Patient Infromation

PATIENT FORMS:

Click here to download the Informed Consent document.
Click here to download the Patient Instruction form.
Click here to download the Endoscopic Assisted Microdisectomy form.

 

PATIENT BILL OF RIGHTS:

You Have the Right…

  • Not to be denied participation in all treatment services based on the grounds of race, color, creed, sex, sexual orientation, national origin, disability, diagnosis, religion, age or socioeconomic status.
  • To be treated under considerate and respectful care.
  • To reasonably expect from staff members responsible for your care and welfare, and receive complete and current information concerning your condition.
  • To know by name and position the staff members responsible for your care.
  • To reasonable consideration of your privacy and to be treated with respect and full recognition of your dignity, individuality, and reasonable cultural needs.
  • To expect a reasonable response to your requests.
  • To be free from all forms of abuse or harassment, neglect, or exploitation.
  • To be reasonably informed at the time of check out of medical and/or ancillary services charges.
  • To be afforded the opportunity to participate in planning and implementing your treatment program, to refuse care, treatment or services in accordance with law and regulation.
  • To the maintenance of confidentiality of your clinical record.
  • To access information contained within your medical record.
  • To be informed, when appropriate, about the outcomes of care, including unanticipated outcomes.

You Have the Responsibility…

  • To be honest about matters that relate to you as a patient.
  • To provide staff with accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other matters pertaining to your health.
  • To report any perceived risks in your care.
  • To report any unexpected changes in your condition to those responsible for your care and welfare.
  • To follow the care, service or treatment plan developed.
  • To ask any questions when you do not understand or have concerns about your plan of care.
  • To understand the consequences of the treatment alternatives and not following your plan of care.
  • To know the staff who are caring for you.
  • To be considerate and respectful of the rights of both fellow patients and staff.
  • To honor the confidentiality and privacy of other patients.
  • To be considerate of the property of NJ Pain & Spine Specialists.
  • To assure the financial obligations of your healthcare are fulfilled as promptly as possible.