Nurse Talking to Patient

Your Bill of Rights

We are always here for you!

YOUR RIGHT TO DECIDE AND MAKE YOUR WISHES KNOWN

PATIENT'S BILL OF RIGHTS AND RESPONSIBILITIES
This/her health care provider recognizes you have rights while a patient receiving medical care. In return, there are responsibilities for certain behavior on your part as the patient. These rights and responsibilities include:
A patient has the right to
 be treated with courtesy and respect, with appreciation of his/her individual dignity, and with protection of his/her need for privacy.
 a prompt and reasonable response to questions and requests.
 know who is providing medical services and who is responsible for his/her care.
 know what patient support services are available, including whether an interpreter is available if he does not speak English.
 know what rules and regulations apply to his/her conduct.
 be given by his/her health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.
 refuse treatment, except as otherwise provided by law.
 be given, upon request, full information and necessary counseling on the availability of known financial resources for his/her care.
 know, upon request and in advance of treatment, whether the health care provider or health care facility accepts the Medicare assignment rate.
 receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
 receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have charges explained.
 impartial access to medical treatment or accommodations, regardless of race, national origin, religion, physical handicap, or source of payment.
 treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
 know if medical treatment is for purposes of experimental research and to give his/her consent or refusal to participate in such experimental research.
 express concerns regarding any violation of patient rights.

A patient is responsible for
 providing to his/her health care provider, to the best of his/her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his/her health.
 reporting unexpected changes in his/her condition to his/her health care provider.
 reporting to his/her health care provider whether he/she comprehends a contemplated course of action and what is expected of him/her.
 following the treatment plan recommended by his/her health care provider.
 keeping appointments.
 his/her actions if he refuses treatment or does not follow the health care provider's instructions.
 assuring that the financial obligations of his/her health care are fulfilled as promptly as possible.
 following health care facility rules and regulations affecting patient care and conduct.

If you have a complaint or concern, please address with the Facility Administrator immediately.

In addition you may contact
Department of Insurance Consumer Services Helpline 800-342-2762
Division of Consumer Services
200 E. Gaines Street
Tallahassee, FL 32399-0322

Health Care Consumer Assistance Hotline 888-419-3456
Agency for Health Care Administration www.fdhc.state.fl.us/index.shtml
Attention: Consumer Division
2727 Mahan Drive
Tallahassee, FL 32305

Medicare Beneficiaries may also contact:
Medicare Beneficiary Ombudsman www.medicare.gov/Ombudsman/resources.asp
The Medicare Beneficiary Ombudsman ensure that Medicare beneficiaries receive the information and help they require to understand their Medicare Options and to apply their Medicare Rights and Protection.

PHYSICIAN OWNERSHIP OF TAMPA BAY CENTER FOR SPECIALIZED SURGERY
Tampa Bay Center for Specialized Surgery is a one hundred percent physician owned Ambulatory Surgical Facility. This disclosure is to enable you to make an informed decision about your care; and, to assure you are aware of the financial interest your surgeon may have in the facility.

It is opinion that physician ownership enables your physician to have a voice in the Administrative and Medical policies of our facility. This involvement helps ensure the finest quality surgical care for their patients. Special emphasis is placed on patient feedback so that we can assure that you are treated professionally and courteously at all time.

Should you have a preference where your procedure is performed, it is you right to advise us immediately.
ADVANCE DIRECTIVES – Your Right to Decide and Make Your Wishes Known
We want to assure that your patient right’s to make an informed decision regarding your care are met. Please note that our facility policy regarding Advance Directives is as follows:
• In an ambulatory care setting, where we expect to provide less invasive care to patients who are not acutely ill, admission to an ambulatory surgical 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.
• If a patient, who is to receive surgery at the surgery center, presents an advance directive/living will that patient must be advised that the surgery center will NOT honor any advance directives/living wills that do not allow resuscitation. It is our policy 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.
• We are required by regulation to notify you that we will NOT honor a previously signed advance directive.
• Additional information regarding Advance Directives as supplied by the Agency for Healthcare Administration is available upon request.
• Patients that disagree with this policy must address the issue with the surgeon PRIOR to signing the form to acknowledge an understanding of our policy regarding advance directives/living will.

I acknowledge that I have received the Information regarding my Bill of Right’s including agency information; Physician Ownership of CSS and our Policy regarding Advance Directives