Rights & Responsibilities
As The Patient, You Have the Right to:
- Have access to the patient rights and responsibilities established by this center
- Be treated with respect, consideration and dignity
- Effective communication
- Be respected for your cultural and personal values, beliefs, and preferences
- Be provided appropriate privacy
- Pain management
- Access, request amendment to, and obtain information on disclosures of your health information, in accordance with law and regulation
- Receive care in a safe setting
- Receive information in a manner tailored to your age, language, and ability to understand
- Interpreting and translation services
- Proper communication with the patient who has vision, speech, hearing, or cognitive impairments in a manner that fits your needs
- Be free from all forms of abuse or harassment
- Be fully informed about a treatment or procedure and the expected outcome before the procedure is performed
- Respect from the organization for your right to receive care in a safe setting
- Appropriate information regarding the absence of malpractice insurance coverage
The Patient has the Right to Advance Notice of Rights:
- The patient has the right to receive verbal and written notice in advance of the date of the procedure, in a language and manner that the patient or the patient’s representative understands. The center gives brochures to each patient being admitted with the center’s written policies and the nurse making the preoperative call informs the patient verbally.
The Patient has a Right to Information Concerning:
- Patient rights, conduct and responsibilities
- Provisions for after hour emergency care
- Fee for services
- Payment policies
- Patient’s right to refuse participation in experimental research
- Advance directives, as required by state and/or federal law and regulations
- The credentials of health care professionals
- The center’s policy on Advance Directives: To provide the patient, or as appropriate, the patient’s representative in advance of the date of the procedure, with information concerning its policies on advance directives, including a description of applicable state health and safety laws and if requested, official state advance directive information forms. (The ASC must document in a prominent part of the patient’s current medical record, whether or not the individual has executed an advance directive.) Because of the elective nature of ambulatory surgery, this center does not honor advanced directives. Copies of advanced directive information are available at the center.
- The center’s Patient Grievance Procedure: Patients are informed about procedures for expressing suggestions, complaints, and grievances, including those required by state and federal regulations.
- The center’s Disclosure of Ownership: Patients receive written information about their physician’s possible ownership in the ASC. Patients are informed about the physician ownership at least 24 hours prior to being admitted to the center. If a patient is adjudged incompetent under applicable state health and safety laws by a court of proper jurisdiction, the rights of the patient are exercised by the person appointed under state law to act on the patient’s behalf. If a state court has not adjudged a patient incompetent, any legal representative designated by the patient, in accordance with the state law, may exercise the patients’ rights to the extent allowed by state law.
The Ambulatory Surgery Center is Responsible for:
- Posting written notice of the patient rights in a place or places within the ASC likely to be noticed by patients (or their representative, if applicable) waiting for treatment. The written poster will include name, address, and telephone number of a representative of the state agency to whom the patient can report complaints, as well as the website for the Office of the Medicare Beneficiary Ombudsman
- Treating patient disclosures and records confidentially, and giving patients the opportunity to approve or refuse their release, except when release is required by law
- Giving patients the opportunity to participate in decision involving their healthcare, treatment, or services, except when such participation is contraindicated for medical reasons
- Providing patients, to the degree known, complete information concerning their diagnosis, evaluation, treatment, and prognosis. When it is medically inadvisable to give such information to a patient, the information is provided to a person designated by the patient or a legally authorized person
- Informing patients of their right to change their provider if other qualified providers are available
- Involving the patient’s family in care, treatment, or services decision to the extent permitted by the patient or surrogate decision-maker, in accordance with law and regulation
- Providing the patient, or surrogate decision-maker, with the information about the outcomes of care, treatment, or services that the patient needs in order to participate in current and future health care decisions
- Informing the patient, or surrogate decision-maker, about unanticipated outcomes of care and/or treatment
- Ensuring marketing or advertising regarding the competence and capabilities of the organizations is not misleading to patients.
- Informing patients about procedures for expressing suggestions, complaints, and grievances, including those required by state and federal regulations.
- Insuring the patient has the right to exercise his or her rights without being subject to coercion, discrimination, reprisal, or interruption of care that could adversely affect the patient.
As a Patient, You Are Responsible for:
- Providing complete and accurate information to the best of your ability about your health, any medications, including over the counter products and dietary supplements and any allergies or sensitivities
- Following the treatment plan prescribed by your provider
- Providing a responsible adult to transport you home from the facility and remain with you for twenty-four (24) hours, if required by your provider
- Informing your provider about any living will, medical power of attorney, or other directives that could affect your care
- Accepting personal financial responsibility for any charges not covered by your insurance
- Being respectful of all the health care providers and staff, as well as other patients
The center strives to provide quality care and achieve patient satisfaction. Patient grievances or complaints provide a means to measure achievement of this goal and to identify need for performance improvement. Patients shall be provided with a means to register a complaint concerning any aspect of the service/care provided by the center.
Each patient shall receive a written patient questionnaire upon discharge: giving him/her an opportunity to evaluate his/her care.
Any patient may express his/her concerns through the said questionnaire, formal grievance form, or by a simple informal complaint. Such a complaint may be registered by telephone, in writing or in person to any member of the center staff. All complaints received by center personnel shall be forwarded to the Clinical Director or his/her designee the same day.
The Clinical Director or his/her designee will attempt to address and resolve the concern by telephone or in person within three (3) days.
If subsequent to this contact by the center, the patient continues to have a concern, the patient may submit the complaint or grievance in writing to the Medical Director. The Medical Director will consider the submitted grievance and may request additional information or documentation.
Once the collection of relevant information for the grievance is determined to be complete, the Medical Director will respond to the grievance in writing within thirty (30) days. If the Medical Director is not able to make a determination within this thirty (30) day period, he/she will notify the patient in writing regarding the status of his/her grievance.
Advanced Directives Policy
Because of the elective nature of your procedure, Independent Surgery Center, LLC does not honor advance directives. If you have an advanced directive, we will put that in your chart and in an emergency it will be transferred with you to the hospital. If you have questions about this policy please feel free to call the center to ask.
Disclosure of Ownership
Independent Surgery Center, LLC is a Limited Liability Corporation (LLC) which is owned by Thomas M. Harvey, MD, and Terrence D. McCanna, MD. You have the right to choose an alternative source of service. Please contact your surgeon to obtain a list of sites where he has privileges to practice.
Independent Surgery Center, LLC
Clinical Director (715) 738-1800
Thomas Harvey, MD, Medical Director (715) 738-1800
Commercial Blvd, Ste. 7
Chippewa Falls, WI 54729
Phone: (715) 738-1800
Fax: (715) 738-1805
Division of Quality Assurance Compliant Resources
DQA/Bureau of Health Services
Phone: (800) 642-6552
Office of the Medicare Beneficiary Ombudsman
Centers for Medicare & Medicaid Services (CMS)
Phone: (800) 633-4227
Division of Laboratory Services (CLIA)
Phone: (877) 267-2323 ext. 63531