Give accurate and complete health information about your past medical history, including hospitalizations, medications, allergies, and other important health-related information.
Submit any forms that are necessary to participate in the program to the extent required by law.
Notify treating providers of your participation in Eli Pharmacy’s Patient Management Program.
Inform Eli Pharmacy immediately if scheduled prescription dispensing requires cancellation.
Notify your physician and Eli Pharmacy if you choose to end therapy.
Follow your pharmacy plan of care and remain under a physician’s care while receiving Eli Pharmacy services.
Be responsible for costs related to your care which are not covered by Medicaid, Medicare, or other payers.
Notify Eli Pharmacy if you require clarification or have any concerns that have not been addressed.
In accordance with the FDA (CPG Sec. 460.300 Return of Unused Prescription Drugs to Pharmacy Stock), we are not allowed to take returns of any medications once they leave the pharmacy. If there are any issues with the medication, it is the patient’s responsibility to report those issues or missing packages within 2 weeks after the prescription was dispensed. Otherwise, the patient will be responsible for paying the required copay again for their replacement.
Considerate and respectful care from your pharmacists and other healthcare professionals in a manner that supports your dignity.
Receive care and communication that is respectful to your personal and cultural values, beliefs, and preferences.
Receive complete and accurate information about the scope of services that Eli Pharmacy will provide and specific limitations on those services.
Receive relevant, accurate, current and understandable information from your pharmacist concerning your treatment and/or drug therapy.
Receive complete and accurate information from your pharmacist regarding the reason for your treatment and/or drug therapy, the proper use and storage of prescribed medications and the possible adverse side effects and interactions with other drugs, supplements or foods.
Receive effective counseling and education from your pharmacist that empowers you to take an active role in your health condition and treatment decisions.
Make non-emergency decisions regarding your plan of care before and during treatment, as well as refuse any recommended treatment, therapy or plan of care after being informed of the consequences of refusing treatment, therapy or plan of care.
Expect that all dispensed medications you receive are safe, accurately dosed, effective and in usable condition.
Expect that all records, communication, patient counseling by your pharmacists and all related discussions regarding your drug therapy, including its effects and side effects, are conducted in a manner that protects your privacy.
Receive appropriate care without discrimination in accordance with physician orders.
Seek or receive pain management services without discrimination.
Be advised if a medication has been recalled at the consumer level.
Call Eli Pharmacy with any privacy matters and ask for the Privacy Officer; or contact us through our website, www.elipharmacy.com.
Voice your grievances/complaints regarding treatment of care, lack of respect or to recommend changes in policy, personnel, or care/service without restraint, interference, coercion, discrimination, or reprisal, and have your grievances/complaints investigated.
Call Eli Pharmacy with grievances/complaints about your medication and ask for the Pharmacy Manager, or contact us via email at email@example.com, or you also may contact GA Board of Pharmacy at GA Board of Pharmacy: 2 Peachtree St,NW 6th Fl. Atlanta, GA 30303 (404)651-8000
Expect that your personal data, including all contact information, is not released by pharmacists, pharmacies or insurance companies to another party to be used in soliciting the purchase of goods or services, whether or not the solicitation is related to your care.
Choose the pharmacist and pharmacy provider where your prescriptions are filled and to not be pressured or coerced into transferring your prescriptions to another pharmacy or mail-order service. However, some insurers may have mandatory benefit plans that require you to use a specific pharmacy if the insurance company is paying the drug cost.
Choose a health care provider, including choosing an attending physician, if applicable.
Receive, in advance of care/services being provided, complete oral and written explanations of charges for care, treatment, services and equipment, including the extent to which payment may be expected from Medicare, Medicaid, or any other third-party payer, charges for which you may be responsible, and an explanation of all forms you are requested to sign.
Be informed of any financial benefits that might accrue when referred to an organization.
Be advised of any change in Eli Pharmacy’s plan of service before the change is made.
Receive information in a manner appropriate for your age, language, and ability to understand (vision, speech, hearing, or cognitive impairments).
Have family members or identified surrogate decision makers, as appropriate and as allowed by law, and with your authorization or the authorization of your personal representation, be involved in your care and treatment, and/or service decisions affecting you if you are unable to do so and have those decisions respected.
Be provided to you, or a surrogate decision maker, information pertaining to the outcomes of care or services needed to participate in current and future health care decisions, and information on any sentinel event arising from provided services.
To request and receive complete up-to-date information relative to your condition, treatment, alternative treatments, risk of treatment or care plans.
To request and receive, or make changes to disclosures of your health information, in accordance with law and regulation.
To know or ask how to access support from consumer advocates.
To speak to a health professional.
For pharmacy health and safety information to include patient’s rights and responsibilities.
To know about the philosophy and characteristics of the patient management program.
Have personal health information shared with the patient management program only in accordance with state and federal law.
Identify the staff member of the patient management program and his or her job title, and speak with a supervisor of the staff member, if requested.
Receive information about the patient management program.
Receive administrative information regarding changes in or termination of the patient management program.
Have one’s property and person treated with respect, consideration, and recognition of patient dignity and individuality. Be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property.
Decline participation, revoke consent, or disenroll at any point in time from the patient management program.
Be advised on agency’s policies and procedures regarding the disclosure of clinical records.
Be fully informed of your responsibilities.
Receipt of the Patient Bill of Rights and Responsibilities serves as notice that the patient has received and understands all information enclosed. It is the patient’s responsibility to contact Eli Pharmacy with any questions pertaining to the details therein. A patient’s failure to comply with these provisions absolves Eli Pharmacy from impropriety, and may result in termination of the relationship with the patient.