The Website Services (or any portion of the Website Services) and all of the Content (excluding your User Content) including, text, graphics, logos, button icons, photos, images, forms, audio, video, questionnaires, "look and feel" and software, is the property of us or our licensors, and are protected by the United States and international copyright laws. Except as provided in the next paragraph, you are expressly prohibited from reproducing, duplicating, copying, publishing, selling or otherwise exploiting for any commercial purpose the Content, in whole or in part, for any reason, unless prior written consent is obtained from the copyright holder(s). Copyright 2018. All rights reserved for all countries.
You may use and view the Content for your personal use only, provided that such view and use is either within the Website Services or by manually downloading or printing the Content. Any automated process or use of a bot for this purpose is strictly prohibited. Unless expressly authorized in writing by us, any other use of the Content, other than your User Content, is explicitly forbidden. Otherwise, permission to reprint or electronically reproduce any document or graphic in whole or in part for any reason is expressly prohibited, unless prior written consent is obtained from the copyright holder(s). We reserve any rights not explicitly granted in these terms and conditions or any applicable end-user license agreements.
Trademarks and Service Marks
The names, words, symbols, and graphics representing QT Centers LLC, names of our facilities, names of specific services and service lines, and any other trademarks so indicated are our trademarks and are protected by trademark laws of the United States and other countries. Additional proprietary information may be designated through use of the TM, SM, or symbols. You may not use any of our logos or trademarks for any purpose, including, but not limited to, as metatags or in any other fashion which may create a false or misleading impression of affiliation or sponsorship with or by us.
Limited license to Use Website Services and Prohibited Conduct
We grant you a limited, revocable, nontransferable and non-exclusive license to access and make personal use of the Website Services and the Content. This limited, revocable license does not include the right to:
- any use of the Content for the benefit of a third party or personal financial gain, except as the Website Services contemplated by this TOS;
- any derivative use of the Website Services or the Content;
- any transmission or provision of any content from the Website Services to a third party, except as expressly provided by these terms and conditions;
- any incorporation of the Content from the Website Services in a product designed, developed, marketed, sold or licensed by you or on your behalf;
- any use of data mining, robots, or similar data gathering and extraction tools; or
- any use of the Website Services in a manner contrary to any applicable law.
Any unauthorized use of the Website Services, the Content or the trademarks automatically terminates the licenses granted by you in this TOS. We reserve the right to block access, refuse services or remove or edit Content in connection with the Website Services.
THE WEBSITE SERVICES AND ALL INFORMATION, CONTENT, MATERIALS, PRODUCTS (INCLUDING SOFTWARE) AND SERVICES INCLUDED ON OR OTHERWISE MADE AVAILABLE TO YOU THROUGH THE WEBSITE SERVICES (INCLUDING HYPERLINKED WEBSITES), ARE BEING PROVIDED ON AN "AS IS" AND "AS AVAILABLE" BASIS. NEITHER WE NOR ANY OTHER PERSON OR ENTITY MAKES ANY REPRESENTATIONS OR WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, AS TO THE OPERATION OF THE WEBSITE SERVICES OR THE INFORMATION, CONTENT, MATERIALS, PRODUCTS, (INCLUDING SOFTWARE) OR SERVICES INCLUDED ON OR OTHERWISE MADE AVAILABLE TO YOU THROUGH THE WEBSITE SERVICES (INCLUDING HYPERLINKED WEBSITES).
TO THE FULLEST EXTENT PERMISSIBLE BY APPLICABLE LAW, WE DISCLAIM ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NON-INFRINGEMENT.
NO ORAL OR WRITTEN INFORMATION OR ADVICE CONTAINED IN THE SERVICES OR GIVEN BY US OR ANY OTHER PERSON OR ENTITY (INCLUDING, WITHOUT LIMITATION, OUR EMPLOYEES, AND REPRESENTATIVES) SHALL CREATE A WARRANTY NOR IN ANY WAY INCREASE THE SCOPE OF THIS WARRANTY.
WITHOUT LIMITING THE PRECEDING, NO REPRESENTATIONS OR WARRANTIES ARE MADE REGARDING THE FOLLOWING:
- The accuracy, reliability, completeness, or timeliness of Content, software, text, graphics, links, or communications provided on or through the use of the Website Services.
- The satisfaction of any government regulations requiring disclosure of information on prescription drug products or the approval or compliance of any software tools concerning the content contained on the Website Services.
- We do not warrant that the Website Services, Content, products (including software) or services included on or otherwise made available to you through the Website Services (including hyperlinked websites), their servers or electronic communications sent from us are free of viruses, worms, trojan horses or any other harmful components. You are responsible for backing up your data on your computer hard drives so that you can reconstruct any lost information.
CERTAIN STATE LAWS DO NOT ALLOW LIMITATIONS ON IMPLIED WARRANTIES. IF THESE LAWS APPLY TO YOU, SOME OR ALL OF THE ABOVE DISCLAIMERS, EXCLUSIONS OR LIMITATIONS MAY NOT APPLY TO YOU, AND YOU MIGHT HAVE ADDITIONAL RIGHTS.
THIS SECTION LIMITS OUR LIABILITY TO YOU.
UNDER NO CIRCUMSTANCES WHATSOEVER SHALL WE OR ANY OF OUR SPONSORS, MEMBERS, AFFILIATES, SUBSIDIARIES, EMPLOYEES, CONTRACTORS, AGENTS, REPRESENTATIVES, SUCCESSORS OR ASSIGNS ANY OTHER RELATED PERSONS OR ENTITIES BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY, PUNITIVE OR OTHER DAMAGES (INCLUDING, WITHOUT LIMITATION, THOSE RESULTING FROM LOST PROFITS, LOST DATA, OR BUSINESS INTERRUPTION) ARISING OUT OF OR RELATING IN ANY WAY TO THE WEBSITE SERVICES, ITS RELATED SERVICES AND PRODUCTS, CONTENT CONTAINED WITHIN THE WEBSITE SERVICES AND/OR ANY HYPERLINKED WEBSITE, WHETHER BASED ON WARRANTY, CONTRACT, TORT OR ANY OTHER LEGAL THEORY AND WHETHER OR NOT ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. YOUR SOLE REMEDY FOR DISSATISFACTION WITH THE WEBSITE SERVICES, ITS RELATED SERVICES, AND HYPERLINKED WEBSITES IS TO STOP USING THE WEBSITE SERVICES AND/OR THOSE SERVICES.
CERTAIN STATE LAWS DO NOT ALLOW FOR THE EXCLUSION OR LIMITATION OF CERTAIN DAMAGES. IF THESE LAWS APPLY TO YOU, SOME OR ALL OF THE ABOVE EXCLUSIONS OR LIMITATIONS MAY NOT APPLY TO YOU, AND YOU MIGHT HAVE ADDITIONAL RIGHTS.
YOUR AGREEMENT TO ARBITRATION AND WAIVER TO TRIAL BY JURY
Any dispute or claim relating in any way to your access to and use of the Website Services will be resolved by binding arbitration, rather than trial by jury, except that you may make claims in small claims court if your claims qualify and we may bring suit in court to enjoin infringement or another misuse of our intellectual property rights or to protect the privacy rights of another individual.
Waiver Of Right To Trial
You agree to waive your right to trial by jury, and we agree to waive our right to trial by jury (except to the extent expressly stated in the "Binding Arbitration" provision above).
There is no judge or jury in arbitration, and court review of an arbitration award is limited. However, an arbitrator can award on an individual basis the same damages and relief as a court (including injunctive and declaratory relief or statutory damages) and must follow this TOS as a court would.
How To Begin Arbitration Proceedings
To begin an arbitration proceeding, you must send a letter requesting arbitration and describing your claim to our address as posted on the Website Services, Attention: General Counsel. The arbitration will be conducted by the American Arbitration Association (referred to as "AAA") under its rules, including the AAA's Supplementary Procedures for Consumer-Related Disputes. The AAA's rules are available at www.adr.org or by calling 1-800-778-7879. The AAA's rules will govern payment of all filing, administration and arbitrator fees. We will reimburse those fees for claims totaling less than $250.00 unless the arbitrator determines the claims are frivolous. Likewise, we will not seek attorneys' fees and costs in arbitration unless the arbitrator determines the claims are frivolous. You or we may choose to have the arbitration conducted by telephone, based on written submissions, or in person in the county where you live or at another mutually agreed on location.
YOU ARE WAIVING YOUR RIGHT TO BRING A CLAIM AS PART OF A CLASS ACTION
YOU AGREE WITH US THAT ANY DISPUTE RESOLUTION PROCEEDINGS WILL BE CONDUCTED ONLY ON AN INDIVIDUAL BASIS AND NOT IN A CLASS ACTION, CONSOLIDATED ACTION OR REPRESENTATIVE ACTION.
IF, FOR ANY REASON, ANY CLAIM PROCEEDS IN COURT RATHER THAN IN ARBITRATION, YOU AGREE WITH US TO ONLY BRING YOUR CLAIM ON AN INDIVIDUAL BASIS AND NOT AS PART OF A CLASS ACTION, CONSOLIDATED ACTION OR REPRESENTATIVE ACTION.
BY AGREEING TO THE ABOVE, YOU AGREE TO WAIVE ANY RIGHTS THAT YOU MAY HAVE TO BRING CLAIMS IN A CLASS ACTION, CONSOLIDATED ACTION OR REPRESENTATIVE ACTION.
If you believe that any Content on or from the Website Services infringes on your copyright, you may request removal of such Content (or access to such Content) from the Website Services by contacting our copyright agent (identified below) and providing all of the following information:
- An electronic or physical signature of the person authorized to act on behalf of the owner of the copyright interest;
- A description of the copyrighted work that you claim has been infringed upon;
- A description of and hyperlink to the location of the allegedly infringing Content on the Website Services;
- Your address, telephone number, and e-mail address;
- A statement by you that you have a good-faith belief that the disputed use is not authorized by the copyright owner, its agent or the law;
- A statement by you, made under penalty of perjury, that the above information in your notice is accurate and that you are the copyright owner or authorized to act on the copyright owner's behalf.
Our copyright agent can be reached as follows: General Counsel, QT Centers LLC, Three Hamilton Landing, Suite #180A, Novato, CA 94949.
OTHER LEGAL TERMS
Your right to use and access the Website Services is personal and specific to you, and you may not assign or transfer that right to any third party. We reserve the right to appoint and transfer User Content and your data to a successor-in-interest or new owner if or when we, or a service we provide, are acquired in whole or in part by or merged with another entity or organization.
INVALIDITY OF A TERM OR CONDITION IN THIS TOS
If any of these conditions are deemed invalid, void or for any reason unenforceable, that condition shall be considered to be removed and shall not affect the validity and enforceability of any remaining terms.
This Website Privacy Notice, which is part of our Terms of Service (TOS), describes how we protect your privacy as a user of our Website Services. We do not knowingly interact with patients who may be accessing or using these Website Services. Neither do we intentionally interact with minors.
We do not sell or rent personally identifiable information received through your use of these Web Services. We share such information with third parties who are assisting us in providing these Web Services and then only underwritten obligations of confidentiality.
The Website Services have security measures in place to help protect against the loss, misuse, or alteration of personally identifiable information under our control. Such measures include encryption of data during communication using 128-bit Secure Socket Layer (SSL) and using a secured messaging service when we communicate personally identifiable information between your electronic device and the Website Services. Even with these measures, the confidentiality of any communication or material transmitted to or from us via the Website Services by Internet or e-mail cannot be guaranteed. At your discretion, you may contact us at the Contact Us link at the top of this webpage. If you have privacy or data security related questions, please feel free to contact the office identified at the end of this Website Privacy Notice.
Types of Consumer Data Collected and Used
Site Visitor data
QT Centers LLC routinely gathers information on activity at this Service site, such as how many people visit the site, the pages they visit, where they come from, how long they stay on the site, etc. The data is collected on an aggregate, anonymous basis, which means that no personally identifiable information is associated with the data. This data helps us improve the Service for you, including it site content and overall usage. The information is not shared with other organizations for their independent use.
Collecting and using personal information
Except as described in this Website Privacy Notice and when specifically requested by the Website Services, or you volunteer such information in a text box, we do not collect any identifiable information about visitors to this site.
To help us manage the Website Services, we maintain standard web logs that record data about visitors and customers who use this site, and we store this information for a while. These logs may contain the Internet domain from which you access the site (such as aol.com, abc.org, etc.); the IP address which is automatically assigned to your computer when you get on the Internet (a static IP address may be identifiable as being connected to you, while a dynamic address is usually not identifiable); the type of browser and operating system you use; the date and time you visited the site; the pages you viewed on the site; the address of the website you linked from, if any. If you sign on to Website Services to use our secured features, our web logs will also contain an individual identifier and show the services you have accessed.
All web logs are stored securely and may only be accessed by our personnel supporting our Website Services. We web log information to help us better design for various aspects of our Website Service, to identify popular features, to resolve user, hardware, and software problems, and to make the Website Services generally more useful to visitors.
Use of Email
We may use a third-party vendor to help us manage some of our e-mail communications with you. While such a vendor may have access to email addresses, the vendor may never use them for any purpose other than to support our conversation with you on our behalf. When you click on a link in an e-mail, you may temporarily be redirected through one of the vendor's servers (although this process will be invisible to you) which will register that you've clicked on that link and have visited our Website Services or opened our email to you.
Even if you have permitted us to send e-mails to you, you may revoke that permission at any time by following the "unsubscribe" information at the bottom of each such e-mail. If you have separately opted into or subscribed to different services on our Website Services and you subsequently wish to unsubscribe, you may need to also individually opt-out out of each service.
Use of Data related to the evaluation of the Website Services
We will periodically ask users to complete surveys asking about their experiences with the features of the Website. Our surveys ask visitors for demographic information such as age, gender, and education, and medical history. We use survey information for research and quality improvement purposes, including helping us to improve information and services offered through the Website Services. Also, users giving feedback may be individually contacted for follow-up due to concerns raised during such evaluation. Demographic information and weblog data may be stored for future research and evaluation.
Messages and transactions
Comments or questions sent to us using e-mail or secure messaging forms will be shared with our staff to address your concerns. We will archive your messages once we have made an effort to provide you with a complete and satisfactory response.
Credit card transactions
If you provide us with your credit card number for donation, purchase or other payments, we will securely treat your credit card number. But your credit card number should never be entered into an unsecured webpage - a webpage is not secure if the URL or domain name does not begin with https://.
Not all web pages on the Website Services are intended to be secure, such as those that do not have input forms. Only provide a credit card number in the input box that we specifically designate.
If you request to receive information in an ongoing manner through the Website Services by providing your e-mail address (for example, asking a subscription to one of our online publications), you can request to discontinue future mailings. Similarly, if you receive information about the Website Services through e-mail, you may ask to stop receiving similar messages in the future. All such materials sent to you by e-mail will contain information about how to opt out.
PATIENT PRIVACY NOTICE
Joint Notice of Privacy Practices for Medical Information
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
WHO MUST FOLLOW THIS NOTICE?
We(the facility) provide you (the patient) with health care by working with doctors and many other health care providers (referred to as we, our or us). This is a joint notice of our information privacy practices. The following people or groups will follow this notice:
- Any health care provider who comes to our locations to care for you. These professionals include doctors, nurses, technicians, physician assistants, and others.
- Our employees including regional support offices and affiliates.
- The third-party business partners are working on our behalf to help provide you with technology tools and assist us with healthcare operations.
OUR PLEDGE TO YOU
We understand that medical information about you is private and personal. We are committed to protecting it. Hospitals, doctors, and other staff make a record each time you visit. This notice applies to the records of your care at the facility, whether created by our team or your doctor. Your doctor and other healthcare providers may have different practices or notices about their use and sharing of medical information in their offices or clinics. We will gladly explain this notice to you or your family member.
Law requires us to:
- Keep medical information about you private.
- Give you this notice describing our legal duties and privacy practices for medical information about you.
- Notify you as outlined in state and federal law if a breach of unsecured medical information about you has occurred.
- Follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND SHARE YOUR MEDICAL INFORMATION
This section of our notice tells how we may use medical information about you. In all cases not covered by this notice, we will get separate written permission from you before we use or share your medical information. We will ask you for permission in writing before we use or share your medical information for any of the following reasons:
- Marketing an item or service that is not related to treatment for you or when we are paid to market to you.
- Special notes about you made by therapists and counselors that are not part of your medical record.
- The sale of your medical information.
You can later cancel your permission by notifying us in writing.
We will protect medical information as much as we can under the law. Sometimes state law gives more protection to medical information than federal law. Sometimes federal law provides more protection than state law. In each case, we will apply the laws that protect medical information the most.
QT Centers LLC may use or share medical information about you (in electronic or paper form) with doctors or health professionals at any QT Centers LLC facility for treatment, payment, and health care operations. Please contact the Facility Compliance Office (at the address at the bottom of the notice) for a list of all QT Centers LLC facilities.
Treatment: We will use and share medical information about you for purposes of treatment. An example is sending medical information about you to your doctor or a specialist as part of a referral.
Payment: We will use and share medical information about you so we can be paid for treating you.
Health Care Operations: We will use and share medical information about you for our health care operations. Examples are using information about you to improve the quality of care we give you, for disease management programs, patient satisfaction surveys, compiling medical information, de-identifying medical information and benchmarking.
Appointment Reminders: We may contact you with appointment reminders.
Internet-Based Products and Services: Working with the third party, we may offer you internet-based products or services allowing you to
- schedule appointments
- complete medical history and consent forms
- help you find a physician or provide you access to your medical information
Treatment options and health-related benefits and services: We may contact you about possible treatment options, health-related benefits or services that you might want.
Fund-raising Activities: We may use limited information to contact you for fundraising. We may also share such information with our fundraising foundation. You may choose to opt out of receiving fund-raising requests or contacts.
Research: We may share medical information about you for research projects, such as studying the effectiveness of a service you received. We will usually get your written permission to use or share medical information for research. Under certain circumstances, we may share medical information about you without your written authorization. These research projects, however, must go through a unique process that protects the confidentiality of your medical information.
Public Health: We may disclose your health information as required or permitted by law to public health authorities or government agencies whose official activities include preventing or controlling disease, injury, or disability. For example, we must report specific information about births, deaths, and various conditions to government agencies. We may use your health information to report to monitoring agencies any reactions to medications or problems with medical devices. We may also disclose when requested, information about you to public health agencies that track outbreaks of contagious diseases or that are involved with preventing epidemics.
Required by Law: We are sometimes required by law to report specific information. For example, we must report an assault, abuse, or neglect. Another example is that we will share information about tumors with state tumor registries.
Public Safety: We may, and sometimes have to share medical information about you to prevent or lessen a serious threat to the health or safety of a particular person or the general public.
Health Oversight Activities: We may share medical information about you for health oversight activities where allowed by law. For example, oversight activities include audits, investigations or inspections. The activities are necessary for government review of health care systems and government programs.
Military, Veterans, National Security, and Other Government Agencies: We may use or share medical information about you for national security purposes, intelligence activities or for protective services of the President or certain other persons as allowed by law. We may share medical information about you with the military for military command purposes when you are a member of the armed forces. We may share medical information with the Secretary of the Department of Health and Human Services for investigating or determining our compliance with HIPAA.
Judicial Proceedings: We may use or share medical information about you in response to court orders or subpoenas only when we have followed the procedures required by law.
Law Enforcement Arizona & Nevada: We may share medical information about you with police or other law enforcement personnel where permitted or required by state and federal law. For example, if the police present a search warrant or court order, we must produce the information requested.
Law Enforcement California: We may share medical information about you with police (or other law enforcement personnel) without your written permission:
- If the police present a search warrant
- If the police show a court order
- To report abuse, neglect, or assaults as required or permitted by law
- To report specific threats to third parties
- If you are in police custody or are an inmate of a correctional institution and the information is necessary to provide you with health care, to protect your health and safety, the health and safety of others or for the safety and security of the correctional institution.
Family Members, Personal Representative, and Others Involved in Your Care: Unless you tell us otherwise, we may share medical information about you with friends, family members, or others you have named who help with your care or who can make decisions on your behalf about your healthcare.
Disaster Relief Purposes: We may use or share medical information about you with public or private disaster organizations so that your family can be notified of your location and condition in case of disaster or another emergency. We may also use it to help in coordination of disaster relief efforts.
Electronic Sharing and Pooling of Your Information: We may take part in or make possible the electronic sharing or pooling of healthcare information. This helps doctors and other healthcare providers within a geographic area or community provide quality care to you. If you travel and need medical treatment, it allows other doctors or hospitals to electronically contact us about you. All of this helps us manage your care when more than one doctor is involved. It also helps us to improve the overall quality of care provided to you and others.
YOUR RIGHTS REGARDING MEDICAL INFORMATION
Requesting Information about You:
In most cases, when you ask in writing, you can look at or get a copy of medical information about you in paper or electronic format. You may also request that we send electronic copies directly to a person or entity chosen by you. We will give you a form to fill out to make the request. You can look at medical information about you for free. If you request paper or electronic copies of the information, we may charge a fee. If we say no to your request to look at the information or get a copy of it, you may ask us in writing for a review of that decision.
Correcting Information about You:
If you believe that information about you is wrong or missing, you can ask us in writing to correct the records. We will give you a form to fill out to make the request. We may say no to your request to correct a record if the information was not created or kept by us or if we believe the record is complete and correct. If we say no to your request, you can ask us in writing to review that denial.
Obtaining a List of Certain Disclosures of Information:
You can ask to receive a list of the disclosures we have made of your medical information for the last six years. Your request must be in writing and state the period for the listing. The first request in a 12-month period is free. We will charge you for any additional requests for our cost of producing the list. We will give you an estimate of the cost when you request the additional list.
Restricting How We Use or Share Information about You: You can ask that medical information is given to you in a confidential manner. You must tell us in writing of the exact way or place for us to communicate with you.
You also can ask in writing that we limit our use or sharing of medical information about you. For example, you can ask that we use or share medical information about you only with persons involved in your care. Any time you make a written request, we will consider the request and tell you in writing of our decision to accept or deny your request. We are legally required to agree to only one type of restriction request: if you have paid us in full for a health procedure or item for which we would normally bill your health plan, we must agree to your request not to share information about that procedure or item with your health plan.
All written requests or requests for review of denials should be given to our Facility Compliance Office listed at the end of this notice.
CHANGES TO THIS NOTICE
We may change our privacy practices from time to time. Changes will apply to current medical information, as well as new information after the change occurs. If we make a significant change, we will change our notice. We will also post the new notice in our facilities and on our website at www.QTbreasthealth.com. You can ask in writing for a copy of this notice at any time by contacting the QT Centers LLC Compliance Office. If our notice has changed, we will give you a copy of the notice the next time you register for treatment.
DO YOU HAVE CONCERNS OR COMPLAINTS?
If you think your privacy rights may have been violated, you may contact the QT Centers LLC Compliance Office Hotline at 800-443-1986 or by email at firstname.lastname@example.org. Finally, you may send a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights. Our Facility Compliance Office can provide you the address. We will not take any action against you for filing a complaint.
QT Centers LLC Compliance Office
QT Centers LLC Compliance Office Phone: 800-443-1986
QT Centers LLC Compliance Office Fax: 415-591-6279
Version effective: July 2018
PATIENT RIGHTS AND RESPONSIBILITIES
QT Centers LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation or gender identity. QT Centers LLC does not exclude people or treat them differently because of race, color, national origin, age, disability, sex, sexual orientation or gender identity. Each patient is entitled to compassionate and professionally competent care delivered with respect for each.
You have a right to:
- Considerate and respectful care, and to be made comfortable. You have the right to respect for your cultural, psychosocial, spiritual, and personal values, beliefs, and preferences.
- To communicate effectively with your care team. Receive free and promptly, aids and services if you have a disability or free language services if your primary language is not English. Qualified sign language interpreters, written information in other formats (large print, audio, accessible electronic formats), qualified interpreters and information written in other languages. For assistance contact any Clinic staff member or the Patient Advocates.
- Know the name of the licensed health care provider acting within the scope of his or her professional licensure, who has primary responsibility for coordinating your care, and the names and professional relationships of physicians and non-physicians who will see you.
- Receive information about your health status, diagnosis, prognosis, the course of treatment, prospects for recovery and outcomes of care (including unanticipated outcomes) in terms you can understand. You have the right to effective communication and to participate in the development and implementation of your plan of care. You have the right to participate in ethical questions that arise in the course of your care, including issues of conflict resolution, withholding resuscitative services, and forgoing or withdrawing life-sustaining treatment.
- Make decisions regarding medical care and receive as much information about any proposed treatment or procedure as you may need to give informed consent or to refuse a course of treatment. Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved, alternate courses of treatment or non-treatment and the risks involved in each, and the name of the person who will carry out the procedure or treatment.
- Request or refuse treatment, to the extent permitted by law. However, you do not have the right to demand inappropriate or medically unnecessary treatment or services. You have the right to leave the Clinic even against the advice of members of the Clinic staff, to the extent permitted by law.
- Be advised if the Clinic/licensed health care provider acting within the scope of his or her professional licensure proposes to engage in or perform human experimentation affecting your care or treatment. You have the right to refuse to participate in such research projects.
- Reasonable responses to any reasonable requests made for service.
- Formulate advance directives. This includes designating a decision maker if you become incapable of understanding a proposed treatment or become unable to communicate your wishes regarding care. Clinic staff and providers who provide care in the Clinic shall comply with these directives. All patients’ rights apply to the person who has the legal responsibility to make decisions regarding medical care on your behalf.
- Have personal privacy respected. Case discussion, consultation, examination, and treatment are confidential and should be conducted discreetly. You have the right to be told the reason for the presence of any individual.
- Confidential treatment of all communications and records about your care in the Clinic. You will receive a separate “Notice of Privacy Practices” that explains your privacy rights in detail and how we may use and disclose your protected health information.
- Receive care in a safe setting, free from mental, physical, sexual or verbal abuse and neglect, exploitation or harassment. You have the right to access protective and advocacy services including notifying government agencies of neglect or abuse.
- Be free from restraints and seclusion of any form used as a means of coercion, discipline, convenience or retaliation by staff.
- Reasonable continuity of care and to know in advance the time and location of appointments as well as the identity of the persons providing the care.
- Know which Clinic rules and policies apply to your conduct while a patient with QT Centers LLC.
- Designate a support person as well as a visitor of your choosing, if you have decision-making capacity, whether or not the visitor is related to you by blood, marriage or registered domestic partner status, unless:
- No visitors are allowed.
- The Clinic reasonably determines that the presence of a particular visitor would endanger the health or safety of a patient, a member of the health Clinic staff or other visitors to the Clinic or would significantly disrupt the operations of the Clinic.
- Examine and receive an explanation of the Clinic’s bill regardless of the source of payment.
- Exercise these rights without regard to sex, race, color, religion, ancestry, national origin, age, disability, medical condition, educational background, sexual orientation, gender identity, marital status, registered domestic partner status, economic status or the source of payment for care.
- If you believe that the Clinic has failed to provide these services or discriminated in another way related to race, color, national origin, age, religion, sex, gender identity, sexual orientation, or disability, you can file a grievance with a Patient Advocate. If you want to file a complaint with this Clinic, you may do so by writing, calling or emailing: QT Centers LLC Quality Management, Patient Advocate P.O. Box 3084 Rancho Cordova, CA 94949 Phone 1-888-242-1555PatientAdvocate@com If you need help filing a grievance, Patient Advocates are available to help you. The Patient Advocate will review each complaint and provide you with a written response within 30 days. The written response will contain the name of a person to contact, the steps taken to investigate the grievance, the results of the grievance process and the date of completion of the grievance process. Concerns regarding quality of care will also be referred to the appropriate Peer Review Committee for review.
- File a complaint with the Medical Board of California regardless of whether you use the Clinic’s grievance process. The Medical Board of California 2005 Evergreen Street, Suite 1200 Sacramento, CA 95815 Phone 1-800-633-2322 www.mbc.ca.gov 22. File a civil rights complaint with the U.S Department of Health and Human Services, Office of Civil Rights, electronically through the Office of Civil Rights Complaint Portal, available at https://ocrportal. hhs.gov/ocr/portal/lobby.jsf or by mail or phone. US Department of Health and Human Services 200 Independence Ave, SW Room 509F HHH Building Washington D.C.20201 Complaint forms are available at http://www.hhs.gov/ocr/office/fileindex.html
Your general responsibilities are:
- Providing, to the best of your knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other matters relating to your health.
- Reporting unexpected changes in your condition to the responsible provider.
- Asking questions when you do not understand what you have been told about your care or what you are expected to do.
- Cooperating in the treatment program developed with your provider or other caregivers. You should express any concerns you have about your ability to follow the proposed course of treatment.
- Accepting the consequences of refusing treatment, failing to follow the recommended course of treatment or using other treatments.
- Notifying appropriate persons in the institution of those situations where, in your opinion, your rights are not being respected.
- Respecting the rights of other patients who are also receiving treatment in the Clinic.
- Assuring that the financial obligations of your healthcare are fulfilled as promptly as possible.
- Following Clinic rules and regulations affecting patient care and conduct, including those related to visiting, smoking, and the care of valuables.
Language Assistance Services
If you speak English, language assistance services, free of charge, are available to you. Call 1-800-481-3293 (TTY: 1-916-349-7525).
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-481-3293 (TTY: 1-916-349-7525).
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-481-3293 (TTY: 1-916-349-7525).
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電1-800-481-3293 (TTY: 1-916-349-7525)。CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-481-3293 (TTY: 1-916-349-7525).
주의:한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다. 1-800-481-3293 (TTY: 1-916-349-7525) 번으로전화해주십시오.ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝Եթեխոսումեքհայերեն, ապաձեզանվճարկարողենտրամադրվելլեզվականաջակցությանծառայություններ: Զանգահարեք1-800-481-3293 (TTY (հեռատիպ)՝1-916-349-7525):
تماسدیریگب. تجوه: برگاهبزانفارسیگوگتفمینکی،دتهسیبزتالانیگیارتروصبانشیاربما1-800-481-3293 (TTY: 1-916-349-7525)
دشابا.بمهارمیف注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-481-3293 (TTY: 1-916-349-7525)
まで、お電話にてご連絡ください。ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-481-3293 (телетайп: TTY: 1-916-349-7525).
ध्यानदें: यदिआपहिंदीबोलतेहैंतोआपकेलिएमुफ्तमेंभाषासहायतासेवाएंउपलब्धहैं।1-800-481-3293 (TTY: 1-916-349-7525)
परकॉलकरें।إذاكنتتتحدثاذكراللغة،نإفخدمتاالمساعدةاللغویةتتوافركلب.ناجملااتصلبرقم3293-481-800-1) رمق.(1-916-349-7525 :والبكمالصمهتافATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-800-481-3293 (ATS : 1-916-349-7525).
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-481-3293 (TTY: 1-916-349-7525). ਧਿਆਨਦਿਓ: ਜੇਤੁਸੀਂਪੰਜਾਬੀਬੋਲਦੇਹੋ, ਤਾਂਭਾਸ਼ਾਵਿੱਚਸਹਾਇਤਾਸੇਵਾਤੁਹਾਡੇਲਈਮੁਫਤਉਪਲਬਧਹੈ।1-800-481-3293 (TTY: 1-916-349-7525)
‘ਤੇਕਾਲਕਰੋ।ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-800-481-3293 (TTY: 1-916-349-7525). LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-800-481-3293 (TTY: 1-916-349-7525).
JUNE 1, 2018