Each person receiving service in Midland
Surgical Center shall have the following rights:
1. To be informed of these rights, as evidenced by the patient’s or their court appointed guardian’s or designated surrogate’s written acknowledgement, or by documentation by staff in the medical record, that the patient was offered a written copy of these rights and given a written or verbal explanation of these rights, in terms the patient could understand. The facility shall have a means to notify patients of any rules and regulations it has adopted governing patient conduct in the facility;
2. To be informed of services available in the facility, of the names and professional status of the personnel providing and/or responsible for the patient’s care, and of fees and related charges, including the payment, fee, deposit, and refund policy of the facility and any charges for services not covered by sources of third-party payment or not covered by the facility’s basic rate;
3. To be informed if the facility has authorized other health care and educational institutions to participate in the patient’s treatment. The patient also shall have a right to know the identity and function of these institutions, and to refuse to allow their participation in the patient’s treatment:
4. To receive from the Patient’s physician(s) or clinical practitioner(s), in terms that the patient understands, an explanation of his or her complete medical/health condition or diagnosis, recommended treatment, treatment options, including the option of not treatment, risk(s) of treatment, and expected result(s). If the patient is not capable of understanding the information, the explanation shall be provided to the patient’s next of kin or court-appointed guardian. The patient’s rights will be exercised by the next of kin
or court appointed guardian.
5. To participate in the planning of the patient’s care and treatment, and to refuse medication and treatment. Such refusal shall be documented in the patient’s medical record. 6.To be included in the experimental research only when the patient gives informed, written consent to such participation, or when a guardian gives such consent for an incompetent patient in accordance with law, rule and regulation. The patient may refuse to participate in experimental research, including the investigation of new drugs and medical devices;
7. To voice grievances or recommend changes in policies and services to facility personnel, the governing authority, and/or outside representatives of the patient’s choice either individually or as a group, and free from restrain, interference, coercion, discrimination, or reprisal;
8. To be free from mental and physical abuse, free from exploitation, and free from use of restraints. Drugs and other medications shall not be used for discipline of patients or for convenience of facility personnel.
9. To confidential treatment of information about the patient.
i. Information in the patient’s medical record shall not be released to anyone outside the facility without the patient’s approval, unless another health care facility to which the patient was transferred requires the information, or unless the release of the information is required and permitted by law, a third party payment contract, or peer review, or unless the information is needed by the IDPH for statutorily authorized purposes.
ii.The facility may release data about the patient for studies containing aggregated statistics when the patient’s identity is masked;
10. To be treated in a safe setting, with courtesy, consideration, respect, and recognition of the patient’s dignity, individuality, and right to privacy, including, but not limited to, auditory and visual privacy. The patient’s privacy shall also be respected when facility personnel are discussing the patient;
11. To exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices, or any attendance at religious services, shall be imposed upon any patient;
12. To not be discriminated against because of age, race, religion, sex, nationality, or ability to pay, or deprived of any constitutional, civil, and/or legal rights solely because of receiving services from the facility; and
13. To expect and receive appropriate assessment, management and treatment of pain as an integral component of the patient’s care.
14. To change your provider if other qualified providers are available’
You have the responsibility…
1. To provide the facility with accurate and complete information about your present complaints and your past health history, including all prescribed and over the counter medications you are taking and any allergies you may have.
2. To be considerate of other patients, physicians and facility personnel. To show respect for the belongings of others and facility property.
3. To discuss your health problems with only those involved in your care.
4. To request your records through the facility.
5. To inquire as to the name and purpose of any personnel caring for you.
The Midland Surgical Center administrative staff is available to help with any concerns or suggestions you may have regarding your stay. Complaints will be investigated and a response provided under the provisions of the facility grievance mechanism. Please contact:
Patti Sulaver, RN
If a grievance or complaint is not solved to the patient’s or family’s satisfaction, the grievance may be filed in writing with the Illinois Department of Public Health.
Office of Healthcare Regulation
Illinois Department of Public Health
525 W. Jefferson Street, Springfield IL 62761-0001
or by calling (877)582-6995.
Any concerns may also be reported to the accrediting body. Contact:
5250 Old Orchard Rd.
Skokie, Illinois, 60077
You may also contact the center for Medicare and Medicaid (CMS). Contact
www.Medicare.gov/ombudsmans/activities.asp or 1-800-633-4227