PATIENT RIGHTS AND RESPONSIBILITIES

It is the policy of Surgery Center at Health Park that each patient cared for shall have the following Rights and Responsibilities that are within Surgery Center at Health Park's capacity, mission, and law application. We believe that a patient who understands and participates in his or her health care may achieve better results. Surgery Center at Health Park prepared these Rights and Responsibilities for your benefit.

Your rights as a patient include:

Access to Care: You have the right to be treated by personnel who are qualified through education and experience to perform the services for which they are responsible. You have the right to be treated, when accommodations are available and treatment is medically indicated; regardless of race, religion, creed, sex, national origin, age, handicap, marital status, sexual preference, or sources of payment.

Respect/Dignity: You have the right to have your dignity as an individual human being recognized and respected. Your care will include consideration of your Advance Directives, psychosocial, spiritual, and cultural needs that may influence the perceptions of illness. You as a patient or your representative may exercise your rights without the fear of discrimination or reprisal. You as a patient have the right to be free from all forms of abuse or harassment.

Privacy: You are entitled to privacy, to the extent possible, during any patient/staff interview, discussions about your care, as well as in the course of treatment to be followed. You are entitled to confidential treatment of personal and medical records, and may refuse their release to a person outside the health facility or agency except as required because of a transfer to another health care facility, as required by law or third party payment contract, or as permitted or required under the health insurance portability and accountability act of 1996, Public Law 104-191, or regulations under that act 45 CFR parts 160 and 164.

Care Plan: Your physician will provide you with appropriate care, information about your medical condition, proposed course of treatment and prospects for recovery. You have the right to be fully informed before transfer to another facility.

Refusal of Medical or Surgical Treatment: You are entitled to refuse medical or surgical treatment to the extent provided by law and to be informed of the consequences of that refusal. When a refusal of treatment prevents the physician or staff from providing appropriate care according to ethical and professional standards, the relations with the patient may be terminated.

Personal Safety: You have the right to expect reasonable safety.

Information: As an individual who is or has been a patient, you are entitled to inspect, or receive for a reasonable fee, a copy of your medical record upon request in accordance with the medical records access act, 2004 PA 47, MCL 333.26261 to 333.26271. Except as otherwise permitted or required under the health insurance portability and accountability act of 1996, Public Law 104-191, or regulations promulgated under that act, 45 CFR parts 160 and 164.. A third party shall not be given a copy of your medical record without your prior written authorization except as required by law:

  • Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care.
  • Right to Amend. If you feel that the medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the office.
  • Patient Advocate. You have the right to have your designated representative participate in your care.
  • Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures". This is a list of the disclosures we made of medical information about you.
  • Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.
  • Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail
  • Right to a Paper Copy of the Privacy Notice. You have the right to a paper copy of our Privacy Notice.
  • Quality Improvement Information. You have the right to request information regarding Surgery Center at Health Park's Quality Improvement Program, including information on progress towards meeting quality improvement goals.
  • Preventive Health. Surgery Center at Health Park will provide you with copies of, and/or information regarding, preventive health guidelines. If a preventive health guideline is not provided, you have the right to request a copy. Surgery Center at Health Park is dedicated to informing and encouraging our patients to utilize available health promotion, health education and preventive health services.

Pain: Your reports of pain will be acknowledged and assessed. You will be provided with information about pain, pain relief measures, and effective pain management, as appropriate.

Decisions Involving Your Care are Based on Appropriateness of Care and Services: You have the right to be fully informed of the scope of services available at Surgery Center at Health Park, provisions for emergency care, and related fees for services rendered. You have the right to be provided to the extent known by the physician, complete information regarding diagnosis, treatment and the prognosis, as well as alternative treatments or procedures and the possible risks and side effects associated with treatment. You have the right to continuing medical services throughout the period of need. The plan for these services will be timely and will involve appropriate personnel and community resources. You have the right to change your provider if other qualified providers are available.

Your responsibilities as a patient include:

Honesty: You are responsible for being honest and direct about everything that is related to you as a patient. You must provide to the best of your knowledge complete and accurate medical history including information about present complaints, past illnesses, hospitalizations, medications including over-the-counter and dietary supplements and allergies. You are responsible to inform your caregiver about any Living Will, Medical Power of Attorney or other directive that could affect your care.

Understanding: You are responsible for understanding your health problems to your own satisfaction. If you do not understand your illness or treatment, ask the doctors and staff to explain it to you.

Following Your Treatment Plan: It is your responsibility to tell those treating you whether you can and/or want to follow a certain treatment plan. Remember that your health is your own responsibility. Following your doctor's instructions/advice is very important. Provide a responsible adult to transport you home from the facility and remain with you for 24 hours.

Refusal of Treatment: You are responsible for your actions if you refuse treatment. You do have that right, but you also can change your mind. We respect you and your decisions.

Reporting Changes: It is your responsibility to let us know about any changes in your health and how you feel as you receive medical treatment.

Providing Requests for Information in Writing: It is your responsibility, when you request information from us that you provide it in writing. If you need a copy of a sample letter, please ask the office.

Appointments: You are responsible for keeping appointments, and when unable to do so for any reason, for notifying Surgery Center at Health Park.

Charges: You are responsible for providing Surgery Center at Health Park with accurate and timely information about your sources of payment and ability to meet financial obligations. You are responsible to accept personal financial responsibility for any charges not covered by your insurance.

Respect and Consideration: You are responsible for being considerate to your doctor and staff and other Surgery Center at Health Park patients. You are responsible for observing rules of Surgery Center at Health Park and if instructions are not followed, you may forfeit care provided to you at Surgery Center at Health Park.

Pain: As a patient at Surgery Center at Health Park, we expect that you will ask your doctor or nurse what to expect regarding pain and pain management. Discuss pain relief options with your doctors and nurses. It is important that you ask for pain relief when your pain first begins. Help your doctor and nurse assesses your pain. Tell your doctor or nurse if your pain is not relieved, and tell your doctor or nurse about any worries you have about taking pain medication.

Complaints or Suggestions for Improvement: You, our patient, are our primary concern. We want to make your care at Surgery Center at Health Park as pleasant as possible. If you are dissatisfied with the care or services that you receive, or if you feel that your privacy rights have been violated, you have the right to initiate the complaint process and discuss your concerns with the Executive Director or Doctor. You may also file a complaint to:

Medicare Beneficiary Ombudsman The State of Michigan, Department of Community Health
1-800-MEDICARE (800-633-4227)
www.cms.hhs.gov/center/ombudsman.asp
Bureau of Health Systems:
Complaint Investigation Unit
1-800-882-6006
Hearing Impaired: 1-800-649-3777
General Information:
Capital View Building, 201 Townsend Street
Lansing, MI 48913
1-517-373-3740

Physician Disclosure of Ownership
The following individuals and corporations are investors at Surgery Center at Health Park:
Beecher Ballenger Services, Great Lakes Anesthesia, Dr. Abd Alghanem, Dr. David Diskin, Dr. Jeffrey Diskin, Dr. Kiet Doan, Dr. Zouheir Fares, , Dr. Keith Heslinger, Dr. Steven Karr, Dr. Gary Keoleian, Dr. Joseph Kingsbury, Dr. Martin Lapa, Dr. Edward Lis, Dr. Michael Macksood, Dr. Steven Marchetta, Dr. Srinivas Mukkamala, Dr. Kimberly Pummill, Dr. Wayne Robbins, Dr. Harold Rutila, Dr. Todd Sandrock, Dr. Thomas Shuster, Dr. Michael Sorscher, Dr. John Ulrich, Dr. Mark Vance, Dr. Bonita Wang, Dr. Tarik Wasfie, Dr. Mark Williams, Dr. Thomas Wright.

Advance Directives
An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions. It is our policy that we do not honor advance directives at Surgery Center at Health Park. In all instances of emergency or life threatening situations, life-sustaining treatment will be instituted and patients will be transferred to a higher level of care.

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