Patient Bill of Rights

Our Commitment to You

Withings Medical Group provides clinical services, including telehealth and remote patient monitoring, built around a simple idea: you come first. Our clinicians and staff are dedicated to treating every patient with dignity and as an equal partner in care. You can help make your healthcare experience safe and effective by being an active, involved, and informed member of your care team.

We welcome, respect, and serve all people. We provide care without regard to race, color, national origin, religion, culture, language, age, physical or mental disability, socioeconomic status, sex, sexual orientation, gender identity or expression, military or veteran status, or source of payment.

We are committed to accessible care. If you need help communicating with us in a language other than English, or if you need aids or services because of a disability, we will provide them free of charge. Please tell any member of your care team or contact us using the information at the end of this document.

State law requires your healthcare provider to recognize your rights while you are receiving medical care, and it requires you to respect the provider’s right to expect certain behavior on your part. You may request a copy of the full text of the applicable law from us at any time. Your rights and responsibilities are described below.

Your Rights as Our Patient

Access to Care

• Receive impartial access to medical treatment and accommodations, regardless of race, national origin, religion, disability, or source of payment
• Receive treatment for any emergency medical condition that will deteriorate if treatment is not provided, subject to the limitations of a telehealth setting described below
• Contact and speak with the clinicians involved in your care, and receive a prompt and reasonable response to your questions and requests
• Know what patient support services are available to you, including whether an interpreter is available if you do not speak English
• Have a person of your choosing present with you during a telehealth visit, consultation, or other care setting, unless doing so would risk the safety or health of you, other patients, or our staff, or cannot reasonably be accommodated
• Raise a concern or complaint without fear that doing so will affect your care or result in retaliation

Respect and Dignity

• Be treated with courtesy and respect, with appreciation of your individual dignity, and with protection of your need for privacy
• Be treated as an individual with unique needs, values, and preferences
• Receive compassionate care free from all forms of abuse, harassment, and discrimination
• Have your personal privacy respected during every interaction with our clinicians and staff

Privacy and Confidentiality

• Have your medical information kept confidential, consistent with our Notice of Privacy Practices and applicable law
• Access, request copies of, and request amendment of your medical record as described in our Notice of Privacy Practices
• Know how information collected through connected devices and remote monitoring is used and protected, as described in our Notice of Privacy Practices and Privacy Policy

Information, Communication, and Informed Consent

• Know who is providing your medical services, who is responsible for your care, and the role and licensure of each clinician involved in your care
• Receive from your clinician complete and current information concerning your diagnosis, planned course of treatment, alternatives, risks, and prognosis, in terms you can understand
• Ask questions about anything you do not understand about your diagnosis, treatment, care plan, or follow-up, and receive a clear answer
• Read and understand any form before you sign it, and receive an explanation of anything that is unclear
• Receive effective communication support, including interpreter services and accommodations for patients who are deaf or hard of hearing, at no cost to you

Treatment Decisions

• Make informed choices about your care and treatment, including the decision to refuse any treatment, except as otherwise provided by law
• Accept responsibility for the outcome of refusing treatment or declining to follow your clinician’s instructions
• Complete an advance directive, such as a living will or healthcare power of attorney, and share it with your care team
• Identify a decision-maker to participate in decisions about your care in the event you are unable to do so

Telehealth and Remote Monitoring

• Understand how our telehealth and remote patient monitoring services work, including the technology used, before you consent to receive care through them
• Decline to receive care through telehealth and ask about alternatives, including a referral for in-person care where appropriate
• Know the limitations of telehealth, including that it is not appropriate for emergencies; if you are experiencing a medical emergency, call 911 or go to the nearest emergency room
• Receive support in setting up and using the connected devices that are part of your monitoring program
• Expect that telehealth visits and monitoring data transmissions are conducted through technology designed to protect your privacy and the security of your information
• Know who reviews the measurements and information collected through your monitoring program and how that information is used in your care

Coordination and Continuity of Care

• Know which clinician is in charge of your care and how to reach your care team
• Request a different available clinician within our practice
• Have your care coordinated with your other healthcare providers, with your permission, so your treatment is consistent and informed
• Receive information about what to do and who to contact between visits, including how monitoring alerts are handled

Financial Information and Billing

• Receive, upon request and before treatment, a reasonable estimate of charges for your medical care
• If you are uninsured or not using insurance, receive a Good Faith Estimate of expected charges, consistent with the federal No Surprises Act
• If you are eligible for Medicare, know, upon request and in advance of treatment, whether we accept the Medicare assignment rate
• Receive a reasonably clear, understandable, and itemized bill and, upon request, have the charges explained
• Receive, upon request, full information and necessary counseling on the availability of known financial resources for your care

Research

• Know if any aspect of your medical treatment is for purposes of experimental research, and give your consent or refusal before participating
• Refuse to participate in research without affecting your access to ongoing care

Concerns and Grievances

• Know what rules and policies apply to your conduct as a patient
• Express a grievance regarding any violation of your rights, as stated in applicable state law, through our grievance procedure and to the appropriate state licensing agency
• Receive a timely review of, and response to, any complaint or grievance you raise

Your Responsibilities as Our Patient

As we partner with you in your care, we ask that you:

• Provide, to the best of your knowledge, accurate and complete information about your present complaints, past illnesses, hospitalizations, medications, allergies, and other matters relating to your health
• Report unexpected changes in your condition to your care team
• Tell your care team whether you understand a contemplated course of action and what is expected of you, and ask questions when you do not
• Follow the treatment plan you develop with your clinicians, and accept responsibility for your health outcome if you choose not to follow it
• Take your measurements as directed in your monitoring program, use your connected devices as instructed, and let us know if a device is not working or you need help using it
• Keep your contact information, pharmacy, and emergency contact details current so we can reach you about your care
• Keep scheduled appointments and telehealth visits and, when you are unable to do so for any reason, notify us in advance
• Use telehealth services from a private, safe location where you can communicate openly with your care team
• Call 911 or seek emergency care for urgent or emergency conditions rather than waiting for a telehealth response
• Share a copy of your advance directives with us so we can honor your choices
• Treat our clinicians and staff with courtesy and respect; we do not tolerate abusive, threatening, or discriminatory conduct toward our workforce or other patients
• Tell us if you think there may be a problem with your care or if you do not agree with the treatment plan
• Ensure that the financial obligations of your healthcare are fulfilled as promptly as possible
• Follow the rules and policies of Withings Medical Group affecting patient care and conduct

If You Have Concerns

You have the right to formally express concerns about the quality of your care, communication or language assistance services, or any aspect of your experience with us. We have a process to promptly review and address patient complaints and grievances, and raising a concern will never result in retaliation or affect your access to care.

To share a concern or file a grievance, contact us at:

Withings Medical Group, P.A., Attn: Patient Relations
225 Franklin Street, Suite 1250
Boston, MA 02110
Email : WMG_Compliance@withings.com

You or your representative may also report concerns to the appropriate agency in your state, including the state health department or the licensing board for your clinician. We will provide agency contact information for your state upon request.

If you believe we have not followed our nondiscrimination policies, you may file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

U.S. Department of Health and Human Services, Office for Civil Rights
200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201
Phone: 800.368.1019 (TTY: 711)
Online: ocrportal.hhs.gov/ocr/portal/lobby.jsf. Complaint forms are available at hhs.gov/ocr/complaints/index.html.

Language and Accessibility Assistance

Free and confidential language interpreter services and disability accommodations are available to you and your companions. To request an interpreter, written information in another language or format, or aids and services to accommodate a disability, contact Patient Relations using the information above, or tell any member of your care team.