Patient Bill of Rights
Student's Rights and Responsibilities
Following are the student's rights and responsibilities regarding services at the University of Wisconsin-Green Bay Counseling and Health Center.
Consent for Treatment Form - for students under 18
Parents should complete and sign the form and mail to the address on the form.
Respect: You have the right to...
- Be treated with dignity and respect.
- Personal privacy and to receive your care in a safe setting.
- Not be discriminated against because of race, creed, sex, national origin, sexual orientation or disabilities.
Information: You have the right to...
- Know the identity of the persons providing your care.
- Receive accurate information about diagnosis, treatment, and prognosis.
- Review your medical and/or counseling records with a staff member.
- Receive copies of your medical and/or counseling records.
- An explanation of any charges related to the services you receive.
Confidentiality: You have the right to...
- Expect that your medical and/or counseling records will be maintained in a confidential manner.
- Notice of Privacy Practices
Participation: You have the right to...
- Participate in decisions about your care, including the right to refuse a recommended treatment.
- Include family members and your significant others in decisions about your care.
Please help us care for you by taking the responsibility to:
- Seek medical care promptly.
- Be honest about your medical history.
- Ask about anything you do not understand.
- Respect clinic personnel and policies.
- Follow health advice and medical instructions.
- Report any significant changes in symptoms or failure to improve.
- Keep appointments or cancel in advance.
- Provide useful feedback about services and policies.
- Pay for charges incurred.