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Patient rights and responsibilities

YOU HAVE THE RIGHT TO:
1. Obtain relevant, accurate, current and understandable information from your EFRx Pharmacist concerning your treatment and/or
drug therapy


2. Discuss your specific drug therapy, the possible adverse side effects and drug interactions, and to receive effective counseling and
education from your EFRx Pharmacist


3. Expect that all prescribed medications you receive are accurately dosed, effective and in useable condition


4. Choose the pharmacist and pharmacy provider where your prescriptions are filled and to not be pressured or coerced into transferring
your prescriptions to another pharmacy or mail order service


5. Confidentiality and privacy of all your patient counseling information contained in your patient record and all your Protected Health
Information, as described in EFRx’s Notice of Privacy Practices (NOPP)


6. Receive appropriate care without discrimination in accordance with physician orders


7. Be advised if a medication has been recalled at the consumer level


8. Call EFRx with any complaints about medication or privacy matters at 570.606.3622 and ask for the Chief Compliance Officer, or
contact us about them through our website, www.ethicalfactorrx.com


9. Voice your grievances/complaints regarding treatment or care or lack of respect or to recommend changes in policy, personnel, or
care/service without restraint, interference, coercion, discrimination, or reprisal, and have your grievances/complaints investigated


10. Be able to identify EFRx representatives through proper identification


11. Choose a healthcare provider


12. Receive information about the scope of care/services that are provided by EFRx directly or through contractual arrangements, as well
as any limitations to EFRx’s care/service capabilities


13. Receive in advance of care/services being provided, complete oral and written explanations of charges for care, treatment, services
and equipment, including the extent to which payment may be expected from Medicare, Medicaid, or any other third party payer,
charges for which you may be responsible, and an explanation of all forms you are requested to sign


14. Be informed of any financial benefits that might accrue when you are referred to an organization


15. Be advised of any change in EFRx’s plan of service before the change is made


16. Receive information in a manner, format and/or language that you understand


17. Have family members, as appropriate and as allowed by law, and with your authorization or the authorization of your personal
representation, be involved in your care and treatment, and/or service decisions affecting you


18. Be fully informed of your responsibilities


19. To obtain services regardless of race, nationality, sex, age, sexual orientation, physical and/or mental disabilities, diagnosis or
religious affiliation


20. To speak to a health professional


21. To have personal health information shared with the patient management program only in accordance with state and federal law


22. To receive information about the patient management program


23. To receive administrative information regarding changes to or termination of the patient management program


24. To decline participation, revoke consent, or disenroll at any time


YOU HAVE THE RESPONSIBILITY TO:


1. Adhere to the plan of treatment or service established by your physician


2. Enroll and participate in the development of an effective plan of care/treatment/services with EFRx and notify your physician of
your enrollment and participation in EFRx’s Patient Management Program


3. Provide, to the best of your knowledge, accurate and complete medical and personal information necessary to plan and provide
care/services


4. Ask questions about your care, treatment and/or services, or to have clarified any instructions provided by EFRx representatives


5. Communicate any information, concerns and/or questions related to perceived risks in your services, and unexpected changes in
your condition


6. Notify EFRx if you are going to be unavailable for scheduled delivery times


7. Treat EFRx personnel with respect and dignity without discrimination as to color, religion, sex, or national or ethnic origin


8. Care for and safely use medications, supplies and/or equipment, per instructions provided, for the purpose they were prescribed
and only for/on the individual for whom they were prescribed


9. Notify EFRX of any changes in your physical condition, physician’s prescription or insurance coverage. Notify EFRx immediately
of any address or telephone changes whether temporary or permanent


10. Understand that EFRx acts solely as an agent for you in filling for insurance or other benefits assigned to EFRx; Understand that
EFRx assumes no responsibility for assuring that benefits so assigned will be paid; and understand that your account will only be
credited when EFRx receives payment

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