The Catawba County Health Department cares about you and we want you to have a safe and healthy visit with us. In an effort to provide good services to you, we want you to know what your rights and duties are:

You have the right to be treated in a kind and polite way. You have the right to proper care and help. At each visit a staff member will explain what will be done, what it means, and why it is important. You will be given a form (called Tests and Procedures) that describes what will be done.

We will try to call you one time to let you know if any of your lab results are not normal. If we cannot reach you by phone, a letter will be mailed to the address you have given us.

We will not share any information about you, unless you agree to have the information shared. If you are a minor (under the age of 18) there may be times when we need to talk to your parents (or the person who legally cares for you). If you are a prenatal patient, the Health Department and Catawba Valley Medical Center Labor and Delivery and Nursery staff share information regarding your pregnancy, delivery and newborn.

You are expected to keep all of your appointments. If you cannot come, it is up to you to call for another appointment.

You should always let the Health Department know when your phone number or address changes.

If you are under 18 years of age and are informed to bring a parent/guardian to your appointment, you must do so. If you do not bring them, your parent/guardian will be contacted by the Health Department's doctor.

SOME ABNORMAL TEST RESULTS MAY LEAD TO DANGEROUS HEALTH PROBLEMS IF NOT TREATED. FOR EXAMPLE: DEATH FROM BREAST OR CERVIAL CANCER. You are required to follow all instructions that we give you or get care from your private doctor.

By signing this form, I admit that I have read my Rights and Duties and Tests and Procedures. I have had a chance to ask questions. I understand them and agree to follow them. I have been given a copy of each form to keep.

Your Signature	Date	Signature of staff	Date
Signature of Parent/Guardian	Date	Expiration date (one year from today's date)

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