ALPHASCRIPT BILL OF PATIENT RIGHTS AND RESPONSIBILITIES

As our customer, you are hereby provided this Bill of Rights.  You have the right to be notified in writing of your rights and obligations before treatment has begun.  A patient’s family or guardian may exercise the patient’s rights when the patient has been judged incompetent.  We fulfill our obligation to protect and promote your rights, including the following:

1.1    Rights as the patient/caregiver    

1.1        Rights as the patient/caregiver

You have the RIGHT to:

•       Be notified in writing of your rights before treatment has begun;

•       Be treated with dignity and respect;

•       Confidentiality of your patient records and information regarding your care;

•       Be provided service in a timely manner;

•       Receive an itemized explanation of charges;

•       Express grievance without fear of reprisal or discrimination;

•       Be informed of potential reimbursement for services under Medicare, Medicaid or other third party insurers based on your condition and insurance eligibility (to the best of Alphascript’s knowledge);

•       Be notified of financial responsibility for products or services not fully reimbursed by Medicare, Medicaid or other third party insurers (to the best of Alphascript’s knowledge);

•       Receive essential information in a language or method of communication that you understand;

•       Have your cultural, spiritual and personal values, beliefs and preferences respected;

•       Know about Alphascript’s philosophy and characteristics of its patient management program;

•       Have personal health information shared with the patient management program only in accordance with state and federal law;

•       Identify the program's staff members, including their job title, and to speak with a staff member's supervisor if requested;

•       Speak with a health professional;

•       Receive information about Alphascript’s patient management program;

•       Receive administrative information regarding changes in, or termination of, the patient management program; and

•       Decline participation, revoke consent, or disenroll at any point in time.

11.21Responsibilities as the patient/ caregiver

1.2     Responsibilities as the patient/ caregiver

You are RESPONSIBLE for: 

•       Notifying the pharmacy of change of address, phone number or insurance status

•       Notifying the pharmacy of any change in condition, physician orders or physician

•       Meeting the financial obligations of your health care as set forth by Medicare or your insurance

•       Providing accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other matters pertinent to your health

•       Your actions if you do not follow the plan of care/treatment

•       Treating Alphascript’s staff members with respect

•       Asking questions about your care/treatment

•       Submitting any forms that are necessary to participate in the program, to the extent required by law

•       Giving accurate clinical and contact information and notifying the patient management program of changes in this information; and

•       Notifying your treating provider of your participation in Alphascript’s patient management program, if applicable.

1.3        Alphascript Specialty Pharmacy Rights

1.3   Alphascript Specialty Pharmacy Rights   

Alphascript Specialty Pharmacy has the RIGHT to:

•       Terminate services to anyone who knowingly furnishes incorrect information to secure medication or equipment;

•       Refuse services to anyone who enters our pharmacy and is threatening, intoxicated by alcohol, drugs, and/or chemical substances and could potentially endanger our staff and patients; and

•       Refuse to provide services if, in our clinical judgment, the services are medically harmful or inappropriate.

1.4      Emergency Preparedness

1.4   Emergency Preparedness

Alphascript Specialty Pharmacy has a comprehensive emergency preparedness plan in case a disaster occurs.

Our primary goal is to continue to serve your health care needs. If a disaster occurs, follow instructions from the civil authorities in your area. Alphascript Specialty Pharmacy will use every resource reasonably available to continue service to you during emergency situations.  However, there may be circumstances where Alphascript Specialty Pharmacy cannot meet your needs due to the scope of the disaster.  In that case, you must utilize the resources of your local rescue or medical facility.  Alphascript Specialty Pharmacy will work closely with authorities to ensure your safety.

 

1.5      After Hours Services

1.5   After Hours Services

The after-hours phone number is (800) 780-3584

 

1.6      Complaint Procedure

1.6  Complaint Procedure

You have the right and responsibility to express concerns, dissatisfaction, or make complaints about services you do or do not receive without fear of reprisal, discrimination or unreasonable interruption of services. Alphascript Specialty Pharmacy has a formal grievance policy that ensures your concerns will be reviewed and an investigation started within 24 business hours. The telephone number is 800-780-3584. You can submit comments online via e-mail contact@alphascriptrx.com.  For your privacy protection, please do not include confidential health details when sending an email.

 

You may also write us at:

Alphascript Specialty Pharmacy

Attention: Customer Relations Department

1160 Industrial Rd. #17

San Carlos, CA 94070