Your Rights and Responsibilities:
Active communication between you and your provider, as well as others on your health care team, helps us provide you with the most appropriate and effective care.
We want to make sure you receive the medical information you need about your health care plan, the people who provide your care, and the services available, including important preventative care guidelines.  Having this information contributes to your being an active participant in your own medical care.
As an adult member, you exercise these rights yourself.  If you are a minor or unable to make decision about your medical care, these rights will be exercised by the person with the legal responsibility to participate in make these decisions for you.
You have the right to:
  • Considerate and respectful care, personal dignity and to be made comfortable. You have the right for your cultural, psychological, spiritual, and personal values, beliefs, and preferences to be respected.
  • Know the name of the health care provider who has primary responsibility for coordinating your care and the names and professional relationships of other staff you may see.
  • Receive information about your health status, diagnosis, prognosis, course of treatment, prospect for recovery and outcomes of care (including unanticipated outcomes) in terms you can understand. You have the right to effective communication which address any vision, speech, hearing, language, or cognitive impairment, including the provision of interpretation and translation services, and to participate in development and implementation of your own plan of care. You have the right to participate in ethical questions that arise in the course of your own care.
  • Make decisions regarding medical care and receive as much information about any proposed treatment or procedure as you may need in order to give informed consent or to refuse a course of treatment. You may include family and others in your decision-making process. Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved, alternate course of treatment or non-treatment and the risks involved in each, and the name of the person who will carry out the procedure or treatment.
  • Receive personal medical records. You have the right to review and receive copies of your medical records, subject to legal restrictions and any appropriate copying or retrieval charge(s). You can also designate someone to obtain your records on your behalf.  We will not release your medical information without your written consent, except as required or permitted by law.
  • Request/refuse treatment or leave the facility, even against the advice of the health care provider, to the extent permitted by law. You are not permitted to demand inappropriate or medically unnecessary treatment or services.
  • Be advised if the facility proposes to engage in or perform experimentation affecting your care or treatment. You have the right to refuse to participate in such research projects.
  • Reasonable responses to any reasonable request made for service.
  • Appropriate assessment and management of your pain, information about pain, and pain relief measures.
  • Provide advance directives. All patients’ rights apply to the person who has legal responsibility to make decisions regarding medical care on your behalf.
  • Confidential treatment of all communications and records pertaining to your care. You will have access to a separate “Notice of Privacy Practices” that explains your privacy rights in detail and how we may use and disclose your protected health information. You have the right to be told the reason for the presence of any individual. You have the right to have visitors leave prior to an examination and when treatment issues are being discussed. You have the right to request access to a place and phones to conduct private phone conversations.
  • Receive care in a safe setting, free from mental, physical, sexual, or verbal abuse and neglect, exploitation, or harassment. You have the right to access protective and advocacy services including notifying government agencies of neglect or abuse.
  • Be informed by the health care provider, or a delegate of the provider, of continuing healthcare requirements You have the right to be involved in the development and implementation of your treatment plan.
  • Designate visitors of your choosing, if you have decision-making capacity, unless the facility reasonably determines that the presence of particular visitor would endanger the health or safety of a patient, a member of the health facility staff or other visitors or you have requested you no longer want a person present.
  • Examine and receive an explanation of the medical bill regardless of the source of payment.
  • Exercise these rights without regard to sex, economic status, educational background, race, color, religion, ancestry, national origin, disability, sexual orientation, or marital status.
  • File a grievance. If you wish to file a grievance, you may do so in writing addressed to Coastal Family Urgent Care, 6260 El Camino Real, Suite 101, Carlsbad, CA 92009, or by calling our office manager at (760) 448-6650.
  • File a complaint with the state Department of Health Services. The state Department of Health Service’s phone number and address is: 7575 Metropolitan Drive, Suite # 104, San Diego, CA 92106 (619) 278-3700.
  • File a complaint with The Joint Commissions by phone 1-800-994-6610 or email
You are responsible for:
  • Providing accurate information. Patient/patient’s representative must provide to the best of their knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and matters relating to their health. Patient/patient’s representatives must report perceived risks in their care and unexpected changes in their condition.
  • Asking questions. Patient/patient’s representative must ask questions when they do not understand their care, treatment, service or what they are expected to do.
  • Following instructions. Patient/patient’s representative must follow the care, treatment and service developed. They should express their concerns about their ability to follow the proposed care plan or course of care, treatment, and services. Our providers make every effort to adapt the plan to the specific needs and limitations of the patient.
  • Accepting consequences. Patient/patient’s representative is responsible for the outcomes if they do not follow the care, treatment, or service.
  • Showing respect and consideration. Patient/patient’s representative must be considerate of the staff and property as well as other patients and their property.
  • Meeting your financial commitments. Patient/patient’s representative should promptly meet any financial obligation agreed to.


Updated June 2020