PATIENTS RIGHTS AND RESPONSIBILITIES
Your RIGHTS AND RESPONSIBILITIES
The following rights are granted to patients upon successful intake into an ibogaine therapy program.
1. You have the right to understand and use these rights. If for any reason you do not understand your rights or you need help in understanding your rights, the ibogaine provider must make assistance available, including an interpreter.
2. You have the right to be informed of the dosage and form of ibogaine you will receive.
3. You have the right to receive complete information about your diagnosis, treatment and prognosis.
4. You have the right to participate in all decisions about your treatment.
5. You have the right to receive treatment without discrimination as to race, color, religion, sex, national origin, disability, or sexual orientation.
6. You have the right to receive considerate and respectful care in a clean and safe environment, free of unnecessary restraint.
7. You have the right to be informed of the name, position, experience and credentials of the primary caregiver who will be in charge of your ibogaine therapy.
8. You have the right to receive all the information that you need to give informed consent for any proposed procedure or treatment you will receive, and the possible risks and benefits of the proposed procedure or treatment.
9. You have the right to refuse treatment and be told what effect this may have on your health.
10. You have the right to be informed of alternate therapies.
11. You have the right to privacy while undergoing Ibogaine treatment and confidentiality of all information and records regarding your care.
12. You have the right to review your treatment record without charge and obtain a copy of your treatment record, for which your provider can charge a reasonable fee, with the understanding that you cannot be denied a copy solely because you cannot afford to pay.
13. You have the right to complain without fear of reprisals about the care and services you are receiving, and to have the provider respond to you.
14. You have the right to file a grievance report and have a patient advocate intervene on your behalf.
BY ACCEPTING THE ABOVE GRANTED RIGHTS, YOU ARE ALSO ACCEPTING THE FOLLOWING RESPONSIBILITIES:
1. Ibogaine use is contraindicated with certain medical and psychological conditions. You are responsible for providing accurate and complete information about past illnesses, hospitalizations, medications, and other health-related matters.
2. You are responsible for informing your treatment providers and other caregivers if you anticipate problems in following prescribed treatment.
3. You must take responsibility for requesting additional information or clarification about your health status or treatment when you do not fully understand the current information or instructions.
The risks of this treatment are inherent in the use of an experimental psychedelic drug. As yet, there are no clinical studies of the long-term effects of ibogaine. However, no long-term side effects have been reported at the dosage we use.