Rights and Responsibilities

​You have a right to:

    • Respectful treatment and privacy. You have the right to be treated with respect, giving due consideration to your right to privacy and need to maintain confidentiality of your medical information. You also have the right to be free of any form of restraint or seclusion used as a means of coercion, discipline, or retaliation.
    • Choice and involvement in your care. You have the right to participate in decision making regarding your own health care, including your right to refuse treatment. You have a right to receive information on available treatment options and alternatives, presented in a manner appropriate to your condition and ability to understand, regardless of cost or benefit coverage. You also have the right to make advance directives.
    • Have access to health care. You have a right to be provided with information about PHC and its services, including covered services. You also have the right to choose a Primary Care Provider within PHC's network.
    • Have access to special services. You have the right to have access to a women's health specialist and Minor Consent Services. You also have a right to receive care from an out of network certified nurse mid-wife or certified nurse practitioner if you can't get care from the providers in our network.
    • Have access to family planning services. You have the right to have access to family planning services, Federally Qualified Health Centers (FQHC), American Indian Health Services Facilities, sexually transmitted disease services and emergency services outside PHC's network.
    • File a grievance either verbally or in writing about the PHC or the care you received. You can ask assistance from a patient advocate, provider, ombudsperson or any other person you choose. You also have the right to request an expedited grievance in instances that may involve a serious threat to your health such as severe pain, loss of limb and or life.
    • File an appeal. You have the right to request a review and resolution of an appeal within 60 days when PHC or a PHC delegated entity denies, delays or modifies a requested service. The appeal can be requested orally, but must be followed by a written appeal. You may also request an expedited appeal in instances that may involve a serious threat to your health such as severe pain, loss of limb and or life will cause severe harm to your health.
    • File a State Hearing.  You have the right to request a State Hearing if you have filed an appeal and received a "Notice of Appeal of Resolution" letter telling you that PHC will still not provide services or you never received a "Notice of Appeal of Resolution" letter telling you of the decision and it has been past 30 days. You also have the right to information about how to get an Expedited State Hearing.
    • Information in your language. You have the right to request an interpreter at no charge to you. You should not use children to interpret for you. You also have the right to get the Member Handbook and other information in another language or format (such as audio, large print, or Braille).
    • Access your medical records. You have the right to have access to, and where legally appropriate, receive copies of, amend or correct your medical records.
    • Know your rights. You have a right to exercise these rights without adversely affecting how you are treated by PHC, providers or the State. You also have a right to receive information about your rights and responsibilities, and to make recommendations about these rights and responsibilities.
    • Talk to an Advice Nurse about health questions or worries about your symptoms. PHC provides free telephone Advice Nurse Services, 24 hours a day, 7 days a week. The number for PHC's Advice Nurse is (866) 778-8873.

As a member of PHC, you have a responsibility to:

      • Treat your provider with respect and courtesy. You are responsible for treating your provider(s) and their staff in a respectful and courteous way. You are responsible for showing up to your appointments on time. If you're unable to make an appointment, you must call your provider at least 24 hours before the appointment, to cancel or reschedule.
      • Treat PHC staff with respect and courtesy. You are responsible for treating PHC staff in a respectful and courteous way. You are responsible for making requests, such as for transportation, in advance, and calling PHC to cancel any transportation if you have to cancel or reschedule your medical appointment.
      • Play an active part in your care. You are responsible to provide, to the extent possible, information that PHC and its medical providers need in order to care for you. You are responsible for talking to your medical provider about things you can do to improve your overall health.
      • Understanding treatment options. You are responsible to understand treatment options and participate in developing mutually agreed upon treatment goals to the degree possible.
      • Calling your provider. You are responsible for calling your provider for appointments when you need medical care, including routine checkups.
      • Listen and cooperate with your provider. You are responsible for telling your medical provider about your medical condition and any medications you are taking. You are also responsible for following instructions for the care you have received from your medical provider.
      • Use the Emergency Room (ER) only in an emergency. You are responsible for using the emergency room in cases of an emergency or as directed by your provider or the PHC Advice Nurse.
      • Report wrongdoing. You are responsible for reporting fraud or wrongdoing to PHC. You can do this without giving your name by calling PHC's hotline at (800) 601-2146, 24 hours a day, 7 days a week. You can also call the Department of Health Care Services (DHCS) Medi-Cal Fraud and Abuse Hotline toll-free at (800) 822-6222.