Community Guidelines

One tenant of cohesive community is a list of shared agreements and guidelines. This is the document all patients are asked to sign prior to their appointment. Feel free to review it prior to your visit with us!

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As a Patch in this Work of Community Care, I agree, to:

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• Honor my commitments to myself and others.
  • I understand that if I run 10 minutes or more behind for an appointment, I will be asked to reschedule.
  • If Wren is running 10 or more minutes behind, they will work to reach out to me to provide me with an opportunity to reschedule as well.
  • If I cancel three appointments without 48 hours of notice or fail to show up to three appointments within a 12 months period, I may be asked to seek out a different primary care office for care.
  • If I cancel an appointment within 24 hours, or if I fail to show up for my appointment, or arrive more than 10 minutes late for the schedule time, I will be charged a $50 dollar fee. This includes patients with insurance, except for Medicare and Medicaid who cannot be charged a no show or late fee.
  • Telehealth may be a more accessible option (when appropriate) for me if I have difficulty with transportation, being on time, and/or illness that limits the possibility of an in person visit. Patchwork will inform me if a visit is appropriate for telehealth or if an in person visit is needed for my concern.

• Listen for understanding.
  • At Patchwork, I will be believed. Patchwork commits to validating my lived experience in my body.

• Offer generosity, care, and resources when possible.
  • Patchwork is working to create a Resource Room that offers medical equipment loans, gender-affirming care supplies, a list of affordable medication options, and a clothing closet. If I would like to support these projects or if I am in need of support from these projects, I will let Patchwork know.

• Trust and honor each person’s truth, lived experience, and identity even when it does not line up with my own, extending grace and understanding to others, just as I expect grace and understanding to be extended to me.
  • Patchwork is committed to creating a supportive and accepting community environment.
  • Disrespect including, but not exclusive to racism, sexism, homophobia, transphobia, body shaming, ableism, classism, and ageism should not and will not be tolerated.
  • I agree to apologize and commit to a process of repair when I have caused harm to another, or I will be asked to seek care elsewhere.

• Respect and honor my needs and capacity, and respect and honor the capacity and needs of others.
  • Patchwork works hard to run on time. Because of this and the limits insurance companies place on coverage for longer appointments, Wren and I will work to set an agenda for each visit together. We will likely only be able to cover two concerns thoroughly per follow-up appointment, and we will work together to plan out a schedule of additional appointments to adequately support me in my health and wellness.
  • Job, school, and government form work will require a standalone appointment to complete.

• Respect the boundaries of others, just as I expect my boundaries to be respected.
  • Because Patchwork is a small primary care office, and they are committed to providing adequate time and consideration to my health and wellness, patient messaging through the portal should be limited to questions about recently prescribed medications, recent lab/imaging results, or scheduling/canceling an appointment. Most other concerns will need an appointment. I will reference the attached guide to portal messages if I am unsure if I may need an appointment. I understand that if I fail to respect these boundaries, Patchwork may limit my ability to use the portal for messages.
  • By providing my email address and cell phone number, I agree to receive communications via email and text message, and I understand that communications with Patchwork via email, video chat, facsimile, instant messaging, and cell phone are not guaranteed as secure or confidential methods of communication. Patchwork will do their best to maintain secure and confidential communication. There is some risk that information transferred through E-communications may be misdirected, intercepted, or improperly disclosed, and I waive Patchwork’s obligation to ensure confidentiality with respect to the above forms of communication, and agree to hold harmless Patchwork for any losses or damages resulting from or arising in connection with information that is transmitted through E-communication.
  • Patchwork is a trauma-informed and fully consent based practice. If I am not comfortable with a procedure, treatment, vaccination, etc, that is 100% okay! I will let Wren, or a staff member at Patchwork know so that my boundaries can be respected.

• Be honest, and stand in my truth.
  • Patchwork is committed to transparency in the healthcare process, and we are unable to check individual insurance coverage for particular procedures/medications/etc. Because of this, I understand that I will need to reach out to my insurance company with questions or concerns regarding potential costs of various healthcare related expenses.
  • Patchwork uses assistive devices including ambient listening software to support in the documentation of appointments. All records will be reviewed for accuracy. I can opt out of this at any time during my appointment.
  • The contents of my appointments will be documented in the medical record. If I have questions or concerns about the implications of sensitive information being recorded, I will discuss this with Wren, and we will work together to come up with a mutually agreed upon solution to this concern.

• Tend to my own needs and ask for help and support when necessary.
  • Patchwork offers various appointment accommodations. If there is something I am needing to support my experience, Patchwork will do their best to accommodate me.
  • Healthcare is a collaborative effort. At Patchwork I will be offered suggestions and recommended treatment plans. It is up to me to follow through with this plan to the best of my ability and reach out for help and support when I need it.

• Speak out against injustice.
  • Wren is a mandatory reporter, as is every adult in the state of North Carolina. If there is concern for child abuse or adult/elder abuse, or if I am in imminent danger, Wren will discuss their concerns with me and possible next steps for support and care, working as much as possible for a mutually agreed upon plan.

The above outlined agreements are not meant to be punitive or limiting, and Patchwork recognizes the potential barriers these may place for some patients. Patchwork is trying to balance their need for a consistent schedule and healthy boundaries in order to be able to sustain this practice with an understanding and respect for their patients’ possible limitations. I can discuss this document with Wren further if I have questions or concerns.

Portal Message Guidelines