Patient's Rights and Responsibilities

Patient's Have the Right:

To be treated with respect, consideration and dignity.

To be provided with appropriate privacy.

To have all disclosures and records treated confidentially, and except when required by law, be given the opportunity to approve or refuse their release.

To be provided to the degree known, complete information concerning their diagnosis, evaluation, treatment and prognosis. When it is medically inadvisable to give such information, the information may be provided to a person designated by the patient or to a legally authorized person.

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

To be provided information regarding services at Panhandle Eye Group

To be informed that after-hours, and emergency care services are provided by an affiliation agreement with both Baptist St Anthony Hospital Services and Northwest Texas Hospital or by calling 911.

To be informed of fees for services and payment policies.

To refuse to participate in experimental research.

To advance directives, as required by the State of Texas and Federal laws. However, due to our short term stay status, the ASC will only be able to honor those directives applicable for immediate emergency response.

To information regarding the credentials of our health care professionals.

To be informed that Amarillo Cataract & Eye Surgery Center is a Physician-owned and operated ASC.

Additionally, The Patient's Responsibilities

To provide complete and accurate information to the best of his/her ability about his/her health, any medication, including over-the-counter products and dietary supplements and any allergies or sensitivities and any living will, medical power of attorney, or other directive that could affect your care.

To follow the treatment plan prescribed by his/her provider..

To accept personal financial responsibility for any charges not covered by your insurance.

To be respectful of all health care providers and staff, as well as other patients.

Thank you for helping us provide the best quality eye care available to you!

Please report any grievances to our Administration Offices at 806-354-8891 or 806-331-4444 Or contact the Medicare office at CALL 1-800-MEDICARE Or Visit Online at www.medicare.gov or www.cms.hhs.gov/center/ombudsman.asp

Or write to:

DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2‐12‐25 Baltimore, Maryland 21244‐1850

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