Patient Rights

As a Patient, You have the Right to:

• Treatment without regard to race, sex, age national origin or cultural, economic, educational or religious background or the source of payment of his care.
• Receive considerate and respectful care. Be free from all forms of abuse and harassment.
• The knowledge of the name of the surgeon who has primary responsibility for coordinating his care and the names and professional relationships of other practitioners who will see him.
• Receive information from his surgeon about his illness, his course of treatment, and his prospects for recovery in terms he can understand. When it is medically inadvisable to give such information is provided to a person designated by the patient or to a legally authorized person.
• Receive the necessary information about any proposed treatment or procedure in order to give informed consent or to refuse this course of treatment. Except in emergencies, this information shall include a description of all the procedures(s) or treatment(s) the medically significant risk(s) involved in each, and the name of the person who would carry out the treatment(s) or procedure(s)
• Participate actively in decision-making regarding his medical care, to the extent that is permitted by law.
• Refuse treatment
• Full consideration of privacy concerning his medical care program. Case discussion, consultation, examination and treatment are confidential and shall be conducted discreetly. The patient has the right to be advised as the reason for the presence of any individual.
• Confidential treatment of all communications and records pertaining to his care. His written permission shall be gained before these medical records are made available to anyone not concerned with his care.
• Reasonable responses to any reasonable request he makes for services.
• Reasonable continuity of care and to know in advance the time and location of appointment(s), as well as, the practitioner providing the care.
• Be advised if the surgeon proposes to engage in or perform human experimentation affecting his care or treatment. The patient has the right to refuse to participate in such research projects.
• Be informed by his surgeon, or his designee, of his continuing health care requirements.
• Examine and receive an explanation of his bill regardless of the source of payment.
• Have all patients’ rights explained to the person who has the legal responsibility to make decisions regarding medical care on behalf of the patient.
• Express any grievances or suggestions verbally or in writing.
• All patients receiving anesthesia services or conscious sedation (all but straight local anesthesia) will be asked if there are advance directives the Center should be aware of, but it is clearly explained to the patient that the Atlantic Surgery Center does not honor advance directives, as an ambulatory surgery center and all efforts will be made to resuscitate them for transfer to an acute care facility where the advance directives will be followed.
• Change their provider if other qualified providers are available

As a Patient, You Are Responsible for:

• The Surgery Center expects that a patient will provide accurate and complete information about matters relating to his/her health history in order for the patient to receive effective medical treatment.
• A patient is responsible for reporting whether he/she clearly comprehends a contemplated course of action and what is expected of them.
• The Surgery Center expects that the patient will cooperate with all the Surgery Center’s personnel and ask questions if directions and/or procedures are not clearly understood.
• A patient is expected to be considerate of other patients and the Surgery Center personnel and to observe the no-smoking policy of the surgery center. A patient is also expected to be respectful of the property of other persons and the property of the Surgery Center.
• The patient is expected to help the physicians, nurses, and allied medical personnel in their efforts to care for the patient by following their instructions and medical order.
• It is understood that a patient assumes the financial responsibility of paying for all services rendered whether through third-party payers (his/her insurance company) or being personally responsible for payment for any services which are not covered by his/her insurance policies.
• It is expected that the patient will not take any drugs which have not been prescribed by his/her attending physician and administered by the Surgery Center.
• If you have any questions regarding your rights or responsibilities, complaints or grievances of how these rights were or were not administered, you may speak to the Administrator/Administrator Designee, or the management team, who will conduct an investigation into your issue, the following contact information is provided for your convenience.
  • Administrator Atlantic Surgery Center 541 Health Blvd. Daytona Beach, FL 32114 Phone: 386-239-0021
  • AAAHC 5250 Old Orchard Road #200 Skokie, IL 60077 Phone: 847-853-6060
  • The State Department of Health Phone: 850-245-4444 Florida Department of Health 2585 Merchants Row Boulevard Tallahassee, FL 32199
  • Medicare Phone: 800-633-4227 http://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html
  • Office of Civil Rights U.S. Department of Health and Human Services 200 Independence Ave SW Room 509F, HHH Building Washington, D. C. 20201 Phone: 800-368-1019, 800-527-7697 (TDD) https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Complaint forms are available at: http://www.hhs.gpv/ocr/office/file/index.html
  • State of Florida HHS 1-888-633-4227 or http://www.hss.gov/ocr
  • Elder Abuse Hotline: 800-963-5337

Privacy Policy

This Policy describes how medical information about you may be used and disclosed, and how you can get access to this information.

Uses & Disclosure of Health Information:

We are committed to protecting the privacy of the information you provide to us regarding your health. Information regarding your health will be recorded and maintained in a record kept on-site or off-site in a 24 hour secure facility. Information contained in that record may be used in your treatment (for example, copies of your medical information may be sent to the physician who referred you to your surgeon), obtaining payment for that treatment (for example, submitting a claim for payment to your insurance company), and for administrative purposes (for example, quality assurance and business planning purposes).

We may, under certain circumstances, use or disclose you medical information without your authorization. Subject to certain requirements, we may use or disclose your medical information for: public health purposes; health oversight activities; the reporting of suspected abuse or neglect; workers’ compensation purposes; and for judicial and administrative proceedings. We may disclose your medical information when otherwise required by law, such as for law enforcement purposes under certain circumstances. Other uses of your medical information will be made only with your written authorization, such as uses and disclosures of your medical information for marketing purposes, and disclosures that constitute a sale of your medical information. You may revoke a written authorization for the use or disclosure of your medical information at any time.

We reserve the right to change the terms of this notice at any time and to make the new notice provisions effective for all medical information that we maintain. We will post a copy of the current notice in our waiting room, which will include the effective date of the notice. You may also request a copy of the notice at any time by contacting the Business Office Director or Administrator. Other uses and disclosures not described in this notice will be made only with an authorization from the individual.

Your rights regarding your medical information:

In most cases, you have the right to inspect and receive a copy of the medical information used to make decisions about your care. We may charge you a fee for copies of your medical information. You have the right to amend the medical information we have regarding you, if you believe that information is incorrect or incomplete. You also have the right to receive a list of the instances in which your medical information was disclosed for reasons other than treatment, payment, or our health care operations.

You have the right to request that we communicate with you regarding your medical information in a certain confidential manner, for example by mail sent to you directly. You have the right to opt out of any fundraising communications. You have the right to restrict certain disclosures of your medical information to a health plan if you pay for a service in full and out of pocket. You have the right to request in writing that we not use or disclose your medical information for treatment, payment, or our health care operations purposes, or other persons involved in your care except when specifically authorized by you, except when required by law or in an emergency. We will consider your written request, but are not required to accept such a request. You have the right to be notified of a breach of unsecured medical information in the event you are affected. To exercise any of your rights regarding your medical information, please contact the Business Office Director or Administrator.

Our duties regarding your medical information:

We are required by law to maintain the privacy of your medical information and to provide you with notice of our legal duties and privacy practices with respect to your medical information. We are required to abide by the terms of the notice of our privacy policy currently in effect.

Complaints:

If you believe your rights have been violated, you may contact any of the below listed entities.

• Administrator Atlantic Surgery Center 541 Health Blvd. Daytona Beach, FL 32114 Phone: 386-239-0021
• AAAHC 5250 Old Orchard Road #200 Skokie, IL 60077 Phone: 847-853-6060
• State of Florida HHS 1-888-633-4227 or http://www.hss.gov/ocr Elder Abuse Hotline: 800-963-5337

Advance Directives

The Center respects and upholds the right of a patient to participate in health care decisions and to execute Advance Directives. An Advance Directive is a legal document that guides significant others and health care providers to follow a patient’s wishes should the patient become incapacitated or unable to make decisions. It is the policy of this Center, due to the nature of the outpatient procedures performed, to always attempt to resuscitate a patient and transfer that patient to an acute care facility regardless of any Advance Directive. For more information or questions regarding your Advanced Directives, please contact: Atlantic Surgery Center (386-239-0021) and ask to speak with the Administrator.

In an ambulatory care setting, where we expect to provide less invasive care to patients who are not acutely ill, admission to the center indicates the patient will tolerate the procedure in the ambulatory setting without difficulty. If a patient should suffer cardiac or respiratory arrest or any life threatening condition, the patient will be transferred to a more acute level of care, that is, the hospital emergency room.

All patients are ask if they have an advance directive and this is documented in the medical record. Information regarding advance directives is available for any patient requesting additional information. It is the policy of the Center to transfer any patient requiring resuscitation to the hospital. The hospital can determine when to implement the advance directive/living will once the patient or others notify them of the advance directive/living will.

Patients who disagree with this policy must address the issue with the attending physician prior to signing the form acknowledging an understanding of the policy regarding advance directives/living wills.