PATIENT RIGHTS AND RESPONSIBILITIES 

Patients receiving products and services from Chemistry Rx Pharmacy, a Compound and Specialty Pharmacy, have the following rights: 

1. To select those who provide your health care services. 
2. To receive the appropriate or prescribed service in a professional manner without discrimination relative to your age, sex, race, religion, ethnic origin, sexual preference or physical or mental handicap. 
3. To be promptly informed if the prescribed care or services are not within the scope of service, mission, or philosophy of Chemistry Rx, and therefore be provided with transfer assistance to an appropriate care or service organization. 
4. To be dealt with and treated with friendliness, courtesy, and respect by each and every individual representing Chemistry Rx who comes in contact with you during the course of your therapy insuring freedom from mental, physical, sexual, and verbal abuse, neglect, and exploitation. 
5. To have your privacy and property respected at all times. 
6. To assist in the development and planning of your health care program that is designed to satisfy in the best possible manner your current needs as they have been presented. 
7. To be provided with adequate information from which you can give your informed consent for the commencement of service, the continuation of service, the transfer of service to another health care provider, or termination of service. 
8. To express concerns or grievances or recommend modification to your Chemistry Rx product or services provider without fear of discrimination or reprisal. 
9. To identify the staff member of Chemistry Rx and their job title, and to speak with a supervisor of the staff member if requested. 
10. To request and receive complete and up-to-date information relative to your condition, treatment, alternative treatments, risks of treatment within the physician’s legal responsibilities of medical disclosure. 
11. To receive care and services within the scope of your health care plan, promptly and professionally, while being fully informed of Chemistry Rx policies, procedures, and charges relative to your care and who is providing your care. 
12. To refuse care within the boundaries set by law, and receive professional information relative to the ramifications or consequences that will or may result due to such refusal. 
13. To request and receive the opportunity to examine or review your medical records. 
14. To request and receive data regarding services or costs thereof privately and with confidentiality. 
15. To expect that information received by Chemistry Rx will be kept confidential and will not be released without written consent of you or your responsible party. 
16. To be involved, as appropriate, in discussions and resolutions of conflicts and ethical issues related to your care. 
17. To be informed of any experimental or investigational studies that are involved in your care, and be provided the right to refuse any such activity. 
18. To be informed of any unanticipated or negative outcomes of care, treatment and services that relate to a serious sentinel event during the course of care. 
19. The patient has the right to access, request amendments to, and receive an accounting of disclosures regarding his or her own health information as permitted under applicable law. 
20. Have personal health information shared with the patient management program only in accordance with state and federal law.
21. Speak with a health professional.
22. Receive information about the patient management program.
23. Decline participation or disenroll in the patient management program at any point in time.

Patients receiving products and services from Chemistry Rx Pharmacy, a Compound and Specialty Pharmacy, have the following responsibilities: 

1. To provide accurate information concerning your present health status, current medications, allergies, and insurance coverage to Chemistry Rx as appropriate to your care or service. 
2. To inform a staff member, if applicable, of your health history, including past hospitalizations, illnesses, injuries, etc. 
3. Notify the treating prescriber of their participation in the patient management program.
4. To involve yourself as needed and as able in developing, carrying out, and modifying your plan of care plan, if applicable. 
5. To evaluate your home environment and make necessary corrections to plan for safe medication handling and storage. 
6. To request additional assistance or information on any phase of your health care plan that you do not fully understand. 
7. To notify your physician and Chemistry Rx when you feel ill, or encounter any unusual physical or mental stress or sensations, which may be as a result of the care, products or services being provided. 
8. To notify Chemistry Rx when you will not be home at the time of a scheduled delivery or visit, if applicable. 
9. To notify Chemistry Rx prior to changing your address or telephone number. 
10. To notify Chemistry Rx when you encounter any problem with equipment or service. 
11. To notify Chemistry Rx if you are hospitalized or if your physician modifies or stops your service or care, if applicable. 
12. To ask questions related to the care and services provided to you by Chemistry Rx. 
13. To follow instructions given to you by Chemistry Rx for the care and services being provided, if applicable. 
14. To meet financial commitments resulting from the care and services provided by Chemistry Rx. 
15. To treat Chemistry Rx representatives with respect in the care and services being provided. 
16. To provide information requested from Chemistry Rx needed to provide care. 
17. To follow Chemistry Rx rules and regulations as they pertain to the products and services provided by Chemistry Rx. 
18. To adhere to the above mentioned responsibilities and accept the consequences involved should these responsibilities not be met.