Patient Agreement
General Information
On setting appointments:
Bascon Psych Clinic (BPC) is an outpatient clinic, which means that the doctor sees patients on as appointment basis as required. The first visit generally lasts 45 to 60 minutes. During this visit, the psychiatrist evaluates your situation in detail to understand your concerns and suggest a treatment plan. The follow-up appointments after your initial session generally lasts 30 minutes. However, the duration of the same may change based on your needs.
The attending psychiatrist has a limited caseload to ensure that there is time and energy to plan for your sessions and to ensure she can be fully focused on you and your needs.
Frequency of your visits vary based on your needs and situation. Your psychiatrist will advise you on the interval of your follow-up visits as she deems fit.
Fees
The clinic charges fees for the services offered. Medical documents (certificates, abstracts, etc.) also have corresponding fees. Payment secures the patient's booking.
For online consultations:
The session can be held via Google Meet. The link will be sent to you once the booking is confirmed.
If you need to cancel your session, please do so 12 hours in advance so that your session fee can be waived and so we can have an option to schedule a client who is in need during that time. If you cancel after 12 hours or no-show, you will be billed for the session time at the full rate. If you have an emergency, please message the clinic as soon as possible so that we can offer an alternative time or mode of treatment (phone or video), if available.
Once schedule is confirmed, the call will start at the scheduled time. Please be prompt and make sure your internet connection and hardware (laptop, desktop or mobile phone) are ready and functional. The attending psychiatrist will wait for you for 15 minutes. If after said time you are not present at the call, you will be considered a NO-SHOW, and payment will be forfeited. Payment will be credited to the clinician since said clinician invested time and effort to be present during the said agreed-upon session.
Emergency/Crisis Treatment
BPC is an outpatient clinic, which sees both scheduled and walk-in patients. It does not offer emergency care. If you are experiencing an emergency (e.g. feeling suicidal, having thoughts of hurting others), you should inform your attending psychiatrist or contact the nearest psychiatric hospital.
Also, your psychiatrist would be very happy to discuss your emergency crisis options during your regular visit to the clinic.
Involvement of Family
The clinician/staff at the clinic may talk (in person or over the phone) to your family to collect information to help understand your illness/situation.
Confidentiality
Communication between the psychiatrist and the patient are strictly confidential. Confidentiality prohibits the disclosure of information related to the doctor-patient relationship without consent from the patient. There are some exceptions to this, however. (Please see the Disclosure section below).
Disclosure
Information provided by you may be discussed with your loved ones to facilitate your ongoing care and recovery. The clinician may breach confidentiality if they are worried about your or other people's safety.
Consent for Information Registration and Other Data Processing:
1. I certify that the information above are true and correct.
2. In the course of my treatment or availment of other healthcare services, I consent to the processing (collection, recording, retrieval, use, retention and disposal/destruction) of my personal data, as provided under applicable laws, regulations and the Clinic's policies and guidelines. Such personal data are those relevant to purpose of my diagnoses, treatment, availment of healthcare services and processing of consultation bills, and quality improvement activities for enhancement of patient care.
3. I consent in making my information available to healthcare team members who are involved in the management of my care including clinic's service providers and partners, and to other applicable parties such as regulatory authorities, like Department of Health, PhilHealth; my employer, and/or insurance provider for the payment of my clinic bills.
4. I am aware that the clinic is equipped with CCTV cameras to ensure safety and security of the patients, the employees, and the establishment.
5. I agree to share my personal data with the clinic staff of my doctor in order to facilitate scheduling of my consultation and for billing purposes. I agree not to record in video or audio format nor divulge the details of my consultation in compliance with the Data Privacy Act of 2012.
6. I have the right to:
- Ask non-medical staff to leave the consultation room.
- Terminate the consultation and the physician-patient relationship at any time.
- Obtain a copy of the information obtained and recorded during the consultation.
- Be assisted by a family member or a caregiver in the set-up of tele-consultation or face-to-face consultation.
7. I and my immediate family (and/or legal representative) are aware that we will receive education regarding healthcare services/treatment to be performed at Bascon Psych Clinic. All my questions and concerns will be addressed to my satisfaction before a procedure/treatment will be done.
8. I consent to mental health evaluation and/or treatment (or for my minor child or ward under 18 years of age to participate in mental health evaluation and/or treatment) at Bascon Psych Clinic(BPC) by the attending psychiatrist.
9. I authorize Bascon Psych Clinic and its staff to perform procedure(s) and treatment(s) necessary. If, during the procedure/treatment, other condition(s) are discovered, and in the best judgement of my physician, require an extension of the original contemplated procedure or require additional procedure(s)/treatment(s) or test(s), I understand that this will be explained to me for my concurrence, unless I am not able to express consent and the processing is critical to protect my life and health. I am also aware that the additional procedure(s)/treatment(s) or test(s) may incur cost that will be added to my clinic bill.
10. I am aware that the practice of medicine is not an exact science and that no guarantee or warranty was made as to the result(s) that may be derived from this procedure.
11. I agree that any cause of action arising from the aforementioned, patient care, diagnostic examination and treatment(s) is filed exclusively in the courts of Valenzuela City.
12. This consent will remain in full force until I revoke it in writing.