If you have any questions regarding your rights or responsibilities, please contact us at: 484-586-0227 or firstname.lastname@example.org
As a patient at the Surgery Center of the Main Line, you have the right to:
- Considerate, respectful care at all times and under all circumstances, with recognition of your personal dignity.
- Personal and informational privacy, within the law.
- Information concerning your diagnosis, treatment and prognosis, to the degree known.
- Receive care in a safe setting.
- Confidentiality of records and disclosures. Except when required by law, you have the right to approve or refuse the release of records.
- Participate in and make decisions about medical care, including the right to accept or refuse medical or surgical treatment.
- Know that the facility does not honor advance directives; however, any advance directive will be noted in the patient medical record and will be communicated to other medical facilities, if a transfer is needed.
- Receive information on advance directive state health and safety laws and the official state advance directive forms, if requested.
- Impartial access to treatment regardless of race, color, sex, national origin, religion, sexual orientation, handicap, or disability. (The surgery center adheres to all federal and state rule, regulations and policies to promote a non-discriminatory environment for all of our patients)
- Receive estimated costs prior to the day of surgery and, as a follow up, receive an itemized bill for all services received.
- Know that your physician may have financial interests or ownership in the Surgery Center.
- Know the identity and professional status of individuals providing service to you.
- Report any comments or voice any grievances concerning the quality of services provided to you during the time spent at the facility without being subjected to discrimination or reprisal and receive timely, fair follow-up on your comments.
As a patient at the Surgery Center of the Main Line, you are responsible for:
- Providing, to the best of your knowledge, accurate and complete information about your present health status and past medical history and reporting any unexpected changes to the appropriate practitioner(s).
- Following the treatment plan recommended by the primary practitioner involved in your case.
- Providing an adult to transport you home after surgery and an adult to be responsible for you at home for the first 24 hours after surgery.
- Indicating whether you clearly understand a contemplated course of action and what is expected of you.
- Your actions and adverse consequences that may result if you refuse treatment, leave the facility against the advice of the practitioner, and/or do not follow the practitioner’s instructions relating to your case.
- Assuring that your portion of financial payment is submitted as quickly as possible.
- Providing information about and/or copies of any living will, power of attorney or other directives that you desire us to know about.
The surgery center has multiple reporting mechanisms in place for expressing concerns.
- Karla German, Facility Administrator: 484-586-0227 email@example.com
- Anonymous Corporate Compliance Line: 513-561-8900, ext. 20
- Pennsylvania Department of Health, Division of Acute and Ambulatory Care: 1-800-254-5164
Written complaints may be submitted to:
Division of Acute and Ambulatory Care
Room 532, Health & Welfare building
Harrisburg, PA 17120
- Office of the Medicare Beneficiary Ombudsman