PATIENT’S STATEMENT OF RIGHTS AND RESPONSIBILITIES

 

PATIENT’S RIGHTS AND RESPONSIBILITIES

 

Centers for Medicare and Medicaid Services (CMS)

The patient and the patient’s representative or surrogate has the right to:

• Be free from discrimination or reprisal

• Voice grievances regarding treatment or care that is (or fails to be) provided 

• Be fully informed about a treatment or procedure and the expected outcome before it is performed

• Personal privacy

• Respect, dignity, and comfort

• Receive care in a safe setting 

• Be free from all forms of abuse or harassment

• Receive information about their privacy rights and how their information can be used

• Privacy and confidentiality of medical record information

• Make informed decisions regarding care

• Formulate an Advanced Directive

• Delegate his/her right to make informed decisions to another person

• Know if your physician has a financial interest or ownership in the Center

• File a grievance

 

If a patient is adjusted incompetent under applicable State laws by a court of proper jurisdiction, the rights of the patient are exercised by the person appointed under State law to act on the patient’s behalf.

 

If a state court has not adjudged a patient incompetent, any legal representative or surrogate designated by the patient in accordance with State law may exercise the patient’s rights to the extent allowed by State law.

 

FL State

The patient and the patient’s representative or surrogate has the right to:

• Be treated with courtesy and respect, with appreciation of his or her dignity, and with protection of privacy

• Receive a prompt and reasonable response to questions and requests

• Know who is providing medical services and who is responsible for his or her care

• Know what patient support services are available, including if an interpreter is available if the patient does not speak English

• Know what rules and regulations apply to his or her conduct

• Be given by the health care provider information such as diagnosis, planned course of treatment, alternatives, risks, and prognosis

• Refuse any treatment, except as otherwise provided by law

• Be given full information and necessary counseling on the availability of financial resources for care

• Know whether the health care provider or facility accepts the Medicare assignment rate, if the patient is covered by Medicare

• Receive prior to treatment, a reasonable estimate of charges for medical care.

• Receive a copy of understandable itemized bill and, if requested, to have the charges explained

• Receive medical treatment or accommodations, regardless of race, national origin, religion, handicap, or source of payment 

• Receive 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 go to give his or her consent or refusal to participate in such research

• Express complaints regarding any violation to his or her rights

FL State

The patient or as appropriate the patient’s representative is responsible for:

• Giving the health care provider accurate information about present complaints, past illnesses, hospitalizations, medications, and any other information about his or her health

• Reporting unexpected changed in his or her condition to the health care provider

• Reporting to the health care provider whether he or she understands a planned course of action and what is expected of him or her

• Following the treatment plan recommended by the health care provider

• Keeping appointments and, when unable to do so, notifying the health care provider’s instructions

• Making sure financial responsibilities are carried out

• Following health care facility conduct rules and regulations

 

Complaint/grievance process:

If you, your representative, or surrogate have a problem or complaint, please speak to the receptionist, nurse, physician, or your caregiver; we will address your concern(s). You may also contact the Facility Administrator. If your concern cannot be immediately resolved the facility will investigate the complaint/ grievance and notify you, in writing, the outcome of the investigation.

 

If you are not satisfied with the response of the Surgery Center, you may contact the State of Florida via:

 

Mail:Agency for Health Care Administration

Consumer Assistance Unit

2727 Mahan Drive/BLDG. 1

Tallahassee, FL 32399

Phone:Consumer Assistance Unit at 1-888-419-3456

Email:www.floridashealth.com

 

If you have a complaint against a health care professional contact:

 

Mail: Department of Health

Consumer Services Unit

4052 Bald Cypress Way, Bin C7S

Tallahassee, FL 32399

Phone:Consumer Services Unit at 1-888-419-3456 (press 1)

Email:MQA.consumerservice@flhealth.gov

 

 

NOTE:Role of Medicare Ombudsman is to ensure that Medicare Beneficiaries receive the information and help them need to understand their Medicare options and to apply their Medicare rights and protections.

 

All Medicare beneficiaries may also file a complaint or grievance with the Medicare Beneficiary Ombudsman. Visit the Ombudsman’s webpage on the web at:

            http://www.medicare.gov/claims-and-appeals/medicare-rights/get.help/ombudsman.html