> provide a consultation (including appropriate treatment) with a clinician on the basis of your clinical need. > enable you to choose to have a relative or friend with you during consultations and examinations or provide a trained chaperone if you prefer. > understand that you might be feeling anxious and vulnerable. > inform you on arrival at an appointment if delays are occurring. > enable you to take part in all decisions about your treatment and to have the advantages and disadvantages of treatment, including any risks, side effects and alternative methods of treatment, fully explained > encourage you to ask questions about your diagnosis and treatment and provide clear information > treat with confidence details about you, including your medical records and anything you say, except where we are required by law to divulge information. > ensure that you know the names of all the members of our team involved in your care > provide an explanation and, where appropriate, an apology if you are unhappy with our service. As a patient, you also have a responsibility… > to treat the surgery team who care for you with courtesy and respect at all times > to inform the surgery immediately of any change in contact address or telephone number > to attend appointments on time, or give reasonable notice if you cannot attend in consideration of other patients of the practice who may need an appointment. > to appreciate that there are pressures and limitations of resources on the health service and those working within it that are sometimes outside of our immediate control. > to consider the consequences of refusing treatment or not following medical advice and accept responsibility for your own actions > to give clinical members of staff full information about your condition including any disabilities, any medicines you are taking and any lifestyle factors that may be relevant to your condition. > to tell a member of clinical staff if you are uncertain or don’t understand any aspect of your treatment > to tell a member of clinical staff staff about any change in your health that could affect the treatment you are having > to take any medicines as instructed and seek medical advice before stopping or changing treatment and to let the staff know if you have any allergies or sensitivities to medications Patient signature: Surgery signature: ………………………… ……………………….. Date: Date: …………………………………… …………………………………………
> provide a consultation (including appropriate treatment) with a clinician on the basis of your clinical need. > enable you to choose to have a relative or friend with you during consultations and examinations or provide a trained chaperone if you prefer. > understand that you might be feeling anxious and vulnerable. > inform you on arrival at an appointment if delays are occurring. > enable you to take part in all decisions about your treatment and to have the advantages and disadvantages of treatment, including any risks, side effects and alternative methods of treatment, fully explained > encourage you to ask questions about your diagnosis and treatment and provide clear information > treat with confidence details about you, including your medical records and anything you say, except where we are required by law to divulge information. > ensure that you know the names of all the members of our team involved in your care > provide an explanation and, where appropriate, an apology if you are unhappy with our service. As a patient, you also have a responsibility… > to treat the surgery team who care for you with courtesy and respect at all times > to inform the surgery immediately of any change in contact address or telephone number > to attend appointments on time, or give reasonable notice if you cannot attend in consideration of other patients of the practice who may need an appointment. > to appreciate that there are pressures and limitations of resources on the health service and those working within it that are sometimes outside of our immediate control. > to consider the consequences of refusing treatment or not following medical advice and accept responsibility for your own actions > to give clinical members of staff full information about your condition including any disabilities, any medicines you are taking and any lifestyle factors that may be relevant to your condition. > to tell a member of clinical staff if you are uncertain or don’t understand any aspect of your treatment > to tell a member of clinical staff staff about any change in your health that could affect the treatment you are having > to take any medicines as instructed and seek medical advice before stopping or changing treatment and to let the staff know if you have any allergies or sensitivities to medications Patient signature: ………………………… Date: …………………………………… Surgery signature: ……………………….. Date: …………………………………………
New-Pt-Form-Jan-2018-with-pt-contract.docx