Consent for Treatment
Medical care at Hilltop Medical Clinic requires a relationship between the Patient, the Providers, the Clinic Staff, the Clinic Managers, and the Clinic Owners. The relationship requires trust and mutual respect. In addition to the policies noted below, signing this form authorizes the medical providers at the Clinic, to take a history and perform a medical exam in order to diagnose and develop a treatment plan.
Scope of Treatment
- Hilltop Medical Clinics provides urgent care services. This is different from a medical home or primary care provider, who is responsible for preventive care and management of chronic medical conditions.
- We encourage all patients to have a primary care provider.
- We recognize that that is not always possible, so patients use HTMC for their primary care services. Of course, we do not want your medical care interrupted, but you are responsible for keeping follow up appointments and preventive care services. HTMC does not have a system to remind patients of appointments.
- Examination of sensitive or personal areas will be in the presence of a chaperon. A family member is not a legal chaperon.
- HTMC and its providers will not prescribe medications for assisted suicide. This requires an ongoing relationship with a primary care provider or hospice provider.
- HTMC does not provider medical marijuana prescriptions.
- Prescriptions of controlled medications require a picture ID and fingerprint to be released to the patient. Prescriptions for patients under 18 must be released to the parent or legal guardian.
- Aggressive behavior will not be tolerated and will result in an immediate dismissal from the practice.
- Dismissal from the practice. An explanation or justifications is not required. We will notify you by registered mail and continue to provider medical care for 30 days.
- HTMC is a nondiscriminatory environment, however, genetic and therefore racial and cultural differences are used to make medical decisions based on scientific studies that support this approach.
- Animal bites are reported as required by law.
- You have the right to obtain a second opinion, refuse treatment, or change your mind without judgment or pressure.
- You are encouraged and requested to ask questions in order to understand the diagnosis and treatment options for your medical problem.
- Consent forms for minor procedures and injections are not required for treatment. Receiving treatment is acknowledgment that you understood the risks and benefits and agreed to proceed.
- Results of sensitive tests cannot be sent by text, e-mail or answering phones. You must call in for the results.
- Providers frequently have to ask sensitive, personal questions to diagnose medical conditions. Parents should excuse themselves from the exam room, if they do not want to hear the answers.
- Providers are not obligated to provide medical care or services that they feel are not warranted.
- Providers are required by law to report episodes of complete loss of consciousness to the health department.
- Providers are required to report any suspected episode of child or spousal abuse to the police.
- Medical Records will be maintained in electronic format for the duration of time required by California State law.
- You may obtain a copy of your records at any time in digital format or as a printed copy. Charges apply for copies of your medical records.
- Employees at HTMC may contact and disclose medical information to the persons listed as guardians and emergency contacts, without additional notification or permission from you, the patient.