Patient Rights & Responsibilities

The UnaSource Surgery Center is a state of the art surgical facility designed to meet and exceed your health care expectations. Our staff works in a collaborative manner with you and your physician to achieve the highest standards of care and ensure privacy and provide comfortable surroundings for you and your family. Please inform our staff of any special needs that you may have while at the facility

In an effort to maintain our commitment to service excellence, the following information is provided to assist you regarding your rights and responsibilities as a patient at the UnaSource Surgery Center. It is our hope that you will actively participate in the plan of care during your stay. Please direct questions to your physician, nurse or any other staff person regarding your stay or course of treatment.

Respect & Dignity

It is our goal and objective to ensure that your stay is comfortable and exceeds your expectations. We work hard to respect your privacy. Information about your stay is maintained in a confidential manner. As part of our commitment to excellence, accrediting and licensing agencies as well as your insurance carrier can potentially review your information. Your information will not be provided to friends or family unless specifically authorized by you.

The nursing staff is committed to providing adequate comfort for all patients. Please let your nurses know how we can assist to reduce or eliminate your pain or anxiety

Patient Rights

1. To be informed of your patient rights in advance of care being provided or discontinued
2. Participate in and make informed decisions about your care and pain management, including being able to request or refuse treatment.
3. To change provider if other qualified providers are available
4. Have their condition, treatment, pain alternatives and outcomes explained in a manner that they understand. Patients have the right to interpretation services if needed.
5. Be provided, to a degree known, complete information concerning your diagnosis, evaluation, treatment and prognosis. When it is medically inadvisable to give such information to you, the patient, the information is provided to a person designated by you or to a legally authorized person.
6. Expect timely and appropriate assessment and treatment of physical pain and emotional or spiritual discomfort.
7. Receive safe, high quality, medical care, without discrimination, that is compassionate and respects personal dignity, values, beliefs and preferences and contributes to a positive self-image.
8. You as a patient or your representative may exercise your rights without fear of reprise.
9. Know the name and role of your caregiver (e.g., Doctor, Nurse, Technician, etc.). You have a right to request information and/or credentials about the Physician providing your care. A list of public websites is available upon request.
10. Receive information about continuing your health care at the end of your visit.
11. Be informed of the provisions for after hours and emergency care.
12. Be informed of your right to refuse to participate in experimental research if applicable.
13. Receive private and confidential treatments, communications, and medical records, to the extent permitted by law.
14. Have your patient disclosures and records treated confidentially. You have the right to be given the opportunity to approve or refuse their release, except when release is required by law.
15. Have your protected health information (PHI) treated confidentially. You have the right to be given the opportunity to approve or refuse their release, except when release is required by law. You are entitled not to share your PHI with your health plan provider upon request if you are paying for service out of pocket.
16. Be informed of charges, fees for service, payment policies, receive an explanation of your bill and receive counseling on the availability of known financial resources for health care services.
17. Have your compliments, concerns, complaints, or grievances addressed. Sharing your concern and/or complaints will not compromise your access to care, treatment and services. You may request a grievance form from the registration staff or your care provider. You may initiate the complaint process and discuss your concerns with the Center's Executive Director or your physician. Your concerns will be reviewed and you will be given a response to your concerns . You may contact the Executive Director in person at the time of your visit, by calling 248-265-4610, or report the complaint to:
    
    Contact Information:
    Medicare Beneficiary Ombudsman
    1-800-MEDICARE (800-633-4227)
    www.cms.hhs.gov/center/ombudsman.asp
    State of Michigan
    Michigan Department of Licensing and Regulatory Affairs
    P.O. Box 30664
    Lansing, MI 48909
    1-800-882-6006

Patient Responsibilities

1. To respect and be considerate of the rights of other patients and UnaSource Surgery Center personnel in the control of noise, the number of visitors and to be respectful of the property of other persons and the Center.
2. To follow the rules of UnaSource Surgery Center.
3. To provide, to the best of your knowledge, accurate and complete information about your health, present complaints, past illnesses, hospitalizations, medications including over-the-counter and dietary supplements, allergies, sensitivities and insurance benefits.
4. To ask for more information if you have questions about your care, treatment, services or caregivers. It is also your responsibility to report perceived risks in your care and unexpected changes in your condition.
5. To follow the treatment plan prescribed by his/her provider and participate in his/her care.
6. To ask your care provider when you do not understand medical words or instructions about your plan of care. If you are unable or unwilling to follow the plan of care, you are responsible for telling your care provider. Your care provider will explain the medical consequences of not following the recommended treatment. You are responsible for the outcome of not following your plan of care.
7. To notify UnaSource Surgery Center if you have a need to change or cancel your procedure.
8. You must have a responsible adult to drive you home after your procedure. Your procedure will be cancelled if you do not have a driver. Having a responsible adult accompany you home in a taxi is also acceptable. A responsible adult is to remain with you for 24 hours following your procedure.
9. Inform your caregiver about any living will, medical power of attorney, or other directive that could affect your care.
10. To tell us how satisfied you are with your care, so that we can resolve your concerns and learn from them.
11. To assure that the financial obligations of your healthcare are fulfilled as promptly as possible. Co-pays are expected on day of your procedure . UnaSource Surgery Center will make every ef- fort to validate your Insurance Benefits and to notify you before your procedure date. Ultimate responsibility for Insurance coverage information belongs to the patient and/or legal guardian.
12. To abide by the NO SMOKING policy of UnaSource Surgery Center

Advance Directives

Advance Directives are written instructions that tell your physician what kind of care you would like to have if you become unable to make medical decisions. They do not take away your right to decide about your current healthcare needs.

Advance Directives include the following :
• Living Will
• Life Prolonging Declaration
• Health Care Representative
• Appointment of Durable Power of Attorney for Healthcare

UnaSource Surgery Center recognizes Appointment of Healthcare Representative and Durable Power of Attorney for Healthcare. In most cases, we will be able to honor these directives.

However, the Center does NOT recognize, nor will it honor a Living Will or a Life Prolonging Declaration. In all instances of emergency or life threatening situations, life sustaining treatment will be started; all possible measures will be taken to resuscitate you. You will be transferred to a hospital and at that time any Advance Directives you have provided to UnaSource Surgery Center will be sent to the hospital with you.

Disclosure of Physician Ownership

Patients have a right to know if their physician has a financial interest in the Surgery Center.

The following physicians are investors at UnaSource Surgery Center: Dr. Kyle Anderson, Dr. M. Azhar Ali, Dr. Richard Arden, Dr. Anezi Bakken, Dr. Alan Biddinger, Dr. Timothy Bierema, Dr. Jerome Ciullo, Dr. James Courtney, Dr. M. Emin Donat, Dr. Paul Fortin, Dr. Jason Gilleran, Dr. Steven Glickman, Dr. Joseph Guettler, Dr. Ellen Janetzke, Dr. David Kearney, Dr. Robert Kohen, Dr. Matthew Kopera, Dr. G. Krishna Kumar, Dr. Bruce McIntosh, Dr. Samuel Mucci, Dr. Partha Nandi, Dr. Peggy Nowak, Dr. Nicholas Papakonstantinou, Dr. Todd Proctor, Dr. Rajesh Rao, Dr. Uzma Rehman, Dr. James Relle, Dr. Ronald Rubenstein, Dr. David Scapini, Dr. Tad Sprunger, Dr. C. Christopher Stroud, Dr. William Ward, Dr. John Weber, Dr. Richard Wille, Dr. Michael Yusaf.

If you feel you are a victim of Medicare Fraud:
Office of the Inspector General HHS TIPS Hotline P.O. Box 23489 Washington, DC 20026	Phone: 1-800-447-8477 (HHS-TIPS) Fax: 1-800-223-8164 (10 pgs or less) Email: HHSTips@oig.hhs.gov