ESCNY Surgery Center is committed to ensuring the following Patient Rights
1. The right to safe, confidential and considerate care with respect, consideration and dignity.
2. The right to treatment without regard to race, color, religion, gender, sexual orientation, disability, national origin, age, veteran’s status, marital status, diagnosis, national origin or sponsor and/or source of payment, except for fiscal capability thereof in accordance with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and the regulations of the U.S. Department of Health and Human Services issued pursuant to these statutes at Title 45 of the Code of Federal Regulations (“CFR”) Parts 80, 84, and 91. This Center complies with the privacy and security of individually identifiable health information as specified in Title 45 CFR Parts 160 and 164.
3. The right to not be subjected to abuse; neglect; exploitation; coercion; manipulation; sexual abuse; sexual assault; seclusion; restraint, if not necessary to prevent imminent harm to self or others; and misappropriation of personal property by the Center’s personnel.
4. The right to privacy concerning your treatment and personal needs.
5. The right to be informed by the medical provider(s) complete and current information concerning your diagnosis, treatment plan, informed consent for the procedure including the risks involved and an alternative care option, and prognosis in terms that you can understand or designated surrogate. You will be able to make a knowledgeable decision.
6. The right to be informed of the services available here at the Center and to make informed decisions regarding patient care by either the patient or designated surrogate.
7. When the need arises, reasonable attempts are made for health care professionals and staff to communicate in the language or manner primarily used by the patient or surrogate decision maker.
8. The right to make informed decisions regarding your care and to delegate your right to make informed decisions to a representative or surrogate of your choice. To the degree permitted by New York State law, and to the maximum extent practicable, the Center will respect your wishes and follow that process.
9. The right to have a state appointed representative act on your behalf that may exercise any and all rights afforded to you if you have been determined to be incompetent under a state legal process and are not capable of exercising your rights independently.
10. The right to expect all disclosures and records pertaining to your care and treatment will be treated as confidential unless reporting is permitted or required by law or unless the Center has received your written consent.
11. The right to complete information concerning your diagnosis, evaluation, treatment and prognosis, as well as the risks and dangers of that treatment, expected outcome, and opportunity to participate in informed decisions related to your treatment. When medically inadvisable to give such information to a patient, the information is provided to a person designated by the patient (the patient’s representative or surrogate) or to a legally authorized person.
12. The patient, patient’s representative, or surrogate also has the right to know the name of the person(s) who will implement the procedures and/or treatment and are informed of their right to change their provider if other qualified providers are available.
13. The right to refuse part or all of the treatment suggested to you at the Center, including participation in human experimental research affecting your care or treatment.
14. The right to expect reasonable continuity of care, to receive care in a safe setting and to know what to expect concerning your procedure(s) and expected appointment time. To be informed by your physician, or a delegate of the physician, of your continuing health care requirements following discharge.
15. The right to be provided with appropriate information regarding the absence of malpractice insurance coverage
16. The right to know the Center charges which you incur for treatment, payment policies, immediate and long-term financial implications, regardless of the source of payment. Eligibility for third-party reimbursements and when applicable, the ability of free or reduced cost care.
17. The right to expect that within its capacity, ESCNY must provide evaluation, service and/or referral as indicated by the urgency of the case. When medically necessary, a patient may be transferred to another facility.
18. The right to express any suggestion, complaint, and grievance, either verbally or in writing, to the Center or another entity, regarding your care without discrimination or reprisal and be free from all forms of abuse or harassment.
19. The right to accurate and true marketing and/or advertising regarding the competence and capabilities of the organization.
20. The right to submit an Advance Directive.
21. The right to request the New York Advance Directive Form.
22. The right to access the Advanced Health Care Directive in Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO), who administers a national consumer engagement initiative to improve care at the end of life. This program includes instructions for completing the New York Advance Directive for Healthcare, learning options for end-of-life services and care, implementing plans to ensure your wishes are honored, voicing your decisions to family, friends and healthcare providers, engaging in personal or community efforts to improve end-of-life care, and the New York Durable Power of Attorney for Healthcare.
23. The right to be informed, if you are a Medicare beneficiary, that the role of the Medicare Beneficiary Ombudsman is to ensure that Medicare beneficiaries receive the information and help they need to understand their Medicare options and to apply their Medicare rights and protections.
24. The right to consent to photographs of you before being photographed for identification, administrative, educational, or marketing purposes.
25. The right to provide written consent to the release of your medical and financial records, except as otherwise permitted by law.
26. The right to receive treatment that supports and respects your individuality, choices, strengths, and abilities.
27. The right to review, upon your written request, your own medical record.
28. The right to receive a referral to another health care institution of the Center is unable to provide physical health services for you.
29. The right to be informed of the provisions of off-hours emergency coverage.
30. The right to receive an itemized copy of his/her account statement upon request.
As a patient, you are responsible for
1. Providing complete and accurate information relating to your health. This includes your current health condition(s), past medical history, allergies and sensitivities, and the medications you are taking (prescription medicines, as well as over-the-counter products and dietary supplements).
2. Informing your provider about any living will, medical power of attorney, or other directive that could affect your care.
3. Asking questions when you do not understand information or instructions or do not believe you can follow through with the treatment prescribed by your physician.
4. Being considerate of the rights of other patients and the staff of the Center by assisting in the control of noise, eating, not smoking, and limiting the number of visitors.
5. Assuring that your financial obligations to the Center are fulfilled as promptly as possible.
6. Following the treatment plan prescribed by your provider.
7. Observing prescribed rules of the Center during your stay and treatments, and if instructions are not followed, forfeiture of care at the Center.
8. Providing a responsible driver for transportation home and for a responsible person to remain with you for 24 hours, if required by your physician.
The Center has the right to refuse care to or dismiss a patient from care in the event they are disruptive, uncooperative, and belligerent or physically threatening to the staff or other patients. Additionally, the Center has the right to refuse care to or dismiss a patient from care in the event the designated responsible patient representative, caregiver or surrogate is incapacitated, disruptive, uncooperative, belligerent, or physically threatening to the staff or
Questions or Concerns
If you have questions or concerns regarding the Patient’s Bill of Rights and Responsibilities, or in the event you desire to file a complaint, a list of resources is as follows:
1. Clinical Director, Eye Surgery Centers of New York, 3130 Grand Concourse, Suite B5, Bronx, New York; Phone: 718-502-3937. The Center will provide you with a response within 30 days of your complaint.
2. The New York Department of Health Services, the responsible agency for ambulatory surgical centers’ complaint investigation. Complaints may be filed with the Department by Patient Safety Center: Office of Quality and Patient Safety, New York State Department of Health, Corning Tower, Room 1938, Albany, NY 12237. (518) 408-1219; fax: (518) 486-6098 or email: [email protected] You may file a complaint with the accreditation agency for this Center. The Center must post a telephone number for the accreditation agency.
3. You may also file a complaint with the Department of Health’s (DOH) Office of Professional Medical Conduct (OPMC) at 1-800-804-5447.
4. The Office of the Medicare Ombudsman website is medicare.gov, or telephone 1-800-MEDICARE.
5. For more information about advanced directives, Website: www.health.state.ny.us
To obtain a free copy of the New York State Health Care Proxy form with instructions click here.
To obtain a free copy of the DNR Order form (DOH 3474) or information about a DNR bracelet visit: health.ny.gov. Or Caring Connections at: caringinfo.org.
6. Accreditation Association for Ambulatory Health Care, Inc. (“AAAHC”) website, aaahc.org.