Patient Bill of Rights and Responsibilities

As a PerformSpecialty patient, you have the right to:

  • Receive information about your rights and responsibilities and to acknowledge this in writing before receiving pharmacy services.
  • Choose your pharmacy service providers.
  • Know how to contact the staff seven (7) days a week, and what to do if an emergency situation arises.
  • Take part in developing and/or changing your plan of care and receive the needed information to take part in your care, including the proper use, handling and storage of your medications, and knowledge of their effects.
  • Assist in making decisions regarding your care.
  • Receive verbal and written explanations of the services, care and medication to be provided by PerformSpecialty, and to have your medication questions answered by a pharmacist.
  • Participate in determining alternative communication methods for varying circumstances, such as, but not limited to: if you speak and/or read languages other than English, if you have limited literacy in any language, if you have visual or hearing impairments, if you are on a ventilator, if you have cognitive impairments, or if you are a child.
  • Be completely informed, before or at the time of receiving services, about changes and costs related to your care, including any costs not covered by Medicare or other payers. To be informed, in advance, if you will be responsible for any charges. To receive prior notice of any changes in covered costs verbally and in writing within 30 calendar days from the date PerformSpecialty becomes aware of the change(s).
  • Receive timely care.
  • Receive proper and professional pharmacy care without discrimination against your race, sex, color, religion, sexual orientation, physical limitation, age or any other basis prohibited by law.
  • Receive therapy with consideration and respect for your person and property.
  • Be treated with dignity and individuality, including respect for your autonomy and right to confidentiality in treatment.
  • Refuse treatment at any time and to be informed of potential consequences of refusing treatment.
  • Be aware that PerformSpecialty pharmacy professionals are qualified to provide the services and care for which they are responsible.
  • Be aware that if your health care needs cannot be met by PerformSpecialty, you will be referred to a health care provider appropriate for your needs.
  • Be aware of any additional health care needs at the end of your treatment.
  • Voice complaints and/or suggest changes in your pharmacy services without compromising your care or causing repercussions. To have any complaint promptly investigated and be notified of the findings and/or corrective action taken.
  • Be aware that if you are dissatisfied, you may contact the PerformSpecialty management team and/or your state’s Board of Pharmacy or URAC.
  • Confidentiality of your personal and medical records and to approve or refuse release of the records to any individual outside the PerformSpecialty organization, except when transferring care or services to another health facility, or as contractually required by the payer of the services you receive, or as required by law.
  • In accordance with law, designate another individual as a surrogate decision-maker on your behalf, and the circumstances under which he or she is authorized to make decisions about the care and services you receive, including refusal of care and services.
  • As permitted by law, involve family members and friends to participate in your care.
  • Discuss treatment options, regardless of cost or benefit coverage.
  • Privacy of your health care needs and information, as required by law.
  • Look at and get a copy of your medical records, as permitted by law.
  • File for a hearing with your state’s Department for Medicaid Services.
  • Make suggestions about your rights and responsibilities.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.

As a PerformSpecialty patient, you have the responsibility to:

  • Give accurate and complete health information about your past medical history, including hospitalizations, medications, allergies and other important health-related information.
  • Help in creating a safe home environment.
  • Inform PerformSpecialty immediately if scheduled prescription dispensing requires cancellation. Assist in developing your pharmacy plan of care.
  • Follow your pharmacy plan of care and remain under a physician’s care while receiving PerformSpecialty services.
  • Request further information and clarification if there is something you do not understand.
  • Notify PerformSpecialty if you have any concerns that have not been addressed.
  • Notify your physician and pharmacist if you choose to end therapy.
  • Be responsible for costs related to your care that are not covered by Medicaid, Medicare or other payers.

Nondiscrimination Statement

PerformSpecialty complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.


PerformSpecialty cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

Chinese Mandarin:

PerformSpecialty 遵守适用的联邦民权法律, 不会因种族, 肤, 来源, 年龄,


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