Patient rights form

A patient rights Form is a document that outlines the rights of patients in a healthcare setting. It is important for patients to be aware of their rights so that they can be treated with respect and dignity. The form should be made available to patients upon their arrival at the healthcare facility.

Time to complete

2 minutes

Eligibility

Every patient who is admitted to the hospital has the right to fill out the patient rights form.

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Questions for Patient rights form

1.

Have you ever been a patient in a hospital or other medical facility?

The answer should be a single choice:
  1. Yes
  2. No
2.

If yes, did you feel that your rights as a patient were respected?

The answer should be a single choice:
  1. Yes
  2. No
3.

If not, please explain what happened that made you feel that your rights were not respected.

The answer should be a text input.
4.

Do you feel that you know your rights as a patient?

The answer should be a single choice:
  1. Yes
  2. No
5.

If not, please list the rights you feel you are entitled to as a patient.

The answer should be a text input.
6.

Have you ever been denied medical treatment?

The answer should be a single choice:
  1. Yes
  2. No
7.

If yes, please explain the circumstances under which you were denied treatment.

The answer should be a text input.
8.

Have you ever been refused access to your medical records?

The answer should be a single choice:
  1. Yes
  2. No
9.

If yes, please explain the circumstances under which you were denied access to your records.

The answer should be a text input.

Similar Ideas

  • Patient information form
  • Patient history form
  • Patient consent form
  • Patient release form

Here are some FAQs and additional information
on
Patient rights form

What are patient rights?

Patient rights are the protections and privileges that patients have with respect to their medical care. They include the right to receive information about their condition and treatment, the right to make decisions about their care, and the right to be treated with respect and dignity.

What are some of the most important patient rights?

The most important patient rights include the right to receive information about their condition and treatment, the right to make decisions about their care, and the right to be treated with respect and dignity.

What are my rights as a patient?

As a patient, you have the right to receive information about your condition and treatment, the right to make decisions about your care, and the right to be treated with respect and dignity.

What if I don't want to be treated?

You have the right to refuse treatment. However, if you refuse treatment, you may be liable for the costs of your care.

Can I be forced to have a certain treatment?

No, you cannot be forced to have a certain treatment. However, if you refuse treatment, you may be liable for the costs of your care.

What if I can't make decisions about my care?

If you are unable to make decisions about your care, your legal guardian or health care proxy can make decisions for you.

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