Middle Tennessee Outpatient
Diagnostic & Imaging Center
351 Que Creek Circle
Smyrna, TN 37167
(615)-459-6444
Payment and Insurance Information Please remember to bring you testing order form that you received from your doctor as well as your insurance information and any pre-authorization. Directions: From Take I-24 West to Exit 66 Merge onto Go approximately 4 miles Take I-24 East to exit 66B Merge onto Go approximately 4 miles and Turn right onto
We participate on most major insurance plans and will file your claim with your insurance company for you. If you do not have insurance coverage make sure that you have made financial arrangements prior to you exam.
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The Patient has the right to
· Receive the care necessary to help regain or maintain his or her maximum state of health and, if necessary, cope with death.
· Expect personnel who care for the patient to be friendly, considerate, respectful and qualified through education and experience, as well as perform the services for which they are responsible with the highest quality of service.
· Expect full recognition of individuality, including personal privacy in treatment and care. In addition, all communications and records will be kept confidential.
· Complete information, to the extent known by the physician, regarding diagnosis, treatment, procedure and prognosis, as well as alternative treatments or procedures and the possible risks and side effects associated with treatment and procedure.
· Be a participant in decisions regarding the intensity and scope of treatment. If the patient is unable to participate in those decisions, the patient’s rights shall be exercised by the patient’s designated representative or other legally designated person.
· Make informed decisions regarding his or her care.
· Refuse treatment to the extent permitted by law and be informed of the medical consequences of such a refusal. The patient accepts responsibility for his or her actions should he or she refuse treatment or not follow the instructions of the physician or facility.
· Approve or refuse the release of medical records to any individual outside the facility, except in the case of transfer to another health facility, or as required by law or third-party payment contract.
· Be informed of any human experimentation or other research/ educational projects affecting his or her care or treatment and can refuse participation in such experimentation or research without compromise to the patient’s usual care.
· Express grievances/complaints and suggestions at any time.
· Provide patient access to and/or copies of his or her individual medical records.
· Expect the facility to agree to comply with Federal Civil Rights laws.
· Have their personal, cultural, spiritual and/or ethnic beliefs considered when communicating to them and their families about their treatment.
The patient is responsible for
· Being considerate of other patients and personnel and for assisting in the control of noise, smoking and other distractions.
· Respecting the property of others and the facility. · Reporting whether he or she clearly understands the procedure and what is expected of him or her.
· Keeping appointments and, when unable to do so for any reason, notifying the facility.
· Providing caregivers with the most accurate and complete information regarding present complaints, past illnesses and hospitalizations, medications, unexpected changes in the patient’s condition or any other patient health matters.
· Observing prescribed rules of the facility during his or her visit and, if instructions are not followed, forfeiting the right to care at the facility and is responsible for the outcome.
· Promptly fulfilling his or her financial obligations to the facility.
· Payment to facility for copies of the medical records the patient may request.
· Identifying any patient safety concerns.
Patient Rights and Responsibilities was established with the expectation that observance of these rights would contribute to more effective patient care and greater satisfaction for the patient, family, physician and the facility caring for the patient. Patients shall have the following rights without regard to age, race, sex, national origin, religion, culture, physical handicap, personal values or belief systems