Medical Home Agreement

Your Medical Home PCP is responsible for:

1. Honoring your rights as a patient and treating you with dignity and respect.
2. Listening to your concerns, educating you on your health care needs, and preventive services.
3. Treating you as a whole person: physically, mentally, and emotionally.
4. Providing you with ongoing quality and safe medical care, including prevention of
future health complications.
5. Working to schedule timely office appointments for your chronic and urgent
healthcare needs.
6. Being available to you 24 hours a day, by office appointment, phone calls, and/or other electronic communication.
7. Providing you with other healthcare resources when they are absent or unavailable.
8. Providing you with referrals to specialists as deemed medically necessary by your
PCP.
9. Providing you with treatment, medications, equipment, and any other resources
deemed medically necessary by your PCP.

As a Medical Home Patient, you are responsible for:

1. Working with your PCP to meet all of your health care needs.
2. Communicating with your PCP about all your healthcare concerns and goals.
3. Reporting any changes related to your health, treatments, medications, etc. This includes the use of all medications - prescription, over-the-counter, herbal, and street drugs. This also includes any medical equipment being used or that has been ordered or recommended for use.
4. Calling your PCP before going to the Emergency Room, unless it is life-threatening.
5. Notifying your PCP after any Emergency Room, Urgent Care Clinic, or Hospital visit.
6. Scheduling medical appointments in a timely manner, including follow-up appointments.
7. Keeping appointments as scheduled with your PCP and any appointments scheduled with a specialist.
8. Calling before your appointment time to cancel or reschedule the appointment as soon as you are aware that you will not be able to make the appointment.
9. Understanding that you may be dismissed from your PCP if you repeatedly miss appointments without notice or do not follow the responsibilities listed in the medical home agreement.