An Affiliate of the New York Eye and Ear Infirmary of Mount Sinai

We consider you a partner in your healthcare. When you are well informed, participate in treatment decisions, and communicate openly with your physician and other health professionals, you help make your care as safe and effective as possible. The Empire State Ambulatory Surgery Center proudly works to respect your rights, values and dignity at all times.



You have the right, per the New York Department of Health, as a patient in New York State, to:


1. Understand and use these rights. If for any reason you do not understand or you need help, the surgery center MUST provide assistance, including an interpreter.

2. Receive treatment without discrimination as to race, color, religion, sex, national origin, disability, sexual orientation or source of payment.

3. Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints.

4. Receive emergency care if you need it.

5. Be informed of the provisions for off-hour emergency coverage.

6. Be informed of the name and position of the doctor who will be in charge of your care in the surgery center.

7. Know the names, positions and functions of any surgery center staff involved in your care and refuse their treatment, examination or observation

8. A no smoking room

9. Receive complete information about your diagnosis, treatment and prognosis.

10. Receive from his/her physician information necessary to give informed consent prior to the start of any non-emergency procedure, treatment or both. An informed consent shall include, as a minimum, the provisions of information concerning the specific procedure, treatment or both, the reasonably foreseeable risks involved, and 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.

11. Receive all the information you need to give informed consent for an order not to resuscitate. You also have the right to designate an individual to give this consent for you if you are too ill to do so. If you would like additional information, please ask for a copy of the pamphlet "Do Not Resuscitate Orders -- A Guide for Patients and Families."

12. Refuse treatment and be told what effect this may have on your health.

13. Refuse to take part in research. In deciding whether or not to participate, you have the right to a full explanation.

14. Privacy while in the surgery center and confidentiality of all information and records regarding your care.

15. Participate in all decisions about your treatment and discharge from the surgery center. The surgery center must provide you with a written discharge plan.

16. Review your medical record without charge. Obtain a copy of your medical record for which the surgery center can charge a reasonable fee. You cannot be denied a copy solely because you cannot afford to pay.

17. Approve or refuse the release or disclosure of the contents of your medical record to any health-care practitioner and/or health-care facility except as required by law or third party contract.

18. Receive an itemized bill and explanation of all charges, upon request.

19. Complain without fear of reprisals about the care and services you are receiving, and to have the surgery center respond to you, and if you request it, a written response. If you are not satisfied with the surgery center's response, you can complain to the New York State Health Department. The surgery center must provide you with the Health Department telephone number.

20. Authorize those family members and other adults who will be given priority to visit consistent with your ability to receive visitors.

21. Make known your wishes in regard to anatomical gifts. You may document your wishes in your health care proxy or on a donor card, available from the surgery center. Public Health Law (PHL) 2803 (l) (g) Patients' Rights 10nycrr, 405.7 (a) (l), 405.7(a) (2)

22. To have competent, caring healthcare providers who act as your advocates

23. To know about any business relationships among the facility, healthcare providers, and others that might influence your care of treatment

24. Patient has the right to be informed of their right to change their provider if other qualified providers are available.

25. Be informed of the charges for services, eligibility for third-party reimbursements and, when applicable, the availability of free or reduced cost care through Bronx Surgery Center's community outreach and free care initiative.



COMPLAINTS AND CONCERNS CAN BE EXPRESSED IN ANY OF THE FOLLOWING WAYS:

1. Call the new York State Department of Health complaint hotline at: 800-804-5447 or write to:

New York State Department of Health
Centralized Hospital Intake Program
Mailstop: CA/DCS
Empire State Plaza
Albany, NY 12237

2. Discuss with your physician

3. Discuss with the Center's Administrator at (718) 708-5777 or write to:

Bronx SC LLC
3170 Webster Ave.
Suite A
Bronx, NY 10467

4. Call the Medicare Beneficiary Hotline at 1-800-MEDICARE (1-800-633-4227) or write to:

Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850

5. Or contact the Medicare Ombudsman via the world wide web at:
http://www.medicare.gov/Ombudsman/activities.asp