UnityPoint Health Specialty Pharmacy

Participating Patient Rights and Responsibilities

Upon enrollment of an eligible patient; the patient management program conveys information on rights and responsibilities to participating patients including:

(a) The right to know about philosophy and characteristics of the patient management program;

(b) The right to have personal health information shared with the patient management program only in accordance with state and federal law;

(c) The right to identify the program's staff members, including their job title, and to speak with a staff member's supervisor if requested;

(d) The right to speak to a health professional;

(e) The right to receive information about the patient management program;

(f) The right to receive administrative information regarding changes in, or termination of, the patient management program;

(g) The right to decline participation, revoke consent; or disenroll at any time;

(h) The responsibility to submit any forms that are necessary to participate in the program, to the extent required by law;

(i) The responsibility to give accurate clinical and contact information and to notify the patient management program of changes in this information; and

(j) The responsibility to notify their treating provider of their participation in the patient management program, if applicable.