Chronic Care/Disease Management and Case Management Patient Bill of Rights and Responsibilities

When you participate in a Chronic Care/Disease Management or Case Management Program, you have certain rights and responsibilities.

You have the right to:

• Know the philosophy and characteristics of the Program.
• Have personally identifiable health information shared by the Program only in accordance with state and federal law.
• Know the identity and job title of staff members and speak with a supervisor upon request.
• Receive accurate information from the Program.
• Receive administrative information regarding changes in or termination of the Program.
• Decline participation, revoke consent or disenroll at any point in time.

You have the responsibility to:

• Submit any forms that are necessary to participate in the Program to the extent required by law.
• Give accurate clinical and contact information, and notify the Program of changes in this information.
• Notify your treating provider of your participation in the Program (if applicable).