Patient Rights and Responsibilities

SalusCare Ethical Code of Conduct

Patient Rights Responsibilities Handout FY 16 Creole Version

Patient Rights Responsibilities Handout FY 16 Spanish Version

SalusCare, Inc. is a Fort Myers, Florida based not-for-profit mental health and substance abuse service provider incorporated in 2013 after the merger of Lee Mental Health Center and Southwest Florida Addiction Services (SWFAS). SalusCare has seven locations throughout Southwest Florida. Our fees are affordable and may be adjusted to the means of our patients based on household income. SalusCare accepts Medicaid, Medicare, Visa, MasterCard and some major health insurance providers. SalusCare provides services for all regardless of disability or handicap. Accommodations will be provided upon request.

The following are general statements of your rights and responsibilities. Your rights and responsibilities as a patient in programs such as crisis stabilization unit, or specific residential programs, will be given to you in writing upon your admission to those programs. If you would like assistance in reading this or if you want more detailed information provided to you verbally, please speak with the staff person who is assisting you with the services you are receiving.

Patient Rights

All SalusCare patients have the same civil rights as do all citizens of the State of Florida and the United States of America. SalusCare does not discriminate in the provision of services on the basis of age, race, color, national origin, ethnicity, gender, marital status, sexual orientation, religion, disability or any other characteristic protected by law.

Patient rights, as outlined in Florida’s Patient Bill of Rights and/or federal regulations include, but are not limited to: The right to quality treatment, the right to refuse services, the right to confidentiality, the right to dignity, the right to privacy, the right to receive humane care, the right to access one’s own record, and the right to a fair and equitable procedure to a register a complaint. Exceptions to any of these described rights do exist and will be discussed on an individual basis at the request of the individual.

General Statements of Patient Rights

  1. Be informed, in writing, and verbally if needed or requested, of your rights and responsibilities as a patient who is receiving services at SalusCare.
  2. Be treated with respect and dignity.
  3. Be offered the least restrictive means of treatment with maximum potential for benefit.
  4. Receive a personalized assessment of your needs.
  5. Know how much money your treatment may cost and how the amount you are to pay was decided.
  6. Have a staff person or team of staff assigned especially to you to work with you on solving your challenges.
  7. Be offered services that begin within a reasonable time.
  8. Be informed of any actions, procedures, or decisions that may affect you and your treatment at SalusCare.
  9. Have an individual treatment plan or service plan developed with your input that will be reviewed on a regular basis.
  10. Be offered services in an environment that is comfortable, clean, and safe.
  11. You may refuse any form of treatment or service unless the service has been ordered by a court or in an emergency situation when needed to prevent harm to yourself or others. As appropriate, you will be informed when your situation may get worse if you do not receive treatment or services.
  12. Be discharged from services when you have reached your treatment goals/objectives and/or have received the maximum benefit from your services.
  13. Be referred to or provided information about community based support programs.
  14. Be given information about any medication that is prescribed for you by a SalusCare physician, Including the possible side effects, purposes and benefits, and potential risks. You have the right to a regularly scheduled review of your condition and medication by your physician. You may refuse medication, except when it is court-ordered or in emergency situations as defined by Florida Statutes.
  15. Be given full information regarding SalusCare’s procedure regarding a Tobacco/Smoke Free environment at all of our facilities, properties, and programs.

Patient Responsibilities

Take the responsibility for participating in your treatment as mutually agreed upon in treatment plan.

Pay for services at the time they are rendered. When no payment or arrangements for payments have been made for balances over 90 days, you may be denied services until payment or payment arrangements are made. You will be responsible for all balances even after your services have ended.

You have the responsibility to attend sessions/treatment/services as scheduled or to cancel as soon as possible, but at least 24 hours in advance.

You have the responsibility to cooperate with SalusCare’s Tobacco/Smoke Free environment procedure at all of our facilities, properties, and programs. Failure to follow this procedure, and repeated violations, will result in consequences which may impact the services you receive. For specific information regarding consequences refer to the information for the specific program you are participating in at any given time.

You have the responsibility to treat all individuals at SalusCare with courtesy and respect.

Patient Satisfaction

What our patients think of the services they received at SalusCare is very important to us. Please feel free to tell staff members when you are satisfied or dissatisfied with our services. At appropriate times you will receive customer satisfaction surveys. We appreciate your answering the questions and offering any comments, criticisms, or suggestions that will help us to continue to improve our quality of customer care

Right to a Complaint Procedure

SalusCare provides patients, their relatives, legal representatives, and other concerned persons with the right to initiate and file a written complaint when there is dissatisfaction with the organization’s operation, the delivery of services, staff actions, and/or a perceived violation of rights. If you are unhappy with the services you are receiving or feel you have been treated unfairly, you may discuss your concern with the involved staff person or the program supervisor. If you wish, you may share your concerns with us by filing a written complaint.

Complaint forms are available at any reception desk or from any SalusCare staff member at any facility. Please complete the complaint form and return it to the reception desk or mail it to the supervisor of the involved program at: SalusCare, Inc., 3763 Evans Ave., Fort Myers, FL 33901. Access to the Complaint form in PDF format is available at Staff will be happy to assist you in completing this form if requested to do so.

SalusCare follows specific procedures for responding to written complaints. These include, but are not limited to, reviews and investigations of the problem by supervisors of involved programs as part of the Quality Management process. Staff will contact you about your concern, and you will receive a written response either mailed, e-mailed, or handed delivered if the complainant resides within the program. Staff will work with you to resolve the complaint. If the complaint has not been resolved at the program supervisor level, the QM Department will direct the complaint to the appropriate Vice President. If the complaint cannot be resolved at this level, it will be forwarded to the CEO or his/her designee. If you remain dissatisfied with the outcome, you may contact the following State of Florida Children & Families Departments:

FL Dept. of Children and Families, Managing Entity – Central Florida Behavioral Health Network (877) 355-2377

Disability Rights Florida 1-800-342-0823 (Voice) or 1-800-346-4127 (TTY/TTD)

Individuals making a complaint for any reason will not be retaliated against for filing a complaint. SalusCare upholds the right of every individual to have freedom to voice concerns without fear of abuse, financial or other exploitation, humiliation, or neglect.

Patient Fee Policy

We are able to provide services to our community at a reasonable rate, in part, because of financial support by the State of Florida, Lee County, and United Way.

Persons are expected to pay at the time services are delivered. Patients may qualify for reduced fees based upon the gross income of all family members living in the same household. You are expected to discuss frankly and honestly sources of income and provide verification of income so that we can establish a fee and satisfy State and Federal requirements. If no proof of income can be provided, the patient will be charged the standard full fee for service.

Patients who have health insurance benefits will be expected to assign the insurance to the SalusCare so a claim can be filed. The patient will be responsible for his/her portion of the fee at the time service is rendered.

SalusCare will not be liable for payment of any medical services that you may require while here if not provided by SalusCare.

Right to Report Abuse

SalusCare staff abides by state and federal regulations regarding abuse and neglect/exploitation reporting. SalusCare insures individuals are protected from physical, sexual, psychological, and fiduciary abuse; harassment and physical punishment; and humiliating, threatening, or exploiting actions. Sexual abuse or harassment may include any gestures, verbal or physical, that reference sexual acts or sexuality or objectify the individual sexually. Fiduciary abuse refers to any exploitation of the individual for financial gain. Any patient, adult or child, who feels they have experienced abuse, neglect, or exploitation at SalusCare, should call:

The Florida Abuse Hotline – 1-800-962-2873

Privacy Practices Notice (HIPAA)

This notice originally became effective on April 14, 2003. This notice describes how information about you (our patient) may be used and disclosed and how you can get access to this information. Please review it carefully. SalusCare is required by law to maintain the privacy of your information, and to provide you with this notice of our legal duties and privacy practices with respect to this information.

Uses & Examples of Disclosures of Information for Treatment and SalusCare Operations and Services

We will use your information for treatment. For example: Information obtained by your clinician, resource coordinator, or service provider will be recorded in your clinical record and used to help determine the course of treatment that you and your treatment team believe will work best for you. The clinician, resource coordinator, or service provider will record the actions they took and their observations. Other members of your treatment team will review your clinical record to assess how your treatment is progressing.

We will use your information in our day-to-day operations to assess your care and to seek to provide you with the best possible care. For example: Members of the SalusCare clinical staff, in order to perform quality improvement or risk management activities, may use information in your clinical record to evaluate the care and outcomes in your situation and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of your care and the service we provide to all people we serve.

We may use your information to contact you to remind you of your appointments.

We may disclose your information to our business associate so that they can perform the job we’ve asked them to do. There are some services provided to our organization through contracts with external business associates. A dietician and a pharmacist also provide services to some individuals served by SalusCare. To protect your information, we require the business associate to appropriately safeguard your information. At your request, we will disclose to you who these associates are and share with you how these associates protect your information.

Uses & Examples of Disclosures of Information with Your Written Authorization

Other uses and disclosures of your confidential information will be made only with your written authorization, unless otherwise permitted or required by law.

You must give specific written permission before being filmed, taped, etc., or becoming part of a research project.

You have the right to determine the amount and type of information to be released to anyone outside of SalusCare. You also have the right to determine the amount and type of information to be sent to SalusCare from outside persons or agencies. You have the right to determine the length of time that information can be released. SalusCare procedures allow permission to be valid for one time only or up to 365 days. You may cancel your permission to release the information at any time, except for information already released.

Uses & Examples of Disclosures of Information Without Your Written Authorization

There are several important instances when confidential information may be released to others without your permission.

If we have reason to believe that you are abusing or neglecting your children, or if you tell us your spouse or someone else is abusing your or any other children, we are obligated by law to report this to the appropriate agency. The law is designed to protect children from harm and the obligation to report suspected abuse or neglect is clear in this regard.

If you are receiving mental health services, and we have reason to believe that you are abusing, neglecting, or exploiting an aged person or disabled adult, or if you tell us that someone is abusing, neglecting, or exploiting and aged person or disabled adult, we are obligated to report this to the appropriate agency.

If you indicate you intend to harm either yourself or someone else, and we believe your intent to be serious, we are obligated under the law to take action to protect you and/or other people from harm. This may include initiating a Baker Act, contacting law enforcement, or other means to keep you and others free from harm.

If we diagnose you as having a reportable communicable disease such as TB, hepatitis, HIV/AIDS, or a sexually transmitted disease, we are required by law to report this to the Health Department.

If you are experiencing a life-threatening or potentially disabling medical emergency, we are required to release to medical personnel the minimum amount of information necessary to quickly aid the situation (for example: diagnosis, medication). The information will be given only on a need to know basis.

In some instances, a court of law can obtain information about you without your permission. Although SalusCare does not automatically release information about you to the court when it receives a court order, a judge may set aside your rights to privileged communication. If you have been referred by the court (court-ordered), you should discuss with us exactly what information you wish included or not included in a report to the court. You should also be aware that failure to release information to a court or a referral agency may have adverse consequences for you.

The state of Florida may require that some of our programs release your social security number and other personal information to qualified state personnel for the purpose of auditing, reporting, and/or program evaluation. The state is also governed by federal regulations and state laws that protect your right to confidentiality.

Considering the exceptions to confidentiality, you should remember that you have the right to tell us only what you want us to know. If you have concerns about confidentiality, please discuss them with us before you share personal information.

Your Rights (as provided by HIPAA)

You have the right to see your record and/or obtain a copy of it for a fee after a written request has been received.

You have the right to amend or enter notes into your clinical record, or record your own observations and comments at any time. This applies to receiving services in any program. Please contact our Privacy Officer/Health Information Management (HIM) Director if you have questions about this.

Even though all disclosures we already make are minimally necessary, you have the right to request a restriction or limitation on the information we use or disclose about you for treatment, payment, or healthcare operations. Also, you have the right to request a restriction on the people who are able to obtain the information we disclose. To request a restriction or limitation, please send your request in writing to the Privacy Officer/HIM Director. However, we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

You have the right to request to receive confidential communication from us by alternative means or at an alternative location. We will accommodate requests. We may ask you for information as to how payment will be handled or how to contact you (by address or phone number). We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer/HIM Director.

You have the right to receive an accounting of disclosures we have made (with the exception of those we are not permitted to disclose), if any, of your confidential information. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003.

You have the right to receive a paper copy of this notice from us, upon request.

We are required to abide by the terms of this Privacy Practices Notice. If we revise this notice, we will distribute copies to active patients. The revised notice will be effective for all confidential information that we maintain at any time. You may also obtain a copy of the notice by accessing our website (, calling SalusCare and requesting that a copy be sent to you, or asking for one at the time of your next visit. If you have any questions about this notice please contact the Privacy Officer/HIM Director, or Compliance Director at: (239) 275-3222. (Rev. 12/2015)

Auxiliary Aids and Services Plan for Patients and Companions who are Deaf or Hard-of-Hearing


SalusCare, Inc. provides all necessary accommodations for patients and their companions who identified themselves as deaf or hard-of-hearing. Please contact us at (239) 275-3222 to ensure we are aware of any needs you have before your arrival. We also will, as soon as you identify yourself as deaf or hard-of-hearing, provide the necessary services, at no cost to you. All efforts are to be made to provide the services requested on a 24/7 basis.

For scheduled appointments, the certified interpreter must be present at the time of the appointment. For non-scheduled aid-essential (intakes, evaluations, etc.) the certified interpreter must be present within two hours. For non-scheduled and non-aid essential communications, the certified interpreter must be present no later than the next business day.

SalusCare, Inc. employs the use of only certified sign language interpreters. American Sign Language Interpreters (ASL Interpreters) are certified through the Registry of Interpreters for the Deaf (RID). All employees are trained to make all efforts possible to meet the needs of patients and companions, and to request assistance from the Single Point of Contact (SPOC). If this does not resolve the situation, a patient is encouraged and will be provided assistance in contacting one of the following parties:

  • Surita Jageashwar, SPOC- (239) 333-2237
  • Julie Patel, Central Florida Behavioral Health Network- (813) 740-4811
  • Dick Valentine- Civil Rights Officer, Suncoast Region-(904) 485-9682

A copy of this Auxiliary Aids and Services Plan for Patients and Companions who are Deaf or Hard-of-Hearing is available by contacting the Agency Single Point of Contact.

SalusCare, Inc. Corporate HQ
3763 Evans Ave.
Fort Myers, FL 33901
Monday-Friday | 8:00am - 5:00pm
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