Roadways to Recovery is not an Emergency or Urgent Care Facility

I understand Highland Roadways to Recovery is a private practice and we do not provide emergency / crisis services. For medical / behavioral health care emergencies, please call 911 or go directly to the nearest emergency room.

Patient Rights

All individuals who apply for services, regardless of sex, race, age, color, creed, financial status, or national origin, are assured that their lawful rights as patients shall be guaranteed and protected. While being served, you, the client, are assured and guaranteed the following rights:

Patient Rights

1. A patient has the right to be treated with courtesy and respect, with appreciation of his or her individual dignity and with protection of his or her need for privacy.

2. A patient has the right to receive care in a safe setting that protects his or her privacy and confidentiality.

3. A patient has the right to have his or her cultural, psychosocial, spiritual and personal values, beliefs and preferences respected.

4. A patient has the right to formulate advance directives and designate a surrogate to make healthcare decisions on behalf of the patient.

5. A patient has the right to participate in the consideration of ethical issues that arise in his or her care.

6. A patient has the right to a prompt and reasonable response to questions and requests.

7. A patient has the right to know who is providing medical services and who is responsible for his or her care.

8. A patient has the right to know what patient support services are available, including whether an interpreter is available if he or she does not speak English.

9. A patient has the right to receive from the healthcare provider information concerning diagnosis, planned course of treatment, alternatives, risks and prognosis.

10. A patient has the right to refuse any care, treatment and services except as otherwise provided by law, and to be informed of the medical consequences of this action.

11. A patient has the right to know what rules and regulations apply to his or her conduct.

12. A patient has the right to be given, upon request, full information and necessary counseling on the availability of known financial resources for his or her care. If eligible for Medicare, the patient has the right to know, upon request and in advance of treatment, whether the healthcare provider or healthcare facility accepts the Medicare assignment rate.

13. A patient has the right to receive, upon request, prior to treatment, a reasonable estimate of charges for medical care, to receive a clear and understandable itemized statement and upon request to have the charges explained.

14. A patient has the right to access, request amendment to and receive an accounting disclosures regarding his or her own health information as permitted under law.

15. A patient has the right to impartial access to medical treatment or accommodations regardless of race, national origin, religion, handicap or source of payment.

16. A patient has the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.

17. A patient has the right to be free from mental, physical, sexual and verbal abuse, neglect and exploitation, and to be free from seclusion or restraints that are not medically necessary or to protect the patient or others from harm.

18. A patient has the right to access protective and advocacy services.

19. A patient has the right to know if medical treatment is for experimental research purposes and to give his or her consent or refusal to participate in such experimental research.

20. A patient has the right to pain management.

21. A patient has the right to express grievances regarding any violation of his or her rights, as stated in Indiana law, through the grievance procedure of the healthcare provider or healthcare facility that served him or her and to the appropriate state licensing agency.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the Chief Executive Officer or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.

I hereby acknowledge receipt of and understand the "Patient Rights" statement.

Random Drug Testing

All clients of Roadways to Recovery receiving a controlled substance or in treatment for a substance use disorder , "the facility", are required to participate in random drug testing as part of our Controlled Drug Monitoring Policy. The Facility drug test is provided by LabCorp or Aegis or similar companies, and an integral part of the test is the confirmations of the urine test that LabCorp also performs. This letter is clarification of the Facility billing practices regarding the processing of your specimen.

Telehealth

The laws that protect the confidentiality of my personal information also apply to telehealth. I understand that there are risks and consequences from telehealth, including, but not limited to, the possibility, despite reasonable efforts on the part of the Facility, that: the transmission of my personal information could be disrupted or distorted by technical failures, the transmission of my personal information could be interrupted by unauthorized persons, and/or the electronic storage of my personal information could be unintentionally lost or accessed by unauthorized persons. The Facility utilizes secure, encrypted audio/video transmission software to deliver telehealth. I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes. Others may also be present during the consultation other than my nurse practitioner or therapist to operate the video equipment. The above-mentioned people will all maintain confidentiality of the information obtained. I understand that I may expect the anticipated benefits such as improved access to care and more efficient evaluation and management from the use of telehealth in my care, but that no results can be guaranteed.

I understand billing will occur from my provider as usual. I have been able to ask questions in regard to this procedure, my questions have been answered and any practical alternatives have been discussed. The Facility offers telehealth appointments and in order to communicate effectively in my care, I authorize the Facility to communicate with me via telephone, email and text messages. I understand and consent for links for telehealth maybe sent via text or email. I understand I must be within the state of Indiana in order to be seen. Coverage is determined by your insurance carrier. We highly encourage you to verify your telehealth benefits with your insurance company or your human resources representative.

Electronic Communication

The transmission of client information by email and/or text has several risks that clients should consider prior to the use of these forms of communication. These include, but are not limited to, the following: Email and texts can be circulated, forwarded, stored electronically and on paper, and broadcast to unintended recipients. Backup copies of emails and texts may exist even after the sender and/or the recipient has deleted his or her copy. Employers and on-line services have a right to inspect emails sent through their company systems. Emails and texts can be intercepted, altered, forwarded, or used without authorization or detection. Email and texts can be used as evidence in court. Email and texts may not be secure and therefore it is possible that the confidentiality of such communication may be breached by a third party. I understand the risks of communicating through electronic means.

No Show Policy

I understand a no-show appointment is a missed appointment in which I do not present for the appointment, or I cancel the appointment less than 24 hours prior to the scheduled appointment.

In the event that a client has two (2) or more no-show appointments in a six (6) month period, that client may not be able to schedule appointments for 6 months and must use the virtual walk-in clinic during virtual walk-in clinic hours. Therapy is not offered in the virtual walk-in clinic. Only one issue may be addressed in the virtual walk-in clinic. If a client has 3 no-shows in 365 consecutive days, they may be discharged from the practice.