Patient Rights, Responsibilities, and Consent for Treatment

DMV Medical Group

P: 240-669-7496

F: 301-321-7800

Website: www.dmvmedgroup.com

Patient Rights

As a patient at DMV Medical Group, you have the right to:

  1. Respectful & Safe Care: Receive considerate and respectful care in a safe environment, free from abuse, harassment, or discrimination.

  2. Participate in Your Care Plan: Actively participate in decisions regarding your treatment, including the right to request or refuse treatment, as permitted by law.

  3. Be Well-Informed: Receive clear and comprehensive information about your illness, treatment options, potential risks, and expected outcomes, including unanticipated outcomes.

  4. Designate a Representative: Assign someone to make healthcare decisions on your behalf if needed.

Patient Responsibilities

As a patient, you are responsible for:

  • Providing Complete & Accurate Information: Disclose your medical history, previous treatments, hospitalizations, medications, and any relevant health information.

  • Keep your contact, billing, and insurance information up to date.

  • Understanding Your Treatment Plan: Ask questions if you do not understand your care, treatment options, or expectations.

  • Follow the treatment plan developed by your provider.

  • Inform your provider if you cannot follow the recommended treatment.

  • Appointment & Conduct Expectations: Arrive on time for all scheduled appointments.

  • Be respectful to staff, other patients, and facility property. This applies to any visitors accompanying you.

  • No unauthorized recordings: Patients may not photograph, videotape, record, or film any person or practice during visits/sessions without written permission from DMV Medical Group.

  • Understanding Your Financial Responsibility: Know your health insurance coverage, including deductibles, co-pays, network coverage, and out-of-pocket expenses before scheduling an appointment.

  • Personal Belongings: Understand that DMV Medical Group cannot accept responsibility for lost, stolen, or damaged personal property.

Addition to Telemedicine Appointments:

  • Internet & Connectivity Responsibility: Patients must ensure they have a stable and functioning internet connection for their telemedicine appointments.

  • Poor internet connectivity is not a valid reason for missing or being unable to complete an appointment.

  • If a telemedicine session cannot proceed due to the patient’s internet issues, a missed appointment fee may be charged.

Addition to Patient Responsibilities:

  • Insurance & Payment Responsibility: Patients are responsible for ensuring that their insurance is valid, updated, and active at the time of service.

  • If insurance is invalid, expired, or does not match the name on the insurance card, the full out-of-pocket rate will be automatically charged.

  • It is the patient’s responsibility to verify that all insurance details are accurate before their appointment.

Consent for Treatment

By signing below, I authorize DMV Medical Group and its assigned providers to provide medical and mental health treatment for myself or my minor child, including but not limited to:

  • Assessment, screening, consultation, and recommendations

  • Psychotherapy and holistic services

  • Psychiatric medication management

I acknowledge and understand that:

  • Treatment Risks & Benefits: I understand that mental health treatment may involve risks and benefits, and I also understand the risks and benefits of declining treatment.

  • I have the right to request information about alternative treatment options, if available.

  • Ancillary Services & Lab Testing: I authorize my provider to order laboratory tests or additional services if deemed necessary for my care and safety.

  • If HIV testing is recommended, I understand that I have the right to decline.

  • Electronic Medical Records & Prescription History: I acknowledge that DMV Medical Group utilizes an electronic medical record system.

  • I authorize DMV Medical Group to access my prescription history from any pharmacy or drug monitoring agency.

Acknowledgment & Agreement

I have carefully read and reviewed this document. My signature indicates that:

  • I understand and agree to my patient's rights and responsibilities as outlined.

  • I consent to receive treatment from DMV Medical Group.

I understand that I may withdraw consent at any time by providing written notice.