Counseling Services

Participant Responsibilities

I understand and agree that it is important that I participate in the decisions about my health, treatment and care options. Therefore, I will:

• Learn about my personal counseling and its options of treatment.
• Provide accurate information about my medical, mental and social history.
• Participate in the development of my dialysis care plan and follow the plan.
• Learn and understand laboratory test results and their relationship to my treatments and health.
• Notify my doctor or nurse in addition to my KMCSRO counselor/staff of any changes in my health condition and status.
• Follow infection control procedures, both for myself and my visitors in session
and at home if and as applicable.
• Comply with all my KMCSRO staff’s requests for counseling and treatment sessions, office visits and additional referrals.
• Participate in activities or efforts leading to rehabilitation.
• Acknowledge that it is my responsibility to arrange for my own transportation and request that coordination assistance from the facility staff is available to help coordinate pick up and arrival times if and as is possible. I understand that neither the transportation facility nor its staff members shall be responsible for providing transportation for me.
• Acknowledge and assume responsibility for any illness or injury that I sustain for failure to follow the recommendations of my doctor and staff members.
• Acknowledge that my failure to comply with my treatment times and schedule,
medications diet and fluid restrictions, and other physician’s orders may result in declining health, hospitalization and possibly in my death.
I agree to be knowledgeable regarding the facilities policies and procedures and follow them.

Therefore, I will:
• Arrive on time for my scheduled treatment and remain on dialysis for the treatment
time prescribed.
• Inform the facility if I am going to be late, or need to be rescheduled, with the
understanding that being late, I may not receive my full treatment.
• Arrive free of the influence of illegal drugs, alcohol and without a weapon. I also agree to refrain from having them in my possession or using them while I am on the premises of this facility.
• Refrain from operating equipment, removing or manipulating equipment
unless I have been trained and have permission to do so.
• Cooperate with the staff member assigned to provide care to me. I understand that I can request but cannot require specific staff members to care for me. If I’m uncomfortable with a specific staff member assigned to my care, I will make the KMCSRO manager aware of my concern(s).
• Apply for Medicare, Medi-cal or other insurance programs when appropriate and to maintain coverage to the best of my ability.
• Inform the facility about personal changes such as address, phone number, marital status, etc. accordingly as applicable.
• Agree to bring my medications into the facility for review when requested to do so.

I further agree to respect the rights of other participants and staff members. Therefore, I will:
• Treat other participants and staff members with respect, dignity and consideration.
• Respect the rights of other participants to have a safe, clean, calm, adequate treatment and treatment environment.
• Assure that my activities or my visitor’s activities do not interfere with facility
operations.
• Use the facility’s grievance procedure to voice concerns or complaints.
• Agree to observe the rules of KMCSRO as well as any and all applicable law and understand that the consequences for breaking the law apply to my conduct inside and outside the  KMCSRO facilities.
• Refrain from any form of verbal abuse, physical abuse, or sexual harassment of
other participants, staff or visitors.
If applicable, as a self-care home patient, I will:
• Be responsible for ordering and having adequate supplies for my treatment needs.
• Make and keep appointments with my treatment facility on a regular basis as
required.
• Follow ALL treatment plans as customized for me.
• Carry out procedures within the rules established during training and not alter
steps of procedures without first consulting with the KMCSRO staff as well as my own personal physician and/or nurse.