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PATIENT’S STATEMENT OF RIGHTS AND RESPONSIBILITIES

NOTIFICATION OF PHYSICIAN OWNERSHIP

 

The staff of this health care facility recognizes you have rights while a patient receiving medical care. In return, there are responsibilities for certain behavior on your part as the patient. This statement of rights and responsibilities is posted in our facility in at least one location that is used by all patients.

 

Your rights and responsibilities include:

 

A patient, patient representative or surrogate has the right to

  • Receive information about rights, patient conduct and responsibilities in a language and manner the patient, patient representative or surrogate can understand.

  • Be treated with respect, consideration and dignity.

  • Be provided appropriate personal privacy.

  • Have disclosures and records treated confidentially and be given the opportunity to approve or refuse record release except when release is required by law.

  • Be given the opportunity to participate in decisions involving their health care, except when such participation is contraindicated for medical reasons.

  • Receive care in a safe setting.

  • Be free from all forms of abuse, neglect or harassment.

  • Exercise his or her rights without being subject to discrimination or reprisal with impartial access to medical treatment or accommodations, regardless of race, national origin, religion, physical disability, or source of payment.

  • Voice complaints and grievances, without reprisal.

  • Be provided, to the degree known, complete information concerning diagnosis, evaluation, treatment and know who is providing services and who is responsible for the care. When the patient’s medical condition makes it inadvisable or impossible, the information is provided to a person designated by the patient or to a legally authorized person.

  • Exercise of rights and respect for property and persons, including the right to

  • Voice grievances regarding treatment or care that is (or fails to be) furnished.

  • Be fully informed about a treatment or procedure and the expected outcome before it is performed.

Have a person appointed under State law to act on the patient’s behalf if the patient is adjudged incompetent under applicable State health and safety laws by a court of proper jurisdiction. If a State court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with State law may exercise the patient’s rights to the extent allowed by State law.

  • Refuse treatment to extent permitted by law and be informed of medical consequences of this action.

  • Know if medical treatment is for purposes of experimental research and to give his consent or refusal to participate in such experimental research.

  • Have the right to change primary or specialty physicians if other qualified physicians are available.

  • A prompt and reasonable response to questions and requests.

  • Know what patient support services are available, including whether an interpreter is available if he or she does not speak English.

  • Receive, upon request, prior to treatment, a reasonable estimate of charges for medical care and know, upon request and prior to treatment, whether the facility accepts the Medicare assignment rate.

  • Receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have charges explained.

 

  • Formulate advance directives and to appoint a surrogate to make health care decisions on his/her behalf to the extent permitted by law and provide a copy to the facility for placement in his/her medical record.

  • Know the facility policy on advance directives.

  • Be informed of the names of physicians who have ownership in the facility.

  • Have properly credentialed and qualified healthcare professionals providing patient care.

  • Know your physician has malpractice insurance, as required by the state.

 

 

A patient, patient representative or surrogate is responsible for

  • Providing a responsible adult to transport him/her home from the facility and remain with him/her for 24 hours, unless specifically exempted from this responsibility by his/her provider.

  • Providing to the best of his or her knowledge, accurate and complete information about his/her health, present complaints, past illnesses, hospitalizations, any medications, including over-the-counter products and dietary supplements, any allergies or sensitivities, and other matters relating to his or her health.

  • Accept personal financial responsibility for any charges not covered by his/her insurance.

  • Following the treatment plan recommended by his health care provider.

  • Be respectful of all the health providers and staff, as well as other patients.

  • Providing a copy of information that you desire us to know about a durable power of attorney, health care surrogate, or other advance directive.

  • His/her actions if he/she refuses treatment or does not follow the health care provider’s instructions.

  • Reporting unexpected changes in his or her condition to the health care provider.

  • Reporting to his health care provider whether he or she comprehends a contemplated course of action and what is expected of him or her.

  • Keeping appointments.

 

ADVANCED DIRECTIVES

An “Advanced Directive” is a general term that refers to your instructions about your medical care in the event you become unable to voice these instructions yourself. Each state regulates advanced directives differently. In the state of Ohio, all patients have the right to make personal decisions about health care. The right to decide (to say yes or no to a proposed treatment) applies to treatments that extend life. An Advanced Directive can be used to name a health care agent as well to say what preferences about treatments that might be used to sustain life.

 

You have the right to informed decision making regarding your care, including information regarding Advance Directives and this facilities policy on Advance Directives. Applicable state forms will also be provided upon request. A member of our staff will be discussing Advance Directives with the patient (and/or patient’s representative or surrogate) prior to the procedure being performed.

 

If the patient has Advanced Directives which have been provided to the surgery center that impact resuscitative measures being taken, please know that such Advance Directives will be considered “suspended” while receiving care at the Dialysis Access Center. We will discuss the treatment plan with the patient and his/her physician to determine the appropriate course of action to be taken regarding the patient’s care.

 

 

COMPLAINTS

Please ask any of our staff to help you if you have a problem or complaint. If necessary, your problem will be advanced to the Administrative Director and /or Medical Director for resolution. You have the right to have your verbal or written grievance investigated and to receive written notification of the actions taken. Contact us if you have a question or concern about your rights or responsibilities

Or, you can call 330-629-2855.

We want to provide you with excellent service, including answering your questions and responding to your concerns.

 

You may also choose to contact the licensing agency of the state

Ohio Department of Health

1-800-342-0553

If you are covered by Medicare, you may choose to contact the Medicare Ombudsman at 1-800-MEDICARE (1-800-633-4227) or on line at https://www.medicare.gov/claims-appeals

 

The role of the Medicare Beneficiary Ombudsman is to ensure that Medicare beneficiaries receive the information and help you need to understand your Medicare options and to apply your Medicare rights and protections.
 

 

 

PHYSICIAN FINANCIAL INTEREST AND OWNERSHIP

 

The Dialysis Access Center is owned by the Kidney Group. The Physicians who referred you to the center and who will be performing your procedures may have a financial and ownership interest. Patients have the right to be treated at another heath care facility of their choice. We are making this disclosure in accordance with federal regulations.

The following physicians have a financial interest in the center:

Dr. Nathanial Doe 

Dr. Kathleen Padgitt

Dr. Mario Leone

 

Dr. Sherif Soliman

Dr. Hasit Pandya

Dr. Christopher Enoch

 

Dr. Andrea Shaer

Dr. Anup Bains

Dr. Michael Koprucki

DIALYSIS ACCESS CENTER

8390 Tod Ave.

Boardman, Ohio 44512

Phone: 330-629-2855 Fax: 330-629-2859

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