Your Rights As Our Patient

ACCESS - Appointments are provided within a reasonable period of time. Discount programs available for individuals based on family size and income. You will not be denied health care services due to your inability to pay.

Clinica Family Health does not discriminate against any person on the basis of race, color, national origin, disability, religion, gender, gender identity, sexual orientation, or age in admission, treatment, or participation in its programs, services, activities, or employment.

Clinica will make accommodations when requested to provide care in your preferred language. You may request other reasonable accommodations related to any disability you may have. For further information about this policy and other accommodations and non-discrimination policies of Clinica, refer to our Accommodations, Nondiscrimination & Accessibility page on our website.. To contact our 504 Coordinator at 303-665-3036, ext. 1550 or email: 504 Coordinator TDD: 1-800-659-2656

All patients have the right to select their pharmacy of choice, diagnostic imaging and test center(s) and preferred specialist. Patients are under no obligation to use Clinica facilities for these services.

DIGNITY - Care is provided in a manner that respects your individuality and dignity. This includes being told by your care givers what your condition is, what treatment they recommend, how they expect your condition to change, and what follow-up care is needed.

PRIVACY - All physical exams, interviews, and discussions about your health care, including appointment check-ins, will occur privately, and your health records will be handled confidentially. Clinica Family Health will handle all of your records in compliance with federal and state privacy laws (HIPAA) and will abide by the terms of this notice.

EMPLOYEE IDENTIFICATION - You have the right to know the names, professional status, and experience of the staff providing your care.

CONSENT - Consent for treatment will be requested by our medical staff before any procedure is performed. The procedure - as well as its value, risks, and other options for treatment - will be explained.

REFUSAL OF TREATMENT - You have the right to refuse any care recommended. You have the right to change your mind before undergoing a procedure for which you have already given your consent.

ACCESS TO RECORDS - You may review or receive a copy of your medical record within 30 days of your written request. Complaints about access to your records can be addressed to the Colorado Department of Public Health and Environment https://www.colorado.gov/cdphe

BILLS - You have a right to an explanation of all charges and discount program adjustments if you qualify for Clinica's discount program.

FILE A COMPLAINT OR GRIEVANCE - You have the right to file a complaint if you are not satisfied with any aspect of your care. You can file a complaint using any of the following methods:

  1. Contact Clinica Family Health at 303-650-4460 and ask to “file a complaint”
  2. You may send a complaint or grievance in writing to:
    VP of Operations
    c/o Clinica Family Health
    1735 S. Public Road
    Lafayette, CO 80026
  3. You may fill out a Your Comments Count feedback card that can be picked up in the clinic
  4. Contact Health and Human Services at www.HHS.gov.

CHANGE YOUR PROVIDER - You have the right to request a change of provider or clinic if another qualified provider is available. For information about how to request a change of provider or clinic, contact Clinica’s Communication Center at 303-650-4460.

USE OF YOUR HEALTH INFORMATION - Clinica Family Health is permitted to use or disclose your health information for the purposes of treatment or payment, or if the disclosure is required by law and the information released does not include any identifiable information.

Also see Patient Responsibilities