YOUR PATIENT RIGHTS

Ascent Surgery Center and the medical staff have adopted the following statement of Patient Rights and Patient Responsibilities. This list includes, but not limited to the following and is delivered upon each patient encounter to the patient. In the event of an incapacitated patient, the information is delivered to the designated patient representative.

PATIENT RIGHTS

• You have the right to the Surgery Center’s reasonable response to your request and needs for treatment or service, within the Surgery Center’s capacity, its stated mission, and applicable law and regulation.

• You have the right to considerate and respectful care. This right includes the consideration of the psychosocial, spiritual, and cultural variables that influence the perceptions of illness. The comfort and dignity of all patients is optimized to the best of ability while delivering care. For care of the AND (Allow Nature Death) patient, this care includes treating primary and secondary symptoms that respond to treatment as desired by the patient or surrogate decision-maker, effectively managing pain, and acknowledging the psychosocial and spiritual concerns of the patient and the family regarding dying and the expression of grief by the patient, significant other, and family.

• Become informed of his or her rights as a patient and participate in care and in advance of, or when discontinuing, the provision of care. The patient may appoint a representative to receive this information should he or she so desire.

• Exercise these rights and have reasonable access to care without regard to sex, sexual orientation, cultural, economic, educational, or religious background or the source of payment for care.

• Considerate and respectful care, provided in a safe environment, free from all forms of abuse, neglect, harassment, and/or exploitation.

• Access protective and advocacy services or have these services accessed on the patient’s behalf.

• Appropriate assessment and management of pain.

• Remain free from seclusion or restraints of any form that are not medically/behaviorally necessary or are used as a means of coercion, discipline, convenience, or retaliation by staff.

• Knowledge of the name of the physician who has primary responsibility for coordinating his/her care and the names and professional relationships of other physicians and healthcare providers who will see him/her.

• Receive information from his/her physician about his/her illness, course of treatment, outcomes of care (including unanticipated outcomes), and his/her prospects for recovery in terms that he/she can understand.

• Receive as much information about any proposed treatment or procedure as he/she may need in order to give informed consent or to refuse the course of treatment. Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved in the treatment, alternate courses of treatment or non-treatment and the risks involved in each, and the name of the person who will carry out the procedure or treatment.

• Participate in the development and implementation of his or her plan of care and actively participate in decisions regarding his/her medical care. To the extent permitted by law, this includes the right to request and/or refuse treatment.

• Formulate advance directives regarding his or her healthcare, and to have Surgery Center staff and practitioners who provide care in the Surgery Center comply with these directives (to the extent provided by state laws and regulations).

• Have a family member, significant other, or representative of his or her choice notified promptly of his or her admission to the Surgery Center and designate visitors, non-visitors of their choosing to include same-sex partners, family, or designee support person(s).

• Have his or her personal physician notified promptly of his or her admission to the Surgery Center.

• Full consideration of privacy concerning his/her medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discreetly. The patient has the right to be advised as to the reason for the presence of any individual involved in his or her healthcare.

• Confidential treatment of all communications and records pertaining to his/her care and his/her stay in the Surgery Center. His/her written permission will be obtained before his/her medical records can be made available to anyone not directly concerned with his/her care.

• Receive information in a manner that he/she understands. Communications with the patient will be effective and provided in a manner that facilitates understanding by the patient. Written information provided will be appropriate to the age, understanding and, as appropriate, the language of the patient. As appropriate, communications specific to the vision, speech, hearing cognitive and language-impaired patient will be appropriate to the impairment.

• Access information contained in his or her medical record within a reasonable time frame (usually within 48 hours of the request).

• Reasonable responses to any reasonable request he/she may make for service.

• Leave the Surgery Center even against the advice of his/her physician.

• Right to change provider if other qualified providers are available.  

• Reasonable continuity of care.

• Be advised of the Surgery Center grievance process, should he or she wish to communicate a concern regarding the quality of the care he or she receives or if he or she feels the determined discharge date is premature. Notification of the grievance process includes: whom to contact to file a grievance and that he or she will be provided with a written notice of the grievance determination that contains the name of the Surgery Center contact person, the steps taken on his or her behalf to investigate the grievance, the results of the grievance, and the grievance completion date.

• Be advised if Surgery Center/personal physician proposes to engage in or perform human experimentation affecting his/her care or treatment. The patient has the right to refuse to participate in such research projects. Refusal to participate or discontinuation of participation will not compromise the patient’s right to access care, treatment, or services.

• Full support and respect of all patient rights should the patient choose to participate in research, investigation, and/or clinical trials. This includes the patient’s right to a full informed consent process as it relates to the research, investigation, and/or clinical trial. All information provided to subjects will be contained in the medical record or research file, along with the consent form(s).

• Be informed by his/her physician or a delegate of his/her physician of the continuing healthcare requirements following his/her discharge from the Surgery Center.

• Examine and receive an explanation of his/her bill regardless of source of payment.

• Know which Surgery Center rules and policies apply to his/her conduct while a patient.

• Designate a representative to make decisions to exercise the patient’s right to participate in the development of care and to make decisions regarding medical care on behalf of the patient.

• Pastoral and other spiritual services.

• All Surgery Center personnel, medical staff members, and contracted agency personnel performing patient care activities shall observe these patients’ rights.

PATIENT RESPONSIBILITIES ARE AS FOLLOW:
The care a patient receives depends partially on the patient themselves. Therefore, in addition to these rights, a patient has certain responsibilities as well. These responsibilities should be presented to the patient in the spirit of mutual trust and respect:

The patient has the responsibility to provide accurate and complete information concerning her/ his present complaints, past illnesses, hospitalizations, medications, and other matters relating to her/his health.

• The patient is responsible for reporting perceived risks in her/his care and unexpected changes in her/his condition to the responsible practitioner.

• The patient and family are responsible for asking questions when they do not understand what they have been told about the patient’s care or what they are expected todo.

• The patient is responsible for following the plan of care established by her/his physician, including the instructions of nurses and other health professionals as they carry out physician’s orders.

• Accepting the consequences of failing to follow the recommended course of treatment or using other treatments.

• The patient is responsible for keeping appointments and for notifying the facility or physician when she/he is unable to do so.

• Respecting the Surgery Center’s property and that of other persons.

• The patient is responsible for following Surgery Center rules and regulations concerning patient care and conduct.

  The patient is responsible for assuring that the financial obligations of his/her Surgery Center Care are fulfilled as promptly as possible.

NOTICE OF NONDISCRIMINATION

Ascent Surgery Center complies with applicable Federal civil rights laws, including Section 1557 of the Affordable Care Act, and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Ascent Surgery Center does not exclude people or treat them differently because of these characteristics.

Ascent Surgery Center provides:

Free aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters

• Written information in alternative formats (large print, audio, accessible electronic formats).

• Free language services to people whose primary language is not English.

• Qualified interpreters

• Information written in other languages (Spanish)

If you need assistance, call 469-986-3700. These services are free.

If you believe that Ascent Surgery Center has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance.

Civil Rights Coordinator:

Name: Blanca Rivera

Address: 6957 W. Plano Parkway, Suite 1000, Plano, TX 75093

Phone: 469-986-3700

For TTY Services, dial 711 Email:

[email protected]

How to File a Grievance:

Contact the Civil Rights Coordinator listed above. This can be done in person, by mail, or email. If you need help filing a grievance, our Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. File with HHS/OCR:

Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

Phone: 1-800-368-1019; TDD: 1-800-537-7697

Mail: U.S. Department of Health and Human Services Office for Civil Rights

200 Independence Avenue, SW Room 509F, HHH

Building Washington, D.C. 20201

Multi-language Taglines

If you need language assistance services, they are available free of charge. Call 469-986-3700.

Español: Si necesita servicios de asistencia lingüística, están disponibles sin costo. Llame al 469-986-3700.

Vietnamese: Nếu bạn cần dịch vụ hỗ trợ ngôn ngữ, chúng có sẵn miễn phí. Gọi 469-986-3700.

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French: Si vous avez besoin de services d’assistance linguistique, ils sont disponibles gratuitement. Appelez le 469-986-3700.

German: Sprachunterstützungsdienste sind kostenlos verfügbar. Rufen Sie 469-986-3700 an. 

Russian: Если вам

нужны услуги языковой помощи, они предоставляются бесплатно.

Позвоните по номеру 469-986-3700.

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Somali: Haddii aad u baahan tahay adeegyada luqadda, waa lacag la’aan. Wac 469-986-3700.