some reason, you felt that the service you received was not satisfactory, please fill out our Patient Complaint Form online. You can also call our Compliance Officer, Taylor to discuss your experience at 203-852-9525 x327. If you prefer to fill out a paper copy of the Patient Complaint Form, please send an email to info@whcccc.org to request one.

 

Circle Care Center
c/o Taylor Edelmann
618 West Avenue
Norwalk, CT 06850