Patient Rights and Responsibilities
As a patient receiving care at 1800 MCDONOUGH ROAD SURGERY CENTER LLC. you have the responsibility to:
Provide complete and accurate information to the best of your ability about your health, any medications, including over-the-counter products and dietary supplements, and any allergies or sensitivities, present complaints, past illnesses, hospitalizations, experience(s) with anesthesia, and other matters related to your health.
Share your information with us related to your expectations of and satisfaction with our organization.
Ask questions if you do not understand your care, treatment, or services or what you are expected to do.
Follow the treatment plan and instructions prescribed by your provider(s). It is also your responsibility to express any concerns you may have about your ability to follow the proposed plan of care, treatment, or services.
Accept your share of responsibility for the outcomes of care, treatment, or services-if-you-do not follow the care, treatment, or services plan.
Follow our organization’s policies and procedures.
Provide a responsible adult to transport you home from our organization and remain with you for 24 hours.
Accept personal financial responsibility for any charges not covered by your insurance or other third-party payer.
Be respectful of all healthcare providers, staff, and property, as well as other patients in their property.
Inform us of any advance directive that could affect your care.
An Advance Directive is a legally binding document that protects your right to refuse and/or request certain medical treatments in the event you are unable to make decisions for yourself. These documents are only binding if completed by a competent adult and is signed by two persons as witnesses acknowledging the signature of the patient. Information on how to establish an Advance Directive is available upon request at the center.
All procedures performed at our center are elective in nature. As a matter of conscience, we cannot honor Advance Directives which include a ‘DO NOT RESUSCIATE’ order or other limitations involving life saving measures during your care at our center. If you have an Advance Directive of any kind, please bring the document with you on the day of your procedure. A copy will be made and placed in your medical record.
I HAVE NOT PROVIDED AN ADVANCE DIRECTIVE FOR MY MEDICAL RECORD
I HAVE AN ADVANCE DIRECTIVE IN EFFECT AND I HAVE PROVIDED THE CENTER WITH A COPY
I HAVE RECEIVED THE PATIENT RIGHTS AND RESPONSIBILITIES IN ADVANCE THE DAY OF SURGERY
I hereby acknowledge that I have received, read, and understand the Patient Rights and Responsibilities.
(No Signature of Patient or Parent Representative Required at this time)