PATIENT RESPONSIBILITIES INCLUDE THE RESPONSIBILITY TO:
Provide accurate and complete information concerning current and past states of health, present complaints, hospitalizations, medications (including over the counter products and dietary supplements), allergies and sensitivities, and any other pertinent health information.
Understand and/or ask questions about care and services delivered, and about instructions following care and treatment.
Follow the treatment plan and care instructions or accept accountability if the treatment plan and care instructions are not followed.
Keep appointments or notify the surgery center if unable to keep an appointment.
Leave valuables with a family member/representative.
Be accompanied at discharge by a responsible adult.
Inform the surgery center staff of a living will, medical power of attorney, or other directive that could affect care.
Accept personal financial responsibility for any charges not covered by insurance.
Show respect for other patients and surgery center staff.
Tell us if there is a problem with care.
* It is the responsibility of a parent or guardian to remain at the surgery center for the duration of a pediatric patient’s stay.
Feedback on Our Services You may contact any of the following:
Gateway Surgery Center: 1-570-718-0671
Pennsylvania Department of Health Quality Assurance Complaint Hotline 1-800-254-5164 or by mail at 625 Forster Street, Harrisburg, PA 17120-0701
Medicare at 1-800-633-4227 or by visiting http://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html
Office of Civil Rights at 1-800-368-1019, 1-800-527-7697 (TDD) or by visiting https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail at U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html
Covenant Surgical Partners Compliance Help Line 855-315-0528 or by visiting www.covenantsurgicalcompliance.com
AAAHC Address: 847-853-6060 or by mail at 5250 Old Orchard Road, Suite 200, Skokie, IL 60077