Patient Rights and Responsibilities and ASC Disclosures

1. The patient has the right to be treated with respect, consideration, and dignity in a safe setting by qualified, appropriately credentialed providers.
2. The patient has the right to be involved in the plan of care and treatment. The patient has the right to obtain from their physician complete current information concerning their diagnosis, treatment and prognosis in terms that can be reasonably expected to understand. When it is not advisable to give such information to the patient, the information should be made available to an appropriate person on their behalf. The patient has the right to know, by name, the physician responsible for coordinating their care. The patient has the right to be involved in the plan of care and treatment.
3. The patient has the right to receive from their physician information necessary to give informed consent prior to the start of any procedure and/or treatment. Except in emergencies, such information for informed consent should include, but not necessarily be limited to, the specific procedure and/or treatment, the medically significant risks involved, and the probable duration of the incapacitation. Where medically significant alternatives for care of treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information. The patient has the right to know the name of the person responsible for the procedures and/or treatment.
4. The patient has the right to request or refuse treatment to the extent permitted by law, and to be informed of the medical consequences of their actions.
5. If a patient is adjudged 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 that patient’s behalf.
6. 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.
7. The patient has the right to every consideration of their privacy concerning their own medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discreetly. Those not directly involved in their care must have the permission of the patient to be present.
8. The patient has the right to expect that all communications and records pertaining to their care should be treated as confidential. Communications in the language and/or manner primarily used by the patient will be offered free of charge.
9. The patient has the right to be advised if the surgery center proposed to engage in or perform human experimentation affecting their care of treatment. The patient has the right to refuse to participate in such research projects.
10. The patient has the right to examine and receive an explanation of their bill regardless of source of payment. The patient has the right to know in advance, the estimated amount of their charges and payment policies.
11. The patient has the right to know what surgery center rules and regulations apply to their conduct as a patient.
12. The patient has the right to know what services are available at the ASC. Marketing or advertising regarding the competency and capabilities of the ASC are not misleading.
13. The patient has right to change primary and specialty care providers if other qualified providers are available.
14. The patient will be provided admission and services without regard to race, color, national origin, disability, sex, gender identity, religion, sexual orientation, source of payment or age, as required by Federal Law.
15. The patient has the right to be free from all forms of abuse and harassment and reprisal.
16. An Advance Directive is a general term that refers to your oral or written instructions about your future medical care in the event that you become unable to communicate those instructions. Should you have an Advance Directive, you may provide a copy for your record, but as a provider of outpatient services, if an adverse event occurs during your stay, based on reasons of conscience, all reasonable efforts will be taken to revive you, including resuscitative or other stabilizing measures, regardless of the contents of any advance directive/living will/health care proxy or instructions from a health care agent. In the unlikely event that you are transferred to a hospital, your Advance Directive will accompany you.
17. The patient has the right to be informed of the mechanism for continued healthcare following discharge from the ASC. Patients have the right to know provisions for after-hours care and emergency care.
18. The patient has the right to expect that referral or transfer will occur if necessary in a timely manner and communication provided to the patient and/or designated responsible party regarding emergency and information regarding the receiving facility.
19. The patient is responsible for behaving respectfully toward all the healthcare professionals and staff as well as other patients and visitors and the organization’s property.
20. The patient is responsible for truthfully answering all medical questions about health, medications including OTC and supplements and any allergy or sensitivity truthfully to the best of their knowledge. The patient is responsible to read and understand all permits and/or consents they sign. If the patient does not understand, it is their responsibility to ask the nurse or physician for clarification.
21. The patient is responsible for reading carefully and following the pre-operative instructions their physician and/or the surgery center has given them. The patient is responsible for notifying the surgery center if they have not followed the pre-operative instructions. It is the patient’s responsibility to read carefully and follow the post-operative instructions they receive from the physician(s) and/or nurses.
22. The patient is responsible for contacting their physician if they have any complications or changes in condition of concern in a timely manner.
23. The patient is responsible for keeping appointments and when unable for any reason, notifying the facility in a timely manner.
24. The patient is responsible to assure all payments for services rendered are on a timely basis and ultimate responsibility is theirs, regardless of whatever insurance coverage they may have.
25. The patient is responsible for informing the provider about any living will, medical power of attorney, designated responsible surrogate/decision maker, or other directive that could affect their care.
26. The patient is responsible for following the facility rules and regulations affecting patient care and conduct including, but not limited to, having a responsible adult to drive them home and monitor them for up-to 24 hours, as ordered by the physician.
27. The patient and their family have the right to present complaints concerning the quality of care either verbally or in writing to the manager, nursing staff, medical staff, or administration without fear of discrimination or reprisal. Presentation of complaints will not serve to compromise a patient’s future care. If a patient would like to send a complaint, please direct them to the Nurse Manager or Facility Administrator:

Sheila Thompson
Facility Administrator
Twin Cities Surgery Center
7211 Ohms Lane, Edina, MN 55439
(952) 204-3500

28. The patient has the right to send a complaint to the Minnesota Division of Health Regulation, Office of Health Facility Complaints should they feel the care received was unsatisfactory:

Minnesota Department of Health 
Health Regulation Division
PO Box 64900, St. Paul, MN 55164-0900
Phone: (651) 201-3709
Email: health.cm-web@state.mn.us

Minnesota Office of Health Facility Complaints
PO Box 64970, St. Paul, MN 55164-0970
Phone: 1-800-369-7994 or (651) 201-4200
Email: health.ohfc-complaints@state.mn.us

28. A Medicare patient has the right to send a complaint to the website for the Medicare Beneficiary Ombudsman or call.

Ombudsman #: 1-800-Medicare (1-800-633-4227)
www.medicare.gov
TTY/TDD: 1-877-486-2048

https://www.cms.gov/center/special-topic/ombudsman/medicare-beneficiary-ombudsman-home