I. Become informed of your rights as a patient both verbally and written in advance of or when discontinuing, the provision of care in a language and manner that you understand you may appoint a representative to receive this information at your request.
2. Exercise these rights without regard to sex or cultural, economic, educational or religious background or the source of payment for care and without being subjected to reprisal.
3. Considerate and respectful care, provided in a safe environment, free from all forms of abuse, neglect, harassment and/or exploitation.
4. Access protective and advocacy services or have these services accessed on your behalf.
5. Appropriate assessment and management of pain.
6. Remain free from seclusion or restraints of any form that are not medically necessary or are used as a means of coercion, discipline, convenience or retaliation by staff.
7. Knowledge of the name of the physician who has primary responsibility for coordinating your care and the names and professional relationship of other physicians and healthcare providers who will see you.
8. Knowledge of physician financial interests of ownership in the Ambulatory Surgical Center (ASC) in writing in advance of the date of the procedure.
9. Receive information from your physician about your illness, course of treatment, outcomes of care (including unanticipated outcomes) and your prospects for recovery in
terms that you can understand.
10. Receive as much information about any proposed treatment or procedures as you 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 of
non-treatment and the risks involved in each and the name of the person who will carry out the procedures or treatment.
11. Receive information concerning the ASC'S policies on advance directives, including a description of applicable state health and safety laws and if requested official state advance directive forms in advance of the date of the procedure.
12. Have a family member or representative of your choice notified promptly of your admission to the facility.
13. Have your personal physician notified promptly of your admission to the facility.
14. Full consideration of privacy concerning your medical care program. Case discussion, consultation, examination and treatment care confidential and should be conducted discreetly. You have the right to be advised as to the reason for the presence of any individual involved in your healthcare.
15. Confidential treatment of all communications and records pertaining to your care and your stay at the facility. Your written permission will be obtained before medical records can be made available to anyone not directly concerned with your care.
16. Receive information in a matter that you understand. Communication with the patient will be effective and provided in a manner that facilities 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.
17. Access information contained in your medical record within a reasonable time frame. 18. Reasonable responses to any reasonable request you may make for service.
19. Leave the facility even against the advice of your physician.
20. Reasonable continuity of care.
21. Be advised of the facility's grievance process should you wish to communicate a concern regarding the quality of the care you receive. Notification of the grievance process shall be given in advance of the date of the procedure including: whom to contact to file a grievance, a written notice if the grievance determination that contains name of the facility's contact person, the steps taken on your behalf to investigate the grievance, the results of the grievance process, and the grievance completion date. You may report complaint to the state agency as well as the Office of the Medicare Beneficiary Ombudsman.