Patient Rights and Responsibilities

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EFFECTIVE November 1, 2015

The Adolescent Care Team is dedicated to improving the health and enriching the lives of all adolescents.  With the sweeping changes being ushered in by the federal government, we want our patients and families to know our mission has not changed!  The way we will accomplish our mission has changed dramatically.

When you joined our practice, you were directed to this website, which outlines the way our practice works.  These additional guidelines will clarify both our and your responsibilities while continuing medical care with us.  The end result is a Team with everyone on the same playing field, understanding the same rules, and winning!

Access to Care

Our patients will be provided impartial access to quality treatment within the scope of our mission, this practice’s capacity, availability, and applicable law.  Your care will not be affected by your race, creed, sex, national origin, religion, age, disability/handicap or source of payment for care/services.

Respect and Dignity

Our patients, whether adult, adolescent, or child, have the right to considerate, respectful care at all times. We respect your personal dignity and the possibility of psychosocial, spiritual, and cultural variables that influence your perception of illness.  You may wear appropriate personal clothing and religious or other symbolic items, as long as they do not interfere with diagnostic procedures or treatment.

Privacy and Confidentiality

Our patients (or your legal representative as defined by the Health Insurance Portability and Accountability Act [HIPAA]) have the right, within the law, to personal and informational privacy, as manifested by your right to:

      Be interviewed and examined in surroundings designed to assure reasonable audiovisual privacy.  This includes the right to have a person of one’s own sex present during certain parts of a physical examination, treatment, or during any procedure performed by a health professional of the opposite sex.

      Audio or visual office recordings may be used in the clinic to document team member’s actions and are strictly for non-medical use.

     Expect that any discussion or consultation involving your case will be conducted discreetly, and that individuals not directly involved in your care/services will not be present without your permission.  Dr. Hipke’s confidentiality policy, outlined in the Parent Game Plan, will be upheld.

     Have your medical records read only by individuals directly involved in your treatment, monitoring of its quality, or by other individuals as outlined by HIPAA.

     Expect all communications and other records pertaining to your care, including the source of payment for treatment, to be treated as confidential as outlined by HIPAA.

     Request a transfer to another treatment room if another patient or visitor is unreasonably disturbing you.

Personal Safety

Our patients and guests, including adults, adolescents and children, have the right to expect reasonable environmental safety.  Please report any concerns to a Team Member.

Know the Identity of Team Members

Our patients (or your legal representative) have the right to know the identity and professional status of all Team Members providing service to you.  This includes the right to know of the existence of any professional relationship among individuals who are treating you, as well as the relationship of this practice to any other health care/services involved in your care.  This clinic does not participate in clinical training programs or research.


Our patients (or your legal representative) have the right to communicate to anyone outside the practice by verbal and written communication.  You can bring visitors to the clinic, but they may not be able to stay with you during the whole visit.  When you (or your legal representative) do not speak or understand English well, you should ask an interpreter to come to the office.  This is particularly true where language barriers are a continuing problem.  If you speak a language other than English, language assistance services are available to you free of charge.  Check with Dr. Hipke to access those services.

Our communication will be with the patient.  Further communication may be with patient’s legal representative, to the extent permitted by law, if the patient:

  • Has been adjudicated incompetent in accordance with the law
  • Is found to be medically incapable of understanding the proposed treatment or procedure
  • Is unable to communicate his or her wishes regarding treatment
  • Is a minor (within the boundaries of confidentiality)

Information and Consents

Our patients (or your legal representative) have the right to obtain complete and current information concerning your diagnosis (to the degree known), treatment, alternatives of treatment and any known prognosis within the guidelines of HIPAA confidentiality.  This information will be communicated in terms you can reasonably be expected to understand.

To the degree possible, this should be based on a clear, concise explanation of your condition and of all proposed technical side effects, problems related to recuperation, and probability of success.

You should not be subjected to any procedure without a voluntary, competent, and understanding consent. 

Our patients (or your legal representative) have the right to know who is responsible for authorizing and performing any procedure or treatment.

Refusal of Care

Our patients (or your legal representative) have the right to accept medical care/services or to refuse treatment to the extent permitted by law.  You will be informed of the medical consequences of your refusal.  When your (or your leagl representative’s) refusal of treatment prevents the provision of appropriate care/services in accordance with ethical and professional standards, the relationship with the patient may be terminated upon reasonable notice.

Transfer and Continuity of Care

Our patients have the right to considerate and respectful care within the scope of our mission.  Should you need a service not provided by our clinic, you have the right to be assisted in transferring to another healthcare entity that can provide the needed service.  If transfer is recommended or requested, you (or your legal representative) will be informed of your risks, benefits and alternatives.

Request to Review Charges

Regardless of the source of payment for the individual’s care/services, our patients (or their legal representative) have the right to request and receive an itemized and detailed explanation of your total bill for services rendered in the clinic.

Voice Complaints and Grievances

Our patients are entitled to information about the mechanism for the initiation, review and resolution of patient complaints.  You can voice your complaint to any Team Member who is empowered to resolve it as quickly as possible.  Complaints will not compromise your access to care or quality of treatment.  You may also address complaints to the Texas State Board of Medical Examiners, 333 Guadalupe, P.O. Box 2018, MC-263, Austin TX 78768-2018, or by calling 1-800-201-9353.

Patient's Responsibilities

Our patients (and/or legal representative) will have certain responsibilities after joining The Adolescent Care Team.  If you have any questions, our Team Members would be honored to help.

Keep Your Doctor Accurately Informed

Because Dr. Hipke is your primary physician, you (or legal representative) have the responsibility to provide, to the best of your knowledge, accurate and complete information about current complaints, past illnesses, hospitalizations, medications and other matters relating to your health, including unexpected changes in your condition, seeing other providers, etc.  Likewise, changes in your address, phone number, marriage status, email address or insurance should be forwarded to our office.

Ask for Clear Explanations

If the explanation of your diagnosis or treatment is not clear, ask for the information you need.  Patient education is an integral part of your treatment plan.  You have the right to as much information as you need.

Follow Your Treatment Plan

You (or legal representative) are responsible for following the treatment plan recommended by Dr. Hipke.  This may include following the instructions of health care personnel as they carry out the coordinated plan for your care.  Patients (or your legal representative) are responsible for your actions if you do not follow through with the prescribed treatment plan.  We ask you notify Dr. Hipke if you feel unable to follow the plan.

Keep Your Appointments

You (or legal representative) are responsible for keeping appointments and, when unable to do so for any reason, for notifying the clinic 24 hours in advance.  If Annual/Wellness Visits are missed, all care at The Adolescent Care Team, except for medical emergencies and Red Card calls, will be suspended until it is caught up.

Be Responsible For Your Financial Obligations

You (or your legal representative) are responsible for assuring that the financial obligations of health care/services are discussed with Dr. Hipke and for providing updated insurance information.

Best Behavior

You (and your legal representative) are responsible for following practice rules and are asked to be on your best behavior while here.  Family members and visitors will be required to be on their best behavior.  Small children will need to be supervised; Team Members will request increased supervision if needed.

Be Considerate of Others

You (and your legal representative), family members and visitors are responsible for being considerate of the rights of other patients and Team Members, for assisting in noise control and for limiting the number of visitors.  We are a non-smoking facility.  You are also responsible for being respectful of the practice property as well as property of other guests visiting our office.

Be Responsible for Your Own Lifestyle Choices

Your health depends not just on your care/services but in the long term, on the decisions you make in daily life.  You are responsible for recognizing the effect of your lifestyle on your personal life.


Dr. Hipke helps adolescents and their families every day and is proud to have you as a member of the Adolescent Care Team!  We take our mission very seriously and hope to continue to serve each adolescent into adulthood to the best or our abilities!

(The Adolescent Care Team reserves the right to change this Notice without notice.  Updated Patient Rights and Responsibilities copies are available on this website. Click here and you may print a pdf copy of this policy along with its signature page.

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