Acknowledgement regarding patient status and rights and obligations
This Acknowledgement Regarding Patient Status and Patient Rights and Obligations (this “Acknowledgement”) applies to all treatment(s), procedure(s) or service(s) (the “Services”) I, the patient, and my partner(s), as applicable, will receive from River North Center for Reproductive Health ("RNCRH")
PATIENT STATUS AND RIGHTS AND RESPONSIBILITES
Patient Status. Because RNCRH provides assisted reproduction Services to help patients reach their family building goals, patients’ relationship status and age are critical to ensure best care and compliance with medical, legal and regulatory requirements and guidelines and RNCRH’s policies. Patients are required to disclose their marital status, age, and confirm their intentions regarding parental status and obligations before patients begin treatment. Patients are also required to promptly disclose any change in relationship status during the course of treatment and may be required to provide appropriate legal documentation.
Third Party Arrangements. RNCRH provides that Patients using donor egg, sperm or embryo or a gestational carrier face additional requirements and considerations. Developing law as to same-sex marriage, and parentage for single, transgender, unmarried patients, co-parenting arrangements or polyamorous relationships may or may not adequately address patients’ or partners’ parental rights and the legal status of resulting children. Existing laws, which vary from state to state and from country to country, may either restrict or impose limitations on certain arrangements. In such cases, patients are strongly advised, and may be required, to engage independent experienced counsel in family law relating to assisted reproduction services.
Patient's Rights and Obligations. RNCRH strives to ensure that every patient, staff member and medical provider is treated with dignity, respect and consideration in a positive, non-hostile and non-violent healthcare environment where everyone feels safe. We expect all of our staff to behave in a compassionate and respectful manner and, in turn, expect all who enter our offices to do the same.
Effective date (last edited on): 3/27/25