UPSTATE ORTHOPEDICS AMBULATORY SURGERY CENTER PATIENT RIGHTS AND RESPONSIBILITIES

UOASC presents a Patient’s Bill of Rights with the expectation that observance of these rights will contribute to more effective patient care and greater satisfaction for the patient, his/her physician, and UOASC. It is recognized that a personal relationship between the physician and the patient is essential for the provision of proper medical care. The traditional physician-patient relationship takes on a new dimension when care is rendered within an organizational structure. Legal precedent has established that the institution itself also has a responsibility to the patient. It is in recognition of these factors that these rights are affirmed.

Each patient treated at Upstate Orthopedics Ambulatory Surgery Center has the right to:
A. Be treated with respect, consideration and dignity including privacy in treatment without regard to age, race, color, sexual orientation, religion, marital status, sex, national origin or sponsor.
B. Respectful care given by competent personnel with consideration of their privacy concerning their medical care. Your privacy shall be respected when facility personnel are discussing you and your care.
C. Be given the name of their attending physician, the names of all other physicians directly assisting in their care and the names and functions of other health care persons having direct contact with the patient.
D. Have records pertaining to treatment, treated with privacy and confidentiality and except where required by law or third-party payment contract, the right to approve or refuse the release or disclosure of the contents of his/her medical record to any healthcare practitioner and or healthcare facility.
E. To expect and receive appropriate assessment, management and treatment of pain.
F. Expedient and professional transfer to another facility when medically necessary and to have the responsible person and the facility that the patient is transferred to notified prior to transfer. Accessible and available health services; information on after-hour and emergency care.
G. Full information in layman’s terms concerning appropriate and timely diagnosis, treatment, preventive measures and prognosis and expect treatment that is consistent with clinical impression or working diagnosis.
H. Give an informed consent to the physician prior to the start of a procedure which includes the provision of information concerning the specific procedure or treatment or both, the reasonably foreseeable risks involved, the alternatives for care or treatment, if any, as a reasonable medical practitioner under similar circumstances would disclose in a manner permitting the patient to make a knowledgeable decision.
I. Refuse treatment to the extent permitted by law and to be fully informed of the medical consequences of his/her action. To participate in the planning of your care, and to refuse mediation and treatment. Such refusal will be documented in your medical record.
J. Be advised of participation in a medical care research program or donor program; or experimental research. The patient shall give informed, written consent prior to participation in such a program, or may refuse such participation. A patient may also refuse to continue a program that has previously given informed consent to participate in.
K. Receive appropriate and timely follow-up information of abnormal findings and tests and such receive information regarding “continuity of care”
L. Appropriate specialty consultative services made available by prior arrangement.
M. Have access to an interpreter.
N. Be provided with, upon written request, access to all information contained in their medical record.
O. Accurate information regarding the competence and capabilities of the organization.
P. Receivedirectionsforexpressingsuggestionsorgrievancestothestaffortheoperator,and be provided with the phone number for the New York State Department of Health to express grievances or suggestions, without fear of reprisal.
Q. Change primary or specialty physicians if other qualified physicians are available.
R. The opportunity to participate in decisions involving their healthcare, except when such participation is contraindicated for medical reasons.
S. Receive information regarding services provided at the Center.
T. Information on payment and fee policies and provider credentialing as necessary.
U. Information on Advance Directives as required by law in writing prior to their procedure.
V. Information on the charges for services, eligibility for third party reimbursement and, when applicable, the availability of free or reduced cost care and receive an itemized copy of his/her account statement upon request
W. Receive information on physician ownership prior to the procedure and in writing.
X. Be free from any type of abuse or harassment.

Each patient at this facility has the responsibility to:
A. Provide full cooperation with regards to instructions given by his/her surgeon, anesthesiologist and operative care (pre and post) including providing a responsible adult to transport him/her self home from the facility and remain with them for 24 hours if required by the provider.
B. Provide the Surgery Center staff with all medical information that may have a direct effect on the provider at the Surgery Center. This information includes, but is not limited to, any medications, including over-the-counter or dietary supplements, which the patient may be taking as well as any known allergies or sensitivities.
C. Provide the Surgery Center with all information regarding third-party insurance coverage.
D. Accept personal financial responsibility for all services received as determined by the patient’s insurance carrier.
E. Be respectful of healthcare providers, staff and other patients.

To File a Complaint or Grievance:
A. A patient or their representative has the right to file a grievance. These grievances may address care or treatment that is (or fails to be) furnished.
B. A patient or their representative that would like to file a grievance can do so by forwarding a written or oral explanation of the grievance (including patient name, address, and date of service) provided to:
– Executive Director, Upstate Orthopedics ASC, 6620 Fly Road, Suite 300, East Syracuse, NY 13057, 315-432-5960
and/or
– NYS Department of Health Hotline: 1-800-804-5447 (From DOH Website)
and/or
– Medicare Ombudsman: www.cms.hhs.gov/center/ombudsman.asp
C. Upon receipt of patient’s grievance at the surgery center, and investigation will be conducted and the patient will generally be sent a written response within 30 days. Your written response will contain how the grievance was addressed, the contact person at the surgery center, the steps taken to investigate the grievance, the results of the investigation, and the date the grievance process was completed.

Updated 10/16/2016