The patient, the patient’s representative or the patient’s surrogate has the right to:
- Be fully informed of all his/her rights and responsibilities prior to the scheduled procedure.
- Appropriate and professional care relating to physician orders.
- The Fountain Point Surgery Center of Norfolk not taking punitive action as a reprisal or discriminate against a patient, their representative or surrogate. This includes reprisals or discrimination against a patient merely because he or she has exercised their rights.
- Be treated with respect, consideration and dignity including privacy in treatment without regard to age, race, color, sexual orientation, religion, marital status, sex, national origin or sponsor.
- Respectful care given by competent personnel with consideration of their privacy concerning their medical care.
- Be given the name of their attending physician, the names of all other physicians directly assisting in their care and the names and functions of other health care persons having direct contact with the patient.
- Have records pertaining to treatment, treated with privacy and confidentiality and except where required by law or third-party payment contract, the right to approve or refuse the release or disclosure of the contents of his/her medical record to any healthcare practitioner and or healthcare facility.
- Know what Fountain Point Surgery Center rules and regulations apply to their conduct as a patient.
- Expect emergency procedures to be implemented without unnecessary delay.
- Absence of clinically unnecessary diagnostic or therapeutic procedures.
- Expedient and professional transfer to another facility when medically necessary and to have the responsible person and the facility that the patient is transferred to notified prior to transfer.
- Treatment that is consistent with clinical impression or working diagnosis.
- Good quality care and high professional standards are continually maintained and reviewed.
- An increased likelihood of desired health outcomes.
- Full information in layman’s terms concerning appropriate and timely diagnosis, treatment, preventive measures and prognosis.
- Receive a second opinion concerning the proposed surgical procedure, if requested.
- Accessible and available health services; information on after-hour and emergency care.
- Give an informed consent to the physician prior to the start of a procedure which includes the provision of information concerning the specific procedure or treatment or both, the reasonably foreseeable risks involved, the alternatives for care or treatment, if any, as a reasonable medical practitioner under similar circumstances would disclose in a manner permitting the patient to make a knowledgeable decision.
- Refuse treatment to the extent permitted by law and to be fully informed of the medical consequences of his/her action.
- Be advised of participation in a medical care research program or donor program; the patient shall give consent prior to participation in such a program; a patient may also refuse to continue a program that has previously given informed consent to participate in.
- Refuse to participate in experimental research.
- Receive appropriate and timely follow-up information of abnormal findings and tests.
- Receive appropriate and timely referrals and consultation.
- Receive information regarding “continuity of care.”
- Refuse drugs or procedures and have a physician explain the medical consequences of the drugs or procedures.
- Appropriate specialty consultative services made available by prior arrangement.
- Have access to an interpreter.
- Be provided with, upon written request, access to all information contained in their medical record.
- Accurate information regarding the competence and capabilities of the organization.
- Receive information regarding expressing suggestions or grievances to the organization without fear of reprisal.
- Appropriate information regarding the absence of malpractice insurance coverage.
- Change primary or specialty physicians or dentists if other qualified physicians or dentists are available.
- Health services provided are consistent with current professional knowledge.
- The opportunity to participate in decisions involving their healthcare, except when such participation is contraindicated for medical reasons.
- Receive information regarding services provided at the Fountain Point Surgery Center.
- Information on payment and fee policies.
- Information on Advanced Directives as required by law.
- Information on provider credentialing as necessary.
- Information on the charges for services, eligibility for third party reimbursement and, when applicable, the availability of free or reduced cost care and receive an itemized copy of his/her account statement upon request.
Each patient, the patient's representative or the patient's surrogate at this facility has the responsibility to:
- Observe prescribed rules of the Fountain Point Surgery Center for their stay and treatment and, if instructions are not followed, forfeits the right to care at the Fountain Point Surgery Center and is responsible for the outcome.
- Promptly fulfill the financial obligations to the Fountain Point Surgery Center.
- Be considerate of other patients and personnel and for assisting in the control of noise, smoking and other distractions.
- Respect the property of others and the Fountain Point Surgery Center.
- Report whether he/she clearly understands the course of treatment and what is expected of them.
- Be accountable for his/her actions should he/she refuse treatment or does not follow the physician’s or Fountain Point Surgery Center's instructions.
- Keep appointments and, when unable to do so for any reason, of notifying the physician and Fountain Point Surgery Center.
- Inform the physician and Fountain Point Surgery Center personnel of changes in his/her medical condition which may affect the outcome of the procedure to be performed.
- Have a responsible adult drive them to and from the Fountain Point Surgery Center and provide care for the first 24 hours after surgery.
The patient or visitor has a right to file a grievance by contacting the Administrator of this facility, Danielle Johnsen, by calling (402) 379-5555, and/or the Local, State and Federal Agencies listed below.
NE Dept of Health & Human Services
209 North 5th Street
Norfolk, NE 68701
(402) 370-3120 or (800) 782-8844
DHHS, Division of Public Health
Licensure Unit, Acute Care Facilities
PO Box 94986
Lincoln, NE 68509
(800) MEDICARE or (800) 633-4227
TTY (877) 486-2048
Office of the Medicare Beneficiary Ombudsman Web Site:https://www.medicare.gov/forms-help-other-resources/contact-medicare