Patient's Rights and Responsibilities Policy

JPCHC patients are encouraged to read this document to understand their rights and responsibilities as a patient. If you have any concern about your rights or responsibilities, please ask any staff member to contact the JPCHC Chief Executive Officer for assistance.

Patient Appointment Responsibilities:

1.  Confirm your appointment at least one (1) day by text or phone. 

2.  Arrive to your appointment on time – preferably 15 minutes early.

3.  Notify the clinic when you will not be able to come to your appointment by text or phone.

4.  If you are running late, notify the clinic by text or phone.

Please note if you arrive late to any scheduled appointment you may need to be rescheduled. The above requests will help JPCHC to plan schedules and do their best to accomodate patients accordingly.

Patient Rights:

1.  Patients have the right to receive services regardless of age, sex, race, creed, color, religion, ethnic origin, ancestry, marital status, physical or mental disability, gender preference, veteran status or criminal record.


2.  Patients may receive services without regard to one’s ability to pay; if you are unable to pay the full fee for services, a sliding fee scale is available to you. You may examine and receive an explanation of your bill of services. 


3.  Patients have the right to present any complaint or grievance on matters pertaining to services received, or any perceived or actual violation of rights. 


4.  Patients have the right to know of the variety of services that may be available in planning his/her treatment. 


5.  Patients may refuse treatment at any time, and patients have the right to be informed of the consequences resulting from the refusal of treatment.


6.  Patients have the right to involve their relative/guardian in their treatment. 


7.  Patient information released to or requested from other sources requires your written consent. Patient records can be subpoenaed by court order and does not require your signature for release of information. 

8. Patients have the right to review, and obtain a copy of your clinical record in accordance with JPCHC’s policy.

Patient Responsibilities:

1.  Give full information, to the best of your knowledge, about your condition, including symptoms, medications, previous health, etc.

2.  Provide accurate contact information. 

3.  Provide accurate insurance/financial information.

4.  Provide accurate emergency contact information.

5.  Ask questions if you do not clearly understand information or instructions about your care and treatment. 

6.  Follow the treatment plan coordinated by your provider. 

7.  Pay your bill on time and in full. 

8.  Ensure that payment for your care is made promptly and in full. 

9.  Understand your insurance coverage and its limits and any added financial responsibilities you may have. 

10.  Follow JPCHC rules and regulations. 

11.  Be considerate of and respectful to your caregivers, other patients and visitors to the health center.

12.  Not have or use alcoholic beverages or “recreational” drugs in the health center.

13.  Not have firearms or other weapons in the health centers. 

JPCHC Responsibility:

1.  JPCHC is required by the Abused and Neglected Child Reporting Act to report any suspected incidents of neglect or abuse.  JPCHC also have the ethical obligation to report suspected maltreatment of senior citizens or adults.

2.  If at any time patients present a clear and present danger to yourself or to others, JPCHC’s staff may release information that is required to protect you or others. 

3.  JPCHC may restrict or terminate delivery of services to patients who have been evaluated and determined as posing a serious physical threat to staff or others. 

Your comments and concerns are important to us:

We want to hear from you regarding your satisfaction with our care and services, as well as suggestions for improvement. All information is used to support our efforts to continually improve the quality of your care and safety. Should you have a concern that is unresolved, please contact the patient experience department of Jane Pauley Community Health Center.  

Late Arrival Policy


A patient’s late arrival for a scheduled appointment can disrupt office flow and impact the care experience for themselves and others. Though it is Jane Pauley Community Health Center’s desire to provide requested care for all who present, due to a patient’s late arrival, at times rescheduling an appointment will be necessary. JPCHC’s goal is for this to be an infrequent solution to the challenge presented by a late-arriving patient, and for the vast majority of patients who present for care to have their needs met that same day. This policy describes the procedures available in response to a late-arriving patient.



Late: A patient is considered late when they arrive 10 minutes after their scheduled appointment time.

Policy: It is the policy of Jane Pauley Community Health Center (JPCHC) to educate patients about the importance of arriving on time. 

JPCHC asks that all patients:

          1. Confirm their appointments at least one (1) day prior to the appointment either by text within JPCHC’s automated        

               communications system or by calling the practice.

          2. Arrive to their appointments on time. Preferably 15 minutes before the scheduled visit time.

          3. Notify the clinic when they know they will be unable to keep an appointment via text or by phone and/or

          4. Notify the patient service representative (PSR) of the clinic if they are running late via text or by phone.

          5. All patients who arrive late for their appointment without providing notice of the late arrival to JPCHC will be welcomed into 

              the facility and reminded of our request to inform JPCHC that they’re going to be late.

Patients are made aware of JPCHC’s Patient Late Arrival Policy:

          • At time of scheduling by staff and through a link in the text message confirming the appointment.

          • Signage in the lobby.

          • In the new patient packet (if site applicable).


Patients who arrive late for an appointment will be provided one of the following options:

          1. JPCHC will not prohibit access to care and will seek to accommodate the patient’s need the same day when able. To do so the    

               patient will be offered the next available open appointment later on the same day until availability is identified. The following                   options for care will be explored sequentially:

                    o Their preferred provider
                    o A partner provider in the same facility
                    o A JPCHC provider in a regionally close facility

Such re-scheduling may require a prolonged wait by the patient if they choose to accept it or a shortened appointment time.

           2. If the patient cannot be accommodated for a medical appointment the same day, the patient will be directed to be triaged by                    nurse.

                    a)  If the patient opts out, the patient will be rescheduled for a different day.

                    b)  If the patient consents to be triaged, the nurse will assess the patient and provide scheduling recommendations which                                 may include working with the care team to add the patient to that day’s schedule.

          3. New Patients who arrive late may be asked to reschedule due to the length of time it takes to complete intake forms,                    

               registration, and the provider assessment process.


          1. Patient will receive and sign the “Authorization and Acknowledgement Form” confirming that the “Patient Bill of Rights and                         Responsibilities” was received and understood. This form explains JPCHC’s late arrival policy and protocol of how to cancel and                 reschedule appointments. 

          2. If a patient utilizes Medicaid transportation services, they will be allowed to schedule an appointment slot 48 hours in advance                to abide by transportation guidelines. 

          3. If a same day appointment slot is not filled due to prior canceled visits, the practice will use this appointment slot for other                          patients. This shall be determined by the automated call reminder system or during the regular appointment verification                            process performed by front desk staff. 

No Show Policy


A patient who fails to show up for an appointment can disrupt office flow and negatively impact the care experience for themselves and others. JPCHC’s goal is to minimize patient no shows. This policy describes procedures available in response to patients who no show for appointments.



No-show:  An appointment is considered a “no-show” if the patient fails to show up for their scheduled visit without providing advance notice.  

Policy:  It is the policy of Jane Pauley Community Health Center (JPCHC) to educate patients about the importance of keeping their scheduled appointments.


JPCHC asks that all patients:

  1. Confirm their appointments at least one (1) day prior to the appointment by text within JPCHC’s automated communications system or by calling the practice. 
  2. Notify the clinic as soon as possible by text or by phone when they’re unable to make an appointment.  

JPCHC will work to minimize patient no show rates by educating patients and using an automated messaging system as outlined. This policy also addresses barriers to care via JPCHC’s automated platform.

  1.  Patients are made aware of JPCHC’s Patient No Show Policy

·         At time of scheduling by staff and through a link in the text message confirming the appointment.

·         Signage in the lobby.

·         In the new patient packet (if site applicable). 


  1. As a courtesy, patients will be reminded of their scheduled appointments via JPCHC’s automated communication service.
  2. When a patient no shows for an appointment they will receive automated communications from JPCHC’s communication platform via text and/or via phone.

·         One (1) day after appointment time patient will receive a text message no show message.

·         A practice may send additional messages to no shows through the automated messaging system. 

4. Payors may be notified if a patient is a chronic no show to scheduled appointments. The purpose of this notification is to provide the patient with case management resources.


Telehealth (Virtual Visit) Policy

Patients of JPCHC may only receive video/virtual and telemedicine visits when the patient is physical located in the state of Indiana at the time of the encounter.