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WELCOME

www.manetchc.org

Your partner for a healthier life.

North Quincy 110 West Squantum St.North Quincy, MAPhone: (617) 376 3000and (857) 403-0820

Snug Harbor9 Bicknell St.Quincy, MAPhone: (617) 471 4715

Hough’s Neck1193 Sea St.Quincy, MAPhone: (617) 471 8683

Hull180 G Washington BlvdHull, MAPhone: (781) 925 4550

TauntonOne Washington Street(Mill River Place)Taunton, MAPhone: (508) 822 5500

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Your partner for a healthier life.www.manetchc.org

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Administrative Office Houghs Neck Hull2 Granite Avenue, Suite 101Milton, MA 02186T - 617-690-6400F- 617-690-6902

1193 Sea St.Quincy, MA 02169T (617) 471-8683F (617) 773-1625

180 George Washington Blvd. Hull, MA 02045T (781) 925-4550F (781) 925-5052

North Quincy Snug Harbor Taunton110 West Squantum StreetNorth Quincy, MA 02171T- 617-376-3000T- 857-403-0820F – 617-376-3036

9 Bicknell St.Quincy, MA 02169T (617) 471-4715F (617) 472-4977

One Washington St., Suite 900Mill River Professional CenterTaunton, MA 02780T (508) 822-5500F (508) 822-5501

Dear Prospective or Returning Patient,

It is my sincere pleasure, on behalf of the Manet Board of Directors and the entire Manet team, to welcome you to Manet Community Health Center.

Manet is a not-for-profit health and social services organization with three locations in Quincy, one location in Hull and our newest location in Taunton. Since 1979, it has been our duty and commitment to provide high quality, accessible health care for all. We exist to be your partner for a healthier life.

At Manet, you will find the finest, most compassionate and talented health care team to care for you. It is our desire that when you come to Manet you feel understood, cared for and comfortable in our spaces. Please ask any questions that you may have of our staff. This will help us to truly partner in your care and assist our providers and care team to lead you and your loved ones to the most optimal health outcomes possible.

Moreover, please know that your feedback matters. In fact, we depend on it to continually assess and improve our services. After each visit, we encourage you to complete a satisfaction survey. Your suggestions and comments on your care experience, our facilities, our performance and our programs and offerings are welcomed and vital—we are ready to listen and respond.

In closing, thank you for choosing Manet. The entire Manet Team looks forward to serving your health needs and those of your family and our community.

Sincerely,

John J. HoliverChief Executive Officer

John J. HoliverChief Executive Officer

Patient Portal Convenient Online Access

With your busy life, it can be hard to stay on top of your family’s health care - even though it’s the most important thing of all. Our online patient portal allows you to communicate with us easily and safely - according to your schedule.

Using your own secure password, you can log into the online patient portal 24 hours a day, 7 days a week from the comfort and privacy of your home or office.

Our Patient Portal Service Allows You To

• View and request appointments• Request prescriptions and refills• Retrieve test results. Results will be posted after provider approval • View personal health information• Update demographic information• Browse health facts and information• View your billing statements and balances• Make secure credit card payments• Communicate with your care team by sending and receiving secure messages

Registering for the Patient Portal is easy! Just let any member of the clinical team or front desk staff know that you would like to register and provide your email address. You will then be instructed on how to log on to the portal using your own secure password.

This is what your Patient Portal page looks like.

Please Note: The Patient Portal is for non-urgent matters only. Questions/messages may not go directly to your provider. They are generally answered by support staff in consultation with the care team within two business days.

www.manetchc.org


Patient Portal

To Learn MoreAsk a Manet staff member about the online Patient Portal, or visit

www.manetchc.org

www.manetchc.org


Preparing for Your First Visit• Obtain your medical records, immunization records, medication list from your previous primary

care provider.• Call your insurance company (the number can usually be found on the back of your insurance

card) to switch your PCP to the advised provider at Manet Community Health Center.• Please arrive a half hour prior to your visit with a photo ID and your insurance card.• Co-pay is expected at the time of services.• If you are uninsured or have a high deductible plan, please schedule an appointment with our

Financial Counselor for financial assistance options by calling 617-376-3000. There are programs that may be available to you or your family based on your family size and income level.

• Please bring any other pertinent documentation for your visit (Advanced Directives and Health Care Proxy, etc.)

Making an Appointment:To schedule an appointment, please call the Manet site at which you wish to be seen.

Cancelling an Appointment:Please call us at least 24 hours in advance if you cannot make your appointment.

Language AssistanceCertified medical interpreters and the Language Line are available to assist patients for which Eng-lish is not their first language. Please let us know your language preferences.

Emergency/Storm Closures:Be aware that the health center may have an unscheduled closure or late opening during a serious storm or other emergency. We make every effort to contact patients with appointments in this situation, but if you strongly anticipate a storm or emergency is going to trigger the closing or canceling of schools or other businesses, please call before making the trip to the health center.

Contacting a Physician After Hours and What to Do In an Emergency:A doctor is available for advice in an emergency 24 hours a day and can be reached via our answer-ing service. In the event of a life-threatening illness (cannot breathe, severe chest pains, se-vere trauma) call 911 and go to the nearest emergency room. If your illness is not life threaten-ing and the health center is closed, please call one of the main numbers listed on this page before going to the emergency room or seeking other services. You will reach our answering service and they will page our “on-call” physician who can help guide you when our offices are closed.

If you wish to speak to an “on-call” physician after the health center is closed, and the physician does not respond to your call within 20-30 minutes, please try calling again to ensure the correct phone number was given. Also, remember to disable “call-blocking” of unlisted numbers or our physicians will not be able to reach you. The answering service will tell you how to disable and then replace your “call-blocking” after the physician calls you.

FOR NEW PATIENTS

www.manetchc.org

Site Main NumbersHoughs Neck617-471-8683TTY Phone: (857) 403-0783

Snug Harbor 617-471-4715TTY Phone: (857) 403-0761

North Quincy 617-376-3000857-403-0820TTY Phone: (857) 403-0405

Hull 781-925-4550

Taunton 508-822-5500TTY Phone: (857) 403-1500

www.manetchc.org


Insurance/Self Pay InformationManet serves all patients regardless of their ability to pay. Patients may be eligible for a sliding fee program or other state programs depending on income and family size. Contact our Navigators for program enrollment assistance options.

The health center accepts most insurance plans, including but not limited to: Neighborhood Health Plan, Boston Medical Center Health Net Plan, Tufts Network Health Plan, Celticare, Medic-aid, Medicare, Blue Cross/Blue Shield, and Harvard Pilgrim Health Care. If a primary care clinician selection is required by your insurance company, their contact information is on the back of your insurance ID card so that you can call and choose Manet. Your co-payment is collected on each visit. The information can usually be found on your insurance ID card or by calling your member service department.

ReferralsA referral is when a medical provider recommends another provider to a patient. The most common type of referral is from a primary care physician to a specialist.

Many insurance plans, especially those known as managed care plans, require referrals. If you need to see a specialist or have certain tests or imaging studies done, the primary care physician you selected at Manet will refer you within the Steward network. These are doctors and facilities that work closely together with Manet to provide the best care for our patients. This assures your primary care physician can follow your care closely.

Manet-affiliated hospitals include Carney Hospital, A Steward Family Hospital, Morton Hospital, A Steward Family Hospital and Boston Medical Center. Manet OB patients deliver at South Shore Hospital in Weymouth and Tufts Medical Center in Boston.

Insurance/Self Pay Information/Referrals

Health Insurance Help

Contact us:healthinsurancehelp@ma-

netchc.org

Hotline: 857-403-1557

Contact the Massachusetts Health

Connector at: betterhealthconnector.com

www.manetchc.org

www.manetchc.org


Laboratory Services:Manet offers laboratory services at all sites and has staff on site to collect laboratory specimens. Our laboratories offer a limited number of “in-house” rapid testing methods, such as but not limited to: urinalysis, urine pregnancy tests and glucose testing. These results are immediately available to your provider for decision making at the time of your visit.

Your provider may find it necessary to order more detailed testing that requires your specimen(s) to be sent to a larger reference laboratory. Depending on your insurance carrier, you may receive bills from the reference laboratory for these services. It is your responsibility to handle any bills received from a reference laboratory as every insurance carrier provides different coverage for laboratory testing. Your insurance carrier is the only one who can supply you with details of your covered laboratory services. Several commercial policies such as BC/BS and Tufts cover routine laboratory testing done as part of your annual physical. The coverage is limited to routinely ordered health maintenance testing, such as complete blood count (CBC), metabolic panels (basic or comprehensive) and lipid panel. It does not always cover every test your provider orders. It is recommended that you ask your insurance carrier what your benefits will cover prior to having your annual physical so you understand your coverage for laboratory testing.

Prescription Renewals:It is important that your medication, which your provider has prescribed, is available at all times. When you visit the health center, you should make sure to let your provider know when prescriptions need to be renewed. Your provider can complete new refills at the time of your visit.

Between visits, try to monitor your refills. Make sure you give yourself a few extra days between when you will be out of medications and when you call for your refill. You should call your pharmacy directly when you need a refill. The pharmacy will have your most up-to-date record and will, in turn, call or fax us with your request.

If you are unable to reach your pharmacy, the next step is to call our office. A receptionist may ask for information or you will be referred to a prescription line. It is important that you have the prescription information when calling us. The information will contain the name and appropriate dosage of the medicine you need. Please remember, it may take 48 hours until your medicine is available at the pharmacy.

For your convenience, Eaton Apothecary is located on the first floor of our North Quincy site to meet all of your pharmacy and prescription needs.

Eaton Apothecary works directly with Manet’s physicians, nurse practitioners and care team to develop appropriate drug treatments toward improved and sustained health and provides easy access to a full range of low cost prescription medications for all patients.

Laboratory and Prescriptions

www.manetchc.org

Manet Vision Center110 West Squantum StreetNorth Quincy, MA 02171617-376-3000 or 857-403-0820

ProviderJeanne Hopkins, OD

Services• Pediatric and adult eye exams• Diabetic eye exams with retinal photography• Glaucoma testing• Treatment of minor eye injuries and infections• Contact lens fittings• Other eye services

PharmacyEaton Apothecary at Manet110 West Squantum StreetNorth Quincy, MA 02171617-472-1200 Fax: 617-773-1300

ProvidersPhung Nguyen, RPh, Pharmacy ManagerSuzy Chan, RPh, Staff Pharmacist Chieu Dang, Certified Pharmacy TechnicianMelissa SooYee, Certified Pharmacy Technician

Most insurances are accepted including Health Safety Net. Eaton Apothecary is available for all Manet patients and is open to the community.

For more information, visit: www.eatonapothecary.com

Vision Center and Pharmacy

HoursMonday 10:30 a.m. – 7 p.m.Tuesday 8:30 a.m. – 5 p.m.Thursday 8:30 a.m. – 5 p.m.

HoursMonday 9 a.m. – 9 p.m.Tuesday 9 a.m. – 5 p.m.Wednesday 9 a.m. – 9 p.m.Thursday 9 a.m. – 9 p.m.Friday 9 a.m. – 5 p.m.Saturday 9 a.m. – 1 p.m.

www.manetchc.orgYour partner for a healthier life.

Locations and ServicesNorth Quincy110 West Squantum StreetNorth Quincy, MA 02171(617) 376-3000 and (857)-403-0820

Onsite Services• Family Medicine • Pediatric Medicine• Internal Medicine• Infectious Disease Medicine• Prenatal, Obstetrical and Gynecological

Care• Interpretation/Translation/Language

Services • Newborn and Well Child Care• Immunizations• Minor Surgical Procedures • Chronic Disease Management• Medical Nutrition Counseling and

Diabetes Self-Management• Health Benefits Counseling, Patient

Navigation, and Food Stamp Assistance (SNAP)

• 24-hour On-call Coverage for registered patients

• HIV and STI Screening, Testing and Risk Reduction Counseling

• Narcan/Naloxone, Opiod Overdose and Reversal Program (counseling and distribution)

• Suboxone (Buprenorphine)• Community Outreach and Health

Education • Tobacco Cessation Counseling • Wellness Programs • Needle disposal kiosk • Onsite Laboratory• Onsite 340B and Retail Pharmacy• Vision Center

Houghs Neck 1193 Sea StreetQuincy, MA 02169(617) 471-8683

Onsite Services• Family Medicine • Pediatric Medicine• Internal Medicine• Prenatal, Obstetrical and Gynecological








• Community Outreach and Health Education

• Tobacco Cessation Counseling • Wellness Programs • Onsite Laboratory

www.manetchc.org


Snug Harbor 9 Bicknell Street Quincy, MA 02169 (P) 617-471-4715




Diabetes Self-Management

• Health Benefits Counseling, Patient Navigation, and Food Stamp Assistance (SNAP)






Taunton1 Washington StreetTaunton, MA 02780(P) 508-822-5500


Care• Interpretation/ Translation/Language








• Wellness Programs • Onsite Laboratory

Hull180 George Washington BoulevardHull, MA 02045(781) 925-4550




Diabetes Self-Management

• Health Benefits Counseling, Patient Navigation, and Food Stamp Assistance (SNAP)








North Quincy 110 West Squantum St.North Quincy, MAPhone: (617) 376 3000

Snug Harbor9 Bicknell St.Quincy, MAPhone: (617) 471 4715

Hough’s Neck1193 Sea St.Quincy, MAPhone: (617) 471 8683

Hull180 G Washington BlvdHull, MAPhone: (781) 925 4550

TauntonOne Washington Street(Mill River Place)Taunton, MAPhone: (508) 822 5500

Manet Map and Locations

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www.manetchc.org

North Quincy 110 West Squantum St., N. QuincyFrom the North (Boston) Via the Southeast Expressway Rt. 128 and 93

Take Exit 12 Neponset. Stay to Right off ramp to Gallivan Blvd. for a few hundred feet. Keeping to the Right go under the Expressway (lights) and take the up-ramp onto the Neponset River Bridge to Quincy. Keeping to the Right take the off-ramp to Route 3A/Quincy onto Hancock St. Go straight on Hancock St. leaving Chinese Restaurant (lights) on your Right. Follow Hancock St. past North Quincy High School (on your left) and take the next right at the gas station and lights onto West Squantum St. Follow West Squantum St. for 3 blocks to 110 West Squantum. Take a Left onto Safford St. and immediate left into Parking Lot.

An Alternate Route from the North Via Expressway Rt. 128 and 93

Exit 10 off the Southeast Expressway to Squantum St. Follow Squantum St. (head-ing East) to 110 West Squantum St. Take a Right onto Safford St. and an immediate Left into parking lot.

From the South and West Via Southeast Expressway

Follow 93 North towards Boston. Take Exit 9 (Adams St., Milton, North Quincy). Go straight ahead off exit through East Milton Square staying on Granite St. At second set of lights go Right onto West Squantum St. towards North Quincy for about 1 mile. Take Right onto Safford St. and immediate Left into parking lot.

From the South to North Quincy Via Hancock Street, Quincy

From Routes 53, 18, 3A follow 3A North on Southern Artery past Quincy Police Department Station and Cemetery. Hancock St. becomes Route 3A at Quincy Football Stadium. Follow 3A North on Hancock St. all the way into North Quincy. After passing Sacred Heart Catholic Church on Right with North Quincy High School coming into view, take a Left at lights onto West Squantum St. passing the T station. Manet is on the Left about 1/3 mile. Take a left onto Safford St. and an immediate Left into parking lot.

Snug Harbor 9 Bicknell St., QuincyFrom Southeast Expressway Routes 128 and 93 either direction North or South

Take Furnace Brook Parkway Exit 8 and follow until it ends at Quincy Shore Drive (at lights, with a view of the ocean). Take a Right onto Quincy Shore Drive up an incline and take a Left at the bottom of the hill onto Sea Street, Houghs Neck/German-town.Follow Sea Street for almost 2 miles and take a Right onto Palmer Street (at the lights and library). Stay on Palmer Street until the church and rotary end. Manet is located at 9 Bicknell Street 1/3 of the way around the rotary beyond the school and church.

From Hingham, Weymouth Route 18 and other points South

Routes 53 and 3A come together at Tom O’Briens Auto (Washington Street and South Artery in Quincy). Follow 3A (Boston) North to Quincy Police Station. At lights take a Right onto Sea Street (cemetery on left). Follow Sea Street for almost 2 miles and take a Right onto Palmer Street (at the lights and library). Stay on Palmer Street until the church and rotary end. Manet is located at 9 Bicknell Street 1/3 of the way around the rotary beyond the school and church.

Hough’s Neck 1193 Sea St., QuincyFrom Southeast Expressway Routes 128 and 93 either directions North or South

Take Furnace Brook Parkway Exit 8 and follow until it ends at Quincy Shore Drive (at the lights, with a view of the ocean). Take a Right onto Quincy Shore Drive, up an incline and take a Left at the bottom of the hill onto Sea Street, Houghs Neck.

From Hingham, Weymouth, Route 18 and other points South

Routes 53 and 3A merge at Tom O’Briens Auto (Washington Street and South Artery in Quincy). Follow 3A (Boston) North to Quincy Police Department station. At lights take a Right onto Sea Street. Cemetery is on the left. Follow Sea Street for 4 miles (solid yellow traffic lines) bearing very very slightly to the Left at the Adams Shore Library. Manet is located at 1193 Sea Street, on the right hand side, across from two Auto Shops.

Hull 180 G Washington Blvd HullFrom Hingham, North Weymouth and Quincy

Follow 3A to Hingham Rotary. At this point, leave Route 3A and follow signs to Hingham Court House. (The Court House is located on George Washington Boulevard). The Hull Medical Center is the first building on the left after passing the course house, approximately 1/2 mile away at 180 George Washington Boulevard.

From Cohassett, Hingham, Scituate and Rockland

Follow Route 228 to Seashore Motel. At this point leave Route 228 and take a left onto Rockland House Road. Follow Rockland House Road to traffic lights at George Washington Boulevard. Take a left onto George Washington Boulevard. The Hull Medical Center is located approximately 1/4 mile on the right at 180 George Washington Boulevard.

Taunton One Washington Street TauntonFrom Boston and points North/North East of Taunton

Take I-93 S to Exit 4 bearing left onto MA-24S toward Brockton. Take Exit 13B to US-44 W toward Taunton. Merge onto US-44 W left onto Taunton Green, turn right onto Cohannet St. Continue onto Post Office Square – turn right onto R Martin Sr. Parkway. R Martin Sr. Parkway turns left and becomes Washington Street – One Washington Street will be on the left.

From New Bedford and points South of Taunton

Take MA-140 North – into Taunton turning left onto Church Green – continue onto Main St. Turn left onto Taunton Green, turn right onto Cohannet St. Continue onto Post Office Square – turn right onto R Martin Sr. Parkway. R Martin Sr. Parkway turns left and becomes Washington Street – One Washington Street will be on the left.

Patient Bill of RightsManet Community Health Center, Inc at all sites including North Quincy, Hull, Snug Harbor, Houghs Neck, and Taunton support your right to know about your health and illness and your right to participate in decisions that affect your well-being. In Massachusetts there is a law designed to help protect the rights of patients in health care facilities (Chapter 111, Section 70E of the General Laws of Massachusetts). Our own statement of patient rights, which is similar in intent incorporates this law and describes the health center’s commitment to protect-ing your rights. A copy of these patient rights are posted at each site of the health center.

Every patient of the health center shall have the right:

(a) Upon request, to obtain from the health center in charge of his/her care the name and specialty, if any, of the physician or other person responsible for his/her care or the coordination of his/her care.

(b) To confidentiality of all records and communications to the extent provided by the law.

(c) To have all reasonable requests responded to promptly and adequately within the capacity of the facility.

(d) Upon request, to obtain and explanation as to the relationship, if any, of the facility to any other health care facility or educational institution insofar as said relationship relates to his/her care or treatment.

(e) Upon request, to obtain from a person designated by the facility a copy of any rules or regulations of the facility which apply to his/her conduct as a patient.

(f) Upon request, to receive from a person designated by the facility and information which the facility has available relative to financial assistance and free health care;

(g) Upon request, to inspect his/her medical records and to receive a copy thereof with the fee for said copy be determined by the rates of copying expenses. Exception: no fee shall be charged to any applicant, beneficiary, or individual representing said ap-plicant or beneficiary for furnishing a medical record if the record is requested for the purpose of supporting a claim or appeal under any provision of Social Security Act or any federal or state financial needs-based benefit program, and the facility shall furnish a medical record requested pursuant to a claim or appeal under any provision of the Social Security Act or any federal or state financial needs-based benefit pro-gram within thirty days of the request; provided however, that any person for whom no fee shall be charged shall present reasonable documentation at the time of such records request that the purpose of said request is to support a claim or appeal under any provision of the Social Security Act or any federal or state financial needs-based program.

(h) To refuse to be examined, observed, or treated by students or any other facility staff without jeopardizing access to psychiatric, psychological, or other medical care and attention.

(i) To refuse to serve as a research subject and to refuse any care or examination when the primary purpose is educational or informational rather than therapeutic.

(j) To privacy during medical treatment or other rendering of care within the capacity of the facility.

(k) To prompt life saving treatment in an emergency without discrimination on account of economic status or source of payment and without delaying treatment for pur-poses of prior discussion of the source of payment unless such delay can be imposed without material risk to his health, and this right shall also extend to those persons not already patients of a facility if said facility has a certified emergency care unit.

(l) To informed consent to the extent provided by law.(m) Upon request to receive a copy of an itemized bill or other statement of charges

submitted to any third party by the facility for care of the patient and to have a copy of said itemized bill or statement sent to the attending physician of the patient.

(n) If refused treatment because of economic status or the lack of a source of payment, to prompt and safe transfer to a facility which agrees to receive and treat such pa-tient. Said facility refusing to treat such patient shall be responsible for: ascertaining that the patient may be safely transferred; contacting a facility willing to treat such patient; arranging the transportation; accompanying the patient when necessary and appropriate professional staff to assist in the safety and comfort of the transfer; assure that the receiving facility assumes the necessary care promptly; and provide pertinent information about the patient’s condition; and maintaining records of the foregoing.

(o) Upon request, to obtain an explanation as to the relationship, if any, of the physician to any other health care facility or educational institutions insofar as said relation-ship relates to his/her care or treatment, and such explanation shall include said physician’s ownership or financial interest, if any, in the facility or other health care facilities insofar as said ownership relates to the care or treatment of said patient.

(p) Upon request to receive an itemized bill including third party reimbursements paid toward said bill, regardless of the sources of payment; and

(q) In the case of patient suffering from any form of breast cancer to complete informa-tion on all alternative treatments which are medically viable.

(r) Every maternity patient, at the time of pre-admission, shall receive complete infor-mation from an admitting hospital on its annual rate of primary caesarian sections, annual rate of repeat caesarian sections, annual rate of total caesarian sections, annual percentage of women who have had a caesarian section who have had a sub-sequent successful vaginal birth, annual percentage of deliveries in birthing rooms and labor-delivery-recovery or labor-delivery-recovery-postpartum rooms, annual percentage of deliveries by certified nurse midwives, annual percentage which were continuously externally monitored only, annual percentage which were continuously internally monitored only, annual percentage which were monitored both internally and externally, annual percentages utilizing intravenous, inductions, augmenta-tion, forceps, episiotomies, spinals, epidurals and general anesthesia, and its annual percentage of women breast-feeding upon discharge from said hospital.

(s) A facility shall require all persons, including students, who examine, observe or treat a patient of such facility to wear an identification badge which readily discloses the first name, licensure status, if any, and staff position of the person so examining, observing or treating a patient; provided, however, that for the purposes of this paragraph, the word facility shall not include a community day and residential set-ting licensed or operated by the department of mental retardation.

(t) Any person who rights under this section are violated may bring, in addition to any other action allowed by law or regulation, a civil action under sections sixty B to sixty E, inclusive, of chapter 231.

Patient Bill of Rights(u) No provision of this section relating to confidentiality of records shall be construed

to prevent any third party reimburser from inspecting and copying, in the ordinary course of determining eligibility for or entitlement to benefits, any and all records relating to diagnosis, treatment, or other services provided to any person, including a minor or incompetent, for which coverage, benefit or reimbursement is claimed, so long as the policy or certificate under which the claim is made provides that such ac-cess to such records is permitted. No provision of this section relating to confidential-ity of records shall be construed to prevent access to any such records in connection with any peer review or utilization review procedures applied and implemented in good faith.

(v) No provision herein shall apply to any institution operated by and for persons who rely exclusively upon treatment by spiritual means through prayer for healing, in ac-cordance with the creed or tenets of a church or religious denomination, or patients whose religious beliefs limit the forms and qualities of treatment to which they may submit.

(w) No provision herein shall be construed as limiting any other right or remedies previ-ously existing at law

Should you have concerns, problems, or complaints about the quality of care or service that you are receiving, you are encouraged to speak to the people directly involved in your care. If the issue is not resolved to your satisfaction, or if you would like the help of someone not immediately involved, any other staff member is trained to document your concern, offer you a form in which you can document your concern, or direct you to the Senior Management of this health center. If you would like to do so on your own the following address will help you:

Mr. John Holiver CEOManet Community Health Center, Inc.

110 West Squantum StreetQuincy, Massachusetts 02171

If you find the above avenues unsatisfactory, you may choose to file a formal grievance with the any of the following agencies:

Massachusetts Board of State Department of Public Health (Or, if you have Medicare) Registration in Medicine Division of Health Care Quality MassPRO 560 Harrison Avenue 10 West Street 235 Wyman Street Boston, MA 02118 Boston, MA 02111 Waltham, MA 02451 617-654-9800 617-753-8150 or 800-252-5533 800-462-5540

Manet Community Health Center, Inc. is accredited by the Joint Commission. This is an independent, not-for-profit organization dedicated to improving the quality of health care in organized health care settings. The Joint Commission was founded in 1951 and engages in issues and activities concerning the advancement of health care safety and quality, including public policy initiatives, the development of standards of health care, and accreditation and certification programs. The health center is surveyed by the Joint Commission at least every three years.

A requirement of accreditation is that Manet Community Health Center provides notice to our patients and the general public that when an individual has any concerns about patient care and safety within the organization that the organization has not addressed, and that he or she is encouraged to contact the Administrative Office of the Manet Community Health Center as described above. If the concerns cannot be resolved through the health center, the individual is encouraged to contact the Joint Commission.

Should patients, their families, caregivers and others wish to share their concerns regarding quality of care issues at the health center, the Joint Commission has provided a toll-free hotline.

The toll-free number is 800-994-6610. This hotline is available 24 hours a day, 7 days a week. Staff member are available to answer calls at this number weekdays between 8:30 AM and 5:00 PM central standard time.


Welcome to yourPatient Centered Medical Home

What is a Medical Home? A Medical Home is a new model of care where a team works with you to help address all of your health care needs.

Medical Home Patient Roles & ResponsibilitiesAs a patient and partner in my health care team, I will:• BringallquestionsIhavetomy

appointmentsandnothesitatetoaskaboutthingsIdonotunderstand.

• Helpyoucreatemyactionplan&trackmyprogress.

• LetyouknowwhenIgetcaresomewhereelse.

• Bringalistofallmedicines,supplements,andherbalorholisticproductsIusetomyofficevisits.

• Fillmyprescriptionsontime,usethemasprescribed,andtellyouofanyproblems.

Medical Home Provider Roles & ResponsibilitiesAs providers and partners in your health care team, we will:• Respectyouandyourfamilyvaluesand

needs.• Respectyourculture&uselanguageyou

understand.• Askyoutotakepartinyourhealthcare.• Helpyousetgoalsandcreateanaction

plan.• Trackthecareyougetfromother

providers.• Askforyourideasonhowwecan

improveyourcare.• Stayincontactwithyouasyourpartner

incare.

Who is on a “Team”?• PrimaryCareProvider• Nurses• MedicalAssistants• RNCareManager• Nutritionist• Someonetohelpyou

withinsurance,benefits,&registration

How will my team work for me?• Youwillseethesameteameveryvisit.• Yourteamwillmakesurethatyouunderstand

yourconditionsandyourcareoptions.• Yourteamwillworkwithyoutocoordinateyour

careandtomanageyourhealthbetter.• Youwillgetappointmentswithyourteam

quickly,evenonthesameday,whenneeded.

ManetCommunityHealthCenter,Inc.servesthebroadhealthneedsofSouthShoreresidentsthroughafamilypracticemodelofcare.Amulti-sitecommunitybasedhealthcenter,Manetworkstoensurethatitspatientshaveaccesstoalllevelsofthehealthcaresystemaswellasevidence-basedcare.Manetisespe-ciallycommittedtoprovidingservicesforthemedicallyunderserved.

Astrongproponentofpreventiveeducationandpublichealthactivities,Manetcollaborateswithothercommunityagenciesandorganizationstoidentifyhealthrelatedneedsandtodevelopresourcestomeettheseneeds.

Manet Mission…We are a not-for-profit health and social service provider and we exist to be your partner for a healthier life.

How do I make an appointment?LocateaconvenientManetsite,andcalltomakeanappointmenttoseeyourprovider.

What if I need refills on my medications?Contactyourpharmacytoseeifrefillsareavailable.Ifnone,thenlogintoyoursecurePatientPortalorcallManetandfollowthepromptstoleaveames-sageontheprescriptionvoicemail.

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MASSACHUSETTS HEALTH CARE PROXY Information, Instructions, and Form

What does the Health Care Proxy Law allow?

The Health Care Proxy is a simple legal document that allows you to name someone you know and trust to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions. It is an important document, however, because it concerns not only the choices you make about your health care, but also the relationships you have with your physician, family, and others who may be involved with your care. Read this and follow the instructions to ensure that your wishes are honored.

Under the Health Care Proxy Law (Massachusetts General Laws, Chapter 201D), any competent adult 18 years of age or over may use this form to appoint a Health Care Agent. You (known as the “Principal”) can appoint any adult EXCEPT the administrator, operator, or employee of a health care facility such as a hospital or nursing home where you are a patient or resident UNLESS that person is also related to you by blood, marriage, or adoption. Whether or not you live in Massachusetts , you can use this form if you recieve your health care in Massachusettes.

What can my Agent do?

Your Agent will make decisions about your health care only when you are, for some reason, unable to do that yourself. This means that your Agent can act for you if you are temporarily unconscious, in a coma, or have some other condition in which you cannot make or communicate health care decisions. Your Agent cannot act for you until your doctor determines, in writing, that you lack the ability to make health care decisions. Your doctor will tell you of this if there is any sign that you would understand it.

Acting with your authority, your Agent can make any health care decision that you could, if you were able. If you give your Agent full authority to act for you, he or she can consent to or refuse any medical treatment, including treatment that could keep you alive.

Your Agent will make decisions for you only after talking with your doctor or health care provider, and after fully considering all the options regarding diagnosis, prognosis, and treatment of your illness or condition. Your Agent has the legal right to get any information, including confidential medical information, necessary to make informed decisions for you.

Your Agent will make health care decisions for you according to your wishes or according to his/her assessment of your wishes, including your religious or moral beliefs. You may wish to talk first with your doctor, religious advisor, or other people before giving instructions to your Agent. It is very important that you talk with your Agent so that he or she knows what is important to you. If your Agent does not know what your wishes would be in a particular situation, your Agent will decide based on what he or she thinks would be in your best interests. After your doctor has determined that you lack the ability to make health care decisions, if you still object to any decision made by your Agent, your own decisions will be honored unless a Court determines that you lack capacity to make health care decisions.

© Massachusetts Health Decisions 1991-2015Licensed for use by the Massachusetts Medical Society

Health Care ProxyAdvanced Directives

Your Agent’s decisions will have the same authority as yours would, if you were able, and will be honored over those of any other person, except for any limitation you yourself made, or except for a Court Order specifically overriding the Proxy.

How do I fill out the form?

1. At the top of the form, print your full name and address. Print the name, address, and phone number of the person you choose as your Health Care Agent. (Optional: If you think your Agent might not be available at any future time, you may name a second person as an Alternate Agent. Your Alternate Agent will be called if your Agent is unwilling or unable to serve.)

2. Setting limits on your Agent’s authority might make it difficult for your Agent to act for you in an unexpected situation. If you want your Agent to have full authority to act for you, leave the limitations space blank. How-ever, if you want to limit the kinds of decisions you would want your Agent or Alternate Agent to make for you, include them in the blank.

3. BEFORE you sign, be sure you have two adults present who will be witnesses and watch you sign the docu-ment. The only people who cannot serve as witnesses are your Agent and Alternate Agent. Then sign the document yourself. (Or, if you are physically unable, have someone other than either witness sign your name at your direction. The person who signs your name for you should put his/her own name and address in the spaces provided.)

4. Have your witnesses fill in the date, sign their names and print their names and addresses.

5. OPTIONAL: On the back of the form are statements to be signed by your Agent and any Alternate Agent. This is not required by law, but is recommended to ensure that you have talked with the person or persons who may have to make important decisions about your care and that each of them realizes the importance of the task they may have to do.

Who should have the original and copies?

After you have filled in the form, remove this information page and make at least four photocopies of the form. Keep the original yourself where it can be found easily (not in your safe deposit box). Give copies to your doctor and/or health plan to put into your medical record. Give copies to your Agent and any Alternate Agent. You can give addi-tional copies to family members, your clergy and/or lawyer, and other people who may be involved in your health care decisionmaking.

How can I revoke or cancel the document?

Your Health Care Proxy is revoked when any of the following four things happens:

1. You sign another Health Care Proxy later on.2. You legally separate from or divorce your spouse who is named in the Proxy as your Agent.3. You notify your Agent, your doctor, or other health care provider, orally or in writing, that you want to revoke

your Health Care Proxy.4. You do anything else that clearly shows you want to revoke the Proxy, for example, tearing up or destroying the

Proxy, crossing it out, telling other people, etc.


MASSACHUSETTS HEALTH CARE PROXY

1. I, , residing at(Principal -- PRINT your name)

(Street) (City or Town) (State/ZIP)

appoint as my Health Care Agent: (Name of person you choose as Agent)

of (Street) (City/town) (State/ZIP) (Phone)Agent’s Tel (h) (w) Email( OPTIONAL: If my Agent is unwilling or unable to serve, then I appoint as my Alternate Agent:

(Name of person you choose as Alternate Agent)of .) (Street) (City/town) (State) (Phone)

2. My Agent shall have the authority to make all health care decisions for me, including decisions about life- sus-taining treatment, subject to any limitations I state below, if I am unable to make health care decisions myself. My Agent’s authority becomes effective if my attending physician determines in writing that I lack the capacity to make or to communicate health care decisions. My Agent is then to have the same authority to make health care decisions as I would if I had the capacity to make them EXCEPT (here list the limitations, if any, you wish to place on your Agent’s authority):

I direct my Agent to make health care decisions based on my Agent’s assessment of my personal wishes. If my personal wishes are unknown, my Agent is to make health care decisions based on my Agent’s assessment of my best interests. Photocopies of this Health Care Proxy shall have the same force and effect as the original and may be given to other health care providers.

3. Signed:

Complete only if Principal is physically unable to sign: I have signed the Principal’s name above at his/her direction in the presence of the Principal and two witnesses.

(Name) (Street)

(City/town) (State)4. WITNESS STATEMENT: We, the undersigned, each witnessed the signing of this Health Care Proxy by the Princi-pal or at the direction of the Principal and state that the Principal appears to be at least 18 years of age, of sound mind and under no constraint or undue influence. Neither of us is named as the Health Care Agent or Alternate Agent in this document.In our presence, on this day of , 20

Witness #1 Witness #1

(Signature) (Signature)

Name (print) Name (print)

Address Address:

YOUR BIRTH DATE / /

5. Statements of Health Care Agent and Alternate Agent (OPTIONAL)

Health Care Agent: I have been named by the Principal as the Principal’s Health Care Agent by this Health Care Proxy. I have read this document carefully, and have personally discussed with the Principal his/her health care wishes at a time of possible incapacity. I know the Principal and accept this appointment freely. I am not an operator, admin-istrator or employee of a hospital, clinic, nursing home, rest home, Soldiers Home or other health facility where the Principal is presently a patient or resident or has applied for admission. But if I am a person so described, I am also related to the Principal by blood, marriage, or adoption. If called upon and to the best of my ability, I will try to carry out the Principal’s wishes.

(Signature of Health Care Agent)

Alternate Agent: I have been named by the Principal as the Principal’s Alternate Agent by this Health Care Proxy. I have read this document carefully, and have personally discussed with the Principal his/her health care wishes at a time of possible incapacity. I know the Principal and accept this appointment freely. I am not an operator, administrator or employee of a hospital, clinic, nursing home, rest home, Soldiers Home or other health facility where the Principal is presently a patient or resident or has applied for admission. But if I am a person so described, I am also related to the Principal by blood, marriage, or adoption. If called upon and to the best of my ability, I will try to carry out the Princi-pal’s wishes.

(Signature of Alternate Agent)

*****

Health Care Proxy developed by Massachusetts Health Decisions in association with the following member orga-nizations of the Massachusetts Health Care Proxy Task Force:

Providers: For prices and information on quantity orders or for non-English language licensing, please contactMassachusetts Health Decisions, PO Box 417, Sharon, MA 02067

Boston University Schools of Medicine and Public Health: Law, Medicine, and Ethics Program Deaconess ElderCare Program Hospice Federation of

Massachusetts Massachusetts Bar AssociationMassachusetts Department of Public Health Massachusetts Executive Office of Elder Affairs Massachusetts Federation of Nursing HomesMassachusetts Health Decisions

Massachusetts Hospital Association Massachusetts Medical Society Massachusetts Nurses Association Medical Center of Central Massachusetts Suffolk University Law School: Elder Law ClinicUniversity of Massachusetts at Boston: The Gerontology

InstituteVisiting Nurse Associations of Massachusetts

rev. 1/15


Name: DOB:

This form will help guide you, your family, and your Health Care Proxy to decide about the types of medical treatment and care you would want, during a time that you were so sick that you couldn’t make these decisions on your own. If you get sick it may be difficult to think about these issues, but we hope that thisworksheet will help you talk with your family and Health Care Proxy so that you can specify your wishes before you get so ill. There are many choices available to you in today’s medical care and some of these decisionscan be almost too much to think aboutYou can change your mind about your decisions at any time. This advanced directive for medical care is de-signed to:

¾ Make your wishes clear about the types of care you want from your doctors if you can’t speak for yourself. ¾ Allow you to tell your doctors how much medical care you would want if you were severely ill. ¾ Serve as a guide for the person you chose to be your Health Care Proxy and for your physician to make health

care decisions that respect your wishes for care; ¾ Make sure that your personal, emotional, physical, and spiritual care include what you want

CARE and COMFORT DirectiveProviding medical care includes maintaining a person’s comfort and dignity. In this section, please specify your personal, emotional, and spiritual wishes. As permissible by law caregivers will adhere to your wishes. (check all that apply)

� I want my caregivers to provide me with effective pain management, so that I can be as comfortable as possible even if that means I may be drowsy.

� I wish to have personal care and attention to my appearance like bathing, shaving, nail clipping, and hair and teeth brushing, as long as they do not cause me pain or discomfort.

� I wish to have a visit by a priest or minister or other spiritual counselor. � I wish to have a psychiatric consult if I show signs of depression agitation or confused thinking. � I wish to have family and friends visit when I am up to it. � I wish to die in my home if plans for my care at home are possible.

My other personal wishes for care:

Organ Donation: Circle oneI wish to be an organ donor.I do not wish to make an organ donor.

Funeral ArrangementsThe following person knows my wishes for funeral/burial: Name Telephone: Other wishes about my funeral/ burial

Personal Statement: This Advanced Directive for Medical Care expresses my wishes regarding my medical treatment, care and comfort in the event that I am unable to communicate them directly. I understand that this is NOT a legal docu-ment. It does not try to answer all questions about every situation but serves as a guide for my heal!h care proxy.

Signed:

Print: Date:

Witness Signed:

Print: Date:

Advanced Directive for Medical TreatmentBelow are three serious medical situations that you may face at some time in your life. Discuss these issues with your family, friends, and spiritual counselors but especially with the person that you have named your health care proxy. Indi-cate below what these special people in your life should know in the case they need to follow your wishes

Situation AI am unable to com-municate my wishes and have a chance of surviving

Situation BI am unable to com-municate my wishes and will likely survive with permanant brain damage. (examples: Alzheimer’s disease, stroke, severe head injury)

Situation CI am unable to commu-nicate my wishes and am not likely to survive form a terminal or acute illness. Medical treatments would only delay the moment of my death. (Examples: teminal cancer, severe trauma)

I want I do not want

I want treat-ment, stop if no im-prove-ment





Antibiotics

Pain Medications - pain relief that may dull conscious-ness and may, in some cases, indirectly shorten my life.Medications to help my heart - medications to maintain blood pressureSimple Diagnostic Tests- such as laboratory tests,x-rays, or EKG’sInvasive Diagnostic Tests-such as a flexible lube tolook into the stomach.Intravenous fluids- Use of fluids for hydration

Artificial nutrition - nutrition provided through a tube in the veins, nose or mouth.Blood or blood products

Major surgery - surgery requiring general anesthesia, such as removal of a tumor.Minor surgery - surgery requiring local anesthesia or“conscious sedation”.Palliative surgery - Surgery that will not cure but will provide some form of relief.Kidney Dialysis- Two or three weekly sessions usinga machine to “clean” the blood after surgical placement of a permanent artificial opening.Chemotherapy/Radiation Therapy - treatment to shrink or cure a malignant tumor.CPR· use of manual chest compressions and artificialbreathing.Defibrillation/Cardioversion-Use of drugs andelectric shock to start the heart beatingIntubation/Mechanical Breathing-use of a breathing tube and ventilator to make me breath.

Contact us: [email protected] Hotline # 857-403-1557

What to bring to your appointment:

£ Proof of Income Two pay stubs for each job or letter from Unemployment, if self employed: most recent tax forms including Schedule C, proof of rental income, proof of child support or alimony

£ Proof of IdentityDrivers license, Massachusetts I.D., military I.D., school I.D., adoption papers

£ Proof of Citizenship of Immigration StatusBirth certificate, passport, certificate of naturalization or green card

£ Social Security Number (IF available)

Steps to take:

1. Make an appointment with a Navigator. 2. Set-up an account BEFORE your appointment if

possible.Here’s how:PGo to Mahealthconnector.org. PLook for the box, “ Create an Account”PFill in your personal information.

*Please note an email address is required to create an account on-line

FOR HEALTH INSURANCE ASSISTANCE

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