- To receive the care and health services that the center is required by law to provide.
- To exercise your rights without being subject discrimination or reprisal.
- To have the right to personal privacy and to receive care in a safe setting.
- To receive an understandable explanation from you physician of your complete medical condition, recommended treatment, expected results, risks involved and reasonable medical alternative. If your physician believes that some of this information would be detrimental to your health or beyond your ability to understand, the explanation must be given to your next of kin.
- To give informed, written consent prior to the start of specified, non-emergency medical procedures or treatments.
- Your physician should explain to you, in words you understand, specific details about the recommended procedure or treatment, any risks involved, time required for recovery, and any reasonable medical alternatives.
- To refuse medication and treatment after possible consequences of this decision have been explained clearly to you, unless the situation is life-threatening or the procedure is required by law.
- To be included in experimental research only if you give informed, written consent. You have the right to refuse to participate.
- To expect and receive appropriate assessment, management and treatment of pain as an integral component of your care.
Communication and Information
- To be informed of the names and functions of all health care professionals providing you with personal care.
- To receive, as soon as possible, the services of a translator or interpreter if you need one to help you communicate with the Center’s health care personnel.
- To be informed of the names and functions of any outside health care and educational institutions involved in your treatment. You may refuse to allow their participation.
- To receive, upon request, the Center’s written policies and procedures regarding life-saving methods and the use or withdrawal of life support mechanisms and the use of or information regarding an Advance Directive.
- To be advised in writing of the Center’s rules regarding the conduct of patients and visitors.
- To receive a summary of your patient rights that includes the name and phone number of the Center staff member to whom you can ask questions or complain about a possible violation of your rights.
- To have prompt access to the information in your medical record. If your physician feels that this access is detrimental to your health, your next of kin or guardian has the right to see your record.
- To obtain a copy of your medical record, at a reasonable fee, within 30 days after a written request to the Center.
- To expect that your medical record will be held in strict confidentiality and released only with your permission as per State and Federal laws.
Cost of Ambulatory Surgical Center Care
- To receive a copy of the Center’s payment rates. If you request an itemized bill, the Center must provide one and explain any questions you may have. You have the right to appeal any charges.
- To be informed by the Center if part of or your entire bill will not be covered by insurance. The Center is required to help you obtain any public assistance and private health care benefits to which you may be entitled.
- To be notified if your physician has a financial interest in the Center.
- To receive information and assistance from you attending physician and other health care providers if you need to arrange for continuing health care after your discharge from the Center.
- To be transferred to another facility only when you or your family has made the request or in instances where the Center is unable to provide you with the care you need.
- To receive an advanced explanation from a physician of the reasons for your transfer and possible alternatives.
- To be treated with courtesy, consideration, and respect for your dignity and individuality.
- To have access to storage space for private use. The Center must also have a system to safeguard your personal property.
Freedom from Abuse and Restraints
- To be free from physical and mental abuse.
- To be free from restraints, unless they are authorized by a physician for a limited period of time to protect the safety of you or others.
Privacy and Confidentiality
- To have physical privacy during medical treatment and personal hygiene functions, unless you need assistance.
- To confidential treatment of information about you. Information in your records will not be released to anyone outside the Center without your approval, unless it is required by law.
- To treatment and medical services without discrimination based on age, religion, national origin, sex, sexual preference, handicap, or diagnosis.
- To exercise all your constitutional, civil, and legal rights.
Patient ResponsibilitiesAs a patient of the Montvale Surgical Center, you are responsible for:
- Providing physicians and Center personnel with accurate information related to your condition and care.
- Following your treatment plans. Patients are responsible for medical consequences which result from refusing treatment or not following instructions of physicians and the Center’s personnel.
- Being considerate of the Center’s staff who are committed to excellence in patient care.
- Supplying accurate insurance information and paying bills promptly so that the Montvale Surgical Center can continue to serve you effectively.
Questions and ComplaintsYou may directly contact:
Office of Acute Care Assessment and Survey
Division of Health Facilities Evaluation and Licensing
Department of Health and Senior Services
P. O. Box 367, Trenton, NJ 08625-0358
Tel: 800-792-9770 or 609-292-9900
Office of the Ombudsman for the Institutionalized Elderly
Division of Elder Advocacy
Department of Public Advocate
P. O. Box 852, Trenton, NJ 08625-0852
Medicare Ombudsman Center Web Site – http://www.cms.hhs.gov/center/ombudsman.asp
The Montvale Surgical Center's Representative
Tina Lamberski, Administrator
6 Chestnut Ridge Road, Montvale, New Jersey 07645
Tel: 201-391-4700 Fax: 201-391-4701