Patient’s Rights and Notification of Physician Ownership
EVERY PATIENT HAS THE RIGHT TO BE TREATED AS AN INDIVIDUAL AND TO ACTIVELY PARTICIPATE IN AND MAKE INFORMED DECISION REGARDING HIS/HER CARE. THE FACILITY AND MEDICAL STAFF HAVE ADOPTED THE FOLLOWING PATIENT RIGHTS AND RESPONSIBILITIES, WHICH ARE COMMUNICATED TO EACH PATIENT OR THE PATIENT’S REPRESENTATIVE PRIOR TO THE PROCEDURE/SURGERY.
Patient’s Rights:
Florida law requires that your health care provider or health care facility recognize your rights while you are receiving medical care and that you respect the health care provider’s or health care facility’s right to expect certain behavior on the part of patients. You may request a copy of the full text of this law from your health care provider or health care facility. A summary of your rights and responsibilities follows:
•A patient has the right to be treated with courtesy and respect, with appreciation of his or her individual dignity, and withprotection of his or her need for privacy.
•A patient has the right to a prompt and reasonable response to questions and requests.
•A patient has the right to know who is providing medical services and who is responsible for his or her care.
•A patient has the right to know what patient support services are available, including whether an interpreter is available if he orshe does not speak English.
•A patient has the right to know what rules and regulations apply to his or her conduct.
•A patient has the right to be given by the health care provider information concerning diagnosis, planned course of treatment,alternatives, risks, and prognosis.
•A patient has the right to be informed of their right to change providers if other qualified providers are available.
•A patient has the right to refuse any treatment, except as otherwise provided by law.
•A patient has the right to be given, upon request, full information and necessary counseling on the availability of known financialresources for his or her care.
•A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment; whether the health careprovider or healthcare facility accepts the Medicare assignment rate.
•A patient has the right to receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
•A patient has the right to receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have thecharges explained.
•A patient has the right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion,handicap, or source of payment.
•A patient has the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
•A patient has the right to know if medical treatment is for purposes of experimental research and to give his or her consent orrefusal to participate in such experimental research.
•A patient has the right to express grievances regarding any violation of his or her rights, as stated in Florida law, through thegrievance procedure of the health care provider or health care facility which served him or her and to the appropriate statelicensing agency.
Patient’s Responsibilities:
•The patient is responsible for providing to the health care provider, to the best of his or her knowledge, accurate and completeinformation about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his or herhealth including over-the- counter products, dietary supplements, and any allergies or sensitives.
•The patient is responsible for reporting unexpected changes in his or her condition to the health care provider.
•The patient is responsible for reporting to the health care provider whether he or she comprehends a contemplated course ofaction and what is expected of him or her.
•A patient is responsible for following the treatment plan recommended by the health care provider and participate in their care.
•A patient is responsible for keeping appointments and, when he or she is unable to do so for any reason, for notifying the healthcare provider or health care facility.
•A patient is responsible for his or her actions should he or she refuses treatment or does not follow the health care provider’sinstructions.
•A patient is responsible for assuring that the financial obligations of his or her health care are fulfilled as promptly as possible andfor any charges not covered by insurance.
•A patient is responsible for following health care facility rules and regulations affecting patient care and conduct.
•A patient is responsible for being respectful of all the healthcare professionals and staff, as well as other patients and visitors
•A patient is responsible for having a responsible adult to provide transportation home and to remain with them as directed bythe provider or as indicated on discharge instructions.
If you need an interpreter:
If you will need an interpreter, please let us know and one will be provided for you. If you have someone who can translate confidential, medical and financial information for you please make arrangements to have them accompany you on the day of your procedure.
Rights and Respect for Property and Person:
The patient has the right to:
•Exercise his or her rights without being subjected to discrimination or reprisal.
•Voice a grievance regarding treatment or care that is, or fails to be furnished.
•Be fully informed about a treatment or procedure and the expected outcome before it is performed.
•Confidentiality of personal medical information.
Privacy and Safety:
The patient has the right to:
•Personal privacy.
•Receive care in a safe setting.
•Be free from all forms of abuse or harassment.
Advance Directives:
You have the right to information regarding advance directives, this facility’s policy on advance directives, and information regarding state regulations concerning advance directives. Applicable state forms are available from the center and will be provided upon request.
When a person becomes unable to make decisions due to a physical or mental change or condition, they are considered incapacitated. To make sure that an incapacitated person’s decisions about health care will still be respected, the Florida legislature enacted legislation pertaining to health care advance directives (Chapter 765, Florida Statutes).The law recognizes the right of a competent adult to make an advance directive instructing his or her physician to provide, withhold, or withdraw life-prolonging procedures; to designate another individual to make treatment decisions if the person becomes unable to make his or her own decisions; and/or to indicate the desire to make an anatomical donation after death. The state rules that address this include 58A-2.0232, 59A-3.254, 59A-4.106, 59A-8.0245, and 59A-12.013, Florida Administrative Code and Florida statute Title XLIV, Chapter 765.
Surgery Center respects the right of patients to make informed decisions regarding their care. The Center has adopted the position that an ambulatory surgery center setting is not the most appropriate setting for end of life decisions. Therefore, it is the policy of this surgery center that in the absence of applicable properly executed Advance Directive, if there is deterioration in the patient’s condition during treatment at the surgery center, the personnel at the center will initiate resuscitative or other stabilizing measures. The patient will be transferred to an acute care hospital, where further treatment decisions will be made.
If the patient has Advance Directives which have been provided to the surgery center that impact resuscitative measures being taken, we will discuss the treatment plan with the patient and his/her physician to determine the appropriate course of action to be taken regarding the patient’s care.
The following are the names and/or agencies you may contact:
SmartCare Palm Harbor, 1325 Belcher Road, Suite B, Palm Harbor, FL 34683 Phone 727-855-4500 or Email - SSmith@SmartCarePH.com
To contact the State of Florida to report a complaint;
Agency for Health Care Administration
Complaint Administration Unit
ATTN: Pat Hall, Supervision
2727 Mahan Drive Building #1
Tallahassee, Florida 32308
State Web site: www.cms.hhs.gov/center/ombudsman.asp
Medicare beneficiaries may also file a complaint with the Medicare Beneficiary Ombudsman at the Medicare Ombudsman Web site:
• http://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html
Medicare:
•www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227)
Office of the Inspector General:
This facility is accredited by the Accreditation Association for Ambulatory Health Care (AAAHC). Complaints or grievances may also be filed at:
•The Accreditation Association for Ambulatory Health Care
5250 Old Orchard Road, Suite 200
Skokie, IL 60077
(847)853-6060
•Email: info@aaahc.org
Physician Ownership
Physician Financial Interest and Ownership: Physician Financial Interest and Ownership: The center is owned, in part, by the physicians. The physician(s) who referred you to this center and who will be performing your procedure(s) may have a financial and ownership interest. Patients have the right to be treated at another health care facility of their choice. We are making this disclosure in accordance with federal regulations.
THE FOLLOWING PHYSICIANS HAVE A FINANCIAL INTEREST IN THE CENTER:
Dr Vladimir Alexander, MD
Dr Thomas Odmark, MD
Dr Daniel Penello MD
Dr Adam Perler, DPM
Dr Jennifer Swaringen MD
Dr Thomas Tolli, MD
Dr Scott Vizzi MD
Dr Ali Zahrai MD