PATIENTS FEE

Payson Christian Clinic suggested donation for services is $20 for the office visit and basic lab orders.

Any additional family member would have a suggested Payson Christian Clinic Donation of $5 during the same visit.

Immediate family members are defined as mother, father, child under 18 years of age living with their parent or guardian, or a guardian of a parent or adult child living in the same household.

Additionally, if the patients say they don’t have any money, the Clinic will offer 20 dollars for any food or medicine expenses.

PATIENT RIGHTS & RESPONSIBILITIES

As a patient of the Payson Christian Clinic, you have the following rights:

• You are to be treated respectfully, with consideration and dignity.
• You shall NOT be:
  • Treated with abuse, neglect, exploitation, coercion, manipulation, sexual abuse, sexual assault.
  • Subject to restraint or seclusion (except… see section R9-10-1012(B).
  • Subject to retaliation for submitting a complaint to the DHS or another entity.
  • Subject to misappropriation of personal and private property by any member of our staff.
  • Discriminated against based on race, national origin, religion, gender, sexual orientation, age, disability, marital status or diagnosis.
• You may provide written consent to the release of information for your medical or financial records to another individual.
• You have the right to:
  • Consent or refuse treatment (except in an emergency);
  • Refuse or withdraw consent for treatment before the treatment is initiated;
  • Review Payson Christian Clinic policy on health care directives;
  • Review Payson Christian Clinic policy on the patient complaint process (see Grievances);
  • Consent or refuse being photographed;
  • Receive treatment that supports and respects your individuality, choices, strengths, and abilities;
  • Receive privacy in treatment and care for personal needs;
  • Review, upon written request, the patient’s own medical record according to DHS requirements;
  • Receive a referral to another health care institution if Payson Christian Clinic is not able to provide or treat you;
  • Participate in the development of, or decisions concerning your treatment; and
  • Receive assistance from a family member, patient representative or other individual in understanding, protecting or exercising your patient rights.

As a patient of the Payson Christian Clinic, you have the following responsibilities:

• The patient shall provide Payson Christian Clinic with accurate and complete information about present complaints, past illness, hospitalizations, medications and other matters relating to your health.
• The patient is responsible for following the treatment plan recommended by the practitioner responsible for your care.
• The patient is responsible for their own actions and if they refuse treatment or do not follow the practitioner instructions.
• The patient is responsible for keeping their appointment or cancelling well in advance.

If you have a comment or complaint, please contact the PCC Administrator:  Marion Cobo at 928-468-2209

If you are still dissatisfied, you may contact the Arizona Department of Health at:

AZ Dept. of Health, 602-364-3030, 150 N. 18^th Ave., Suite 450, Phoenix, AZ 85007-3242

Download Section : PCC related forms and documents (pdfs)