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Family Planning: Your Rights as a Family Planning Consumer

People, regardless of race, religion, age, sex, and ethnic background or economic standing have:

• The right to decide whether or not to have children, and if so, to determine their timing and spacing;
• The right to be treated with dignity and respect;
• The right to privacy and confidentiality in all aspects of their service;
• The right to adequate and objective education and counseling;
• The right to have all procedures explained and questions answered in a language that can be understood;
• The right to know effectiveness, possible side effects, and complications of all contraceptives;
• The right to participate in selecting the contraceptive method to be used;
• The right to know the results and meanings (diagnosis, treatment, prognosis) of all tests and examinations;
• The right to see your record and have it explained;
• The right to know the meaning and implications of all forms you are asked to sign;
• The right to consent to or refuse any contraceptive method, test, examination, or treatment.

Participation of any individual in the program is voluntary and free of compulsion or coercion of any kind. You may request a fair hearing if you are dissatisfied with any action of ours regarding:

• The application process;
• The eligibility determination process;
• Violation of your civil rights;
• The scope and provision of family planning services.

If you feel your rights have been violated, please speak to the director of the clinic.

Confidentiality

Services provided at the clinic are confidential. No information is released to any other person without your consent. Parents will not be contacted without your consent. Because the public health clinics are required to protect children under the age of 18, the following are the only exceptions to our confidentiality policy:

• Disclosure of sexual or physical abuse.
• Disclosure of intent to harm one's self or others.
• Disclosure of unlawful age of sexual partner.

Everything else is confidential.

If You Have a Problem

If you are having a problem or questions about contraception, we urge you to telephone and talk with one of the practitioners. Our clinic is open daily Monday and Friday from 8:00 a.m. to 5:00 p.m., and Tuesday, Wednesday, and Thursday from 8:00 a.m. to 8:00 p.m., except on legal County holidays. Phones are answered Monday through Friday 8:00 a.m. to 12:00 p.m. and 1:00 p.m. to 5:00 p.m.

If you are having an acute medical problem related to your contraceptive method and cannot wait until the clinic is open, you should go to or telephone the Sutter Medical Center Emergency Room (707-576-4040) in Santa Rosa. We would appreciate your notifying us about the problem as soon as the clinic is open.

Payment for Service

We are a division of the County of Sonoma Department of Health Services under the Board of Supervisors, and supported by your local taxes. State funds provide these clinical services for you.

If your income falls below a certain income level established by the State, you may be entitled to receive contraceptive services and supplies, pregnancy testing and counseling, and sterilization services at a minimal charge. We will ask you to complete a simple form to determine your eligibility for services and will review information with you each time you come in. If you have Medi-Cal please bring your card with you. If, for reasons of confidentiality, you are unable to obtain your insurance information, please tell our staff. We may still be able to help you.

If you are a member of a health maintenance program such as Health Plan of the Redwoods, Kaiser or you have other coverage for contraceptive services through your health plan, you are not eligible for state funded services.

Your Responsibilities

To be eligible to receive State subsidized services, you must:

• Complete all application forms required to determine eligibility.
• Report all facts needed to determine eligibility.
• Report any changes in those facts at each clinic visit.
• Report any insurance health care coverage available to you.

If you are over the monthly income allowed by the State Office of Family Planning, you will be expected to pay for the services and supplies provided by the clinic at the time of the visit.

Public Health Clinical Services does not bill private insurance for over-income clients. If you have private insurance that covers services, you will be expected to pay for services and supplies at the time of the visit. You will be given an itemized receipt upon request for your submission to your insurance carrier.