Patient Rights & Responsibilities

Please review these rights carefully to understand how we work to honor your autonomy and support your well-being.

Right to Retain Rights: You have the right to retain all rights, benefits and privileges guaranteed to you by Federal,
State, and local law, except those specifically lost through the due process of law.

Right to be Notified of Rights: You have the right to be notified of all rights accorded to you as a recipient of services at
the time of admission or intake, and in terms that you understand.

Right to Dignity and Respect: You have the right to be treated with courtesy and dignity and are at all times entitled to
respect for their individuality, and the recognition that their strengths, abilities, needs, and preferences are not
determinable based on a psychiatric diagnosis.

Right to Nondiscrimination: You have the right to receive services without discrimination based on race, color, sex,
sexual orientation, age, religion, national origin, domestic/marital status, political affiliation or opinion, veteran’s status,
physical/mental handicap or ability to pay for services.

Right to Cultural Competence and Inclusivity: Services will be provided in a manner that is culturally sensitive and
inclusive of your personal, cultural, and spiritual beliefs. We respect and aim to understand each individual’s values and
customs.

Right to Accessible Services: You have the right to accessible services, including assistance with language, hearing
impairment and other barriers that may impact your ability to receive care.

Right to a Safe Environment: You have the right to be treated in an environment free from physical abuse, sexual
abuse, physical punishment, or psychological abuse by threatening, intimidating, harassing, or humiliating actions on the
part of staff.

Right to Equal Access to Treatment: You have the right to equal access to treatment regardless of race ethnicity, color,
national origin, culture, language, spiritual beliefs, socioeconomic status, gender, age, sexual orientation,
domestic/marital status, political affiliation or opinion, veteran’s status, physical/mental handicap and sources of
payment or ability to pay for services.

Right to Privacy and Confidentiality: Your personal health information and treatment records will be protected and
kept confidential as per HIPAA and other applicable privacy laws. Information will not be disclosed without your
consent, except as required by law or in emergencies.

Right to Informed Consent: You have the right to receive clear, comprehensive information regarding proposed
treatments, including risks, benefits, side effects, and alternatives, to make informed decisions. This includes your right
to refuse treatment at any time without fear of retribution or loss of rights.

Right to Informed Consent for Medication: Before being prescribed any medication, you will be informed of its
purpose, potential risks, and benefits. You have the right to refuse medication, except in cases of legal or medical
emergency interventions.

Right to Refuse Treatment: Legally competent clients have the right to refuse treatment, except in emergency situations
or other circumstances required by law.

Right to Least Restrictive Care: You have the right to be treated in the least restrictive setting to meet your needs.
Lumera Healthcare, LLC is committed to maintaining a restraint free environment.

Right to Quality Care: You have the right to receive services conducted in a manner reflecting quality professional and
ethical standards of practice and shall be apprised of the organization’s code of ethics/conduct.

Right to Participate in Treatment Planning: You, along with family or significant other(s), when appropriate, are
entitled to actively participate in creating, reviewing, and modifying your individualized treatment plan. This plan will
reflect your needs, strengths, goals, and preferences.

Right to Individualized Treatment Planning: You have the right to an individualized, written treatment plan to be
developed promptly following admission, treatment based on the plan, periodic review and reassessment of needs, and
appropriate revisions of the plan including a description of services that may be needed following discharge from
services.

*Right to Access Records: You have the right to review and obtain copies of your treatment and medical records, unless
access is restricted by law or clinical considerations. You may request corrections to your records if you believe there is
an error. You shall be afforded the assistance of an appropriate employee in cases where a reasonable concern exists of a
possible harmful effect to you through the misinterpretation of information in the record. You may receive one free copy
of your records.

Right to a Grievance Process: You have the right to file a grievance, recommendation, or opinion regarding the services
you receive without fear of retaliation. We are committed to investigating complaints fairly and promptly.

Right to Information on Fees and Payment Policies: You have the right to request a written statement detailing all
charges for services provided. This includes a breakdown of fees, services rendered, and any associated costs, which will
be provided to you upon request.

Right to External Consultation: You have the right to request and receive outside/external professional consultation
regarding your treatment at your own expense.

Right to Explanation for Denial of Services: You have the right to an explanation if services are refused to you for any
reason including admission ineligibility or continued care ineligibility and have the right to appeal such decisions.

Right to Refuse Research Participation: You have the right to refuse to participate in research without loss of services
and participation in research on a voluntary basis only with full written informed consent.

Right to Access Services: You have the right to access guardians, self-help groups, advocacy services and legal services
at any time. Access will be facilitated through the person responsible for service coordination.

Right to Safe and Disruption-Free Environment: You have the right to be protected from the behavioral disruptions of
other individuals receiving services.

To maximize the effectiveness of treatment and ensure a positive environment, clients are expected to adhere to the
following responsibilities:

• Respect the Rights of Others: Treat other clients and staff with respect and consideration, fostering a safe and supportive environment for everyone.
• Protect Health and Safety: Act in a way that protects yourself and others from exposure to infectious or communicable diseases, including sexually transmitted infections.
• Express Concerns and Ask Questions: Make your concerns known to Lumera Healthcare’s staff and ask questions whenever you need additional information.
• Follow Safety Rules: Adhere to all safety rules and posted signs within Lumera Healthcare’s facilities.
• Keep Appointments: Attend all scheduled appointments to support consistent and effective treatment.
• Attend Services Substance-Free: Arrive for services without the use of alcohol or illicit drugs.
• Provide Accurate Information: Provide honest and complete information about your medical history, symptoms, and medications, including any changes as they occur.
• Address Financial Obligations: Work with our financial counselors to understand and manage any costs associated with treatment.

Contact Information for Filing Grievances or Complaints
If you feel your rights have been violated, or if you have any concerns regarding your care, you may contact:

Chief Quality and Accreditation Officer
2527 New Holt Rd
Paducah, KY 42001
(270) 534-5128

[email protected]

If you have filed a grievance with our organization and feel that the issue has not been adequately resolved, you have the
right to escalate your concerns to the Ombudsman.

Office of the Ombudsman
209 St. Clair St.
Frankfort, KY 40601
(866) 596-6283
[email protected]

I acknowledge that I have been given an opportunity to review the Patient Rights and Responsibilities
Statement. I acknowledge that I am entitled to have my own personal copy of the Patient Rights and Responsibilities
Statement and that Lumera Healthcare, LLC has made available a copy of this document.