As a client/patient of Elite Mental Health & Wellness, LLC, provider Rhonda Dolen-Hooker, FNP-BC, PMHNP-BC, you have certain rights and responsibilities. Understanding your rights and responsibilities will assist you in receiving the best possible care.

The providers, clinicians, and staff will make every effort to respect your Patient Rights and meet your expectations as follows:

• Provide a welcoming, friendly, professional and respectful environment;

• Be on time for your scheduled appointments unless unforeseen circumstances arise;

• Create a therapeutic relationship with the foundation of trust and respect;

• Be clear about the therapeutic process and attendance expectations, along with problem solving barriers to treatment;

• Be responsive to your requests and follow through in a reasonable amount of time;

• Allow you to express a concern or complaint and receive a prompt response; you have the right to file a formal grievance if you are not satisfied with the resolution of your complaint;

• Receive a clear explanation of all rules, regulations, and guidelines;

• Be provided the opportunity to examine and receive an explanation of your bill/fees regardless of the source of payment;

• Be informed you are receiving your psychiatric care by a certified nurse practitioner and you have the right to consult with a physician at any time;

• Be informed when you are receiving mental/behavioral health care from a trainee or intern, which you can decline and request to see a licensed professional therapist/counselor at any time;

• Be involved in your assessment, treatment planning, evaluation, and discharge planning which, with your consent, be conveyed to your current or future health care provider(s) any recommendations regarding your treatment;

• Keep all communications and records about your care confidential;

• Provide you with a copy of your health care record upon written request, allowing a minimum of 30 business days for request completion;

• Be provided all the appropriate and necessary information you might need to make an informed decision regarding your healthcare, including information about alternative treatment measures, risks and benefits of treatment verses non­treatment, potential treatment outcomes, possible deleterious effects of treatment, who is providing your care, and costs of services;

• Be provided clear written and spoken information in words you can understand;

• Be provided with all available information about possible research participation and obtain your informed consent;

• Be provided with freedom from any type of restraints or seclusion, including chemically-based restraints, that is not medically necessary;

• Respect your decision to decline care;

• Be treated with consideration and respect in a safe environment from all forms of abuse and harassment;

• Respect your privacy.

We ask that you make every effort to adhere to your Patient Responsibilities and make every effort to meet the agency's expectations as follows:

• Be friendly and respectful of staff and other clients/patients;

• Arrive on time; if you are more than 15 minutes late, we consider you a no-show;

• Keep all scheduled appointments or call at least 24 hours ahead of your scheduled appointment time if you need to cancel or reschedule your appointment; failure to do so will be regarded as a no-show and the No-Show, Late & Cancellation Policy may be implemented;

• Actively participate in your treatment and follow your treatment plan to achieve your identified goals for recovery.

• Alert your provider/clinician if you have concerns or feel your rights have not been properly respected;

• Asking for clear explanations and information in order to make well-informed and educated decisions regarding your care and treatment;

• Respect our facility and make every effort to keep it clean and tidy;

• Follow all rules and guidelines of our agency;

• Inform your provider/clinician of the effectiveness of your treatment;

• Pay your charges/fees/bills promptly;

• Contact the agency if you have any questions or financial issues;

• Provide the agency with the most up-to-date address, phone number(s), email address, health insurance information, employment, and any and all other pertinent patient/client information necessary in order for the provider/clinician to provide effective and comprehensive care;

• Provide your provider/clinician with any changes in your health status as soon as possible after occurrence in order to receive safe and effective services/treatment;

• Convey full information about your health including, but not limited to, medical, psychiatric, and substance use conditions and disorders to your provider/clinician in order to receive safe and effective services/treatment.

***Regular attendance and engagement in the treatment process is vital. We expect individuals to keep all scheduled appointments. We have a No-Show, Late, & Cancellation Policy. An alternative scheduling plan will be put into place if you have two (2) consecutive no­ show/late cancellation events within a 60 day period. Clients/Patients who repeatedly cancel, even with notice, may also be provided with an alternative scheduling plan. Alternative scheduling plans will be at the discretion of the provider.***

If you have a concerns or question, you may tell any staff member and expect assistance. It is your right to express a concern or a complaint and receive a quick response. Furthermore, all communications are guaranteed to be handled in a confidential manner. No adverse reaction will occur because of any comments you make. We value your opinion and use all comments, both positive and negative, to improve our services.

Any comments, complaints, concerns, or requests may be put into writing and addressed to:

Rhonda Dolen-Hooker, FNP-BC, PMHNP-BC

5780 Osage Beach Pkwy, Ste 205B

Camdenton, MO 65020

Main (calls): 573.217.4767

Direct (calls and texts): 417.822-7272

After Hours (calls and texts): 573.410.9777

Thank you for entrusting your care to Elite Mental Health & Wellness, LLC!