PATIENT RIGHTS

Decision Making

You or your representative have the right to:

• Be informed before care is given or discontinued whenever possible.
• Receive accurate and current information regarding your health status in terms you can understand, allowing you to make informed decisions.
• Participate in planning for your treatment, care and discharge recommendations. Surrogate whom you may select can represent you if you cannot make your own decisions according to state law.
• Receive an explanation of proposed procedure or treatment; including risks, serious side effects and treatment alternatives, including request for second opinion or specific treatment.
• Participate in managing your pain effectively.
• Refuse or discontinue a treatment to the extent permitted by law and to be informed of the consequences of such refusal.
• Receive emergency care and transfer to higher level of care (hospital) should this be necessary, providing full explanation of the need based on your medical condition & without needing to wait for authorization and without any financial penalty.
• Have persons of your choice promptly notified of hospital admission.
• Write a Living Will, Medical Power of Attorney, and/or a CPR Directive.
• Accept, refuse or withdraw from clinical research.
• Choose or change your healthcare provider.

Quality of Care

You have the right to:

• Respectful treatment, which recognizes and maintains your dignity and personal values without discrimination.
• Accurate information about facility where services are received and credentials of health care personnel involved in your care.
• Interpreters and/or special equipment to assist language needs.
• Information about continuing healthcare requirements following discharge, including how to access care after hours.

Confidentiality and Privacy

You have the right to:

• Personal privacy and care in a safe setting free from abuse, harassment, discrimination or reprisal.
• Personal information being shared only with those who are involved in your care.
• Confidentiality of your medical and billing records.

Grievance Process

You or your representative have the right to:

• Fair, fast and objective review of any complaint you have against your health plan, physician or healthcare personnel without fear of reprisal.
• Submit a formal complaint either verbally or in writing as shown below. You will receive a written notice of decision within 15 business days from when the complaint was made known.

Access to Medical Records

You have the right to:

• Speak privately with health care providers knowing your health care information is secure.
• Review and receive a copy of your medical records (including electronic format) upon written request and received within 30 days by secure transmission.

Seclusion and Restraints

You have the right to:

• Be free from seclusion or restraint for behavioral management unless medically necessary to protect your physical safety or the safety of others.

Billing

You have the right to:

• Information specific to fees for services and payment policies prior to date of services.
• Payment privacy when you choose to opt out of insurance coverage for services.

Advance Directives

You need to be aware that Northwoods Surgery Center does not honor Advance Directives.

• You are able to provide a copy of your Advance Directives for your chart in the event you are transferred to the hospital.
• Upon request a valid Advance Directive Form approved by the State of Wisconsin will be provided for you.
• Information regarding Advance Directives can be obtained from the Wisconsin Department of Health Services at http://dhs.wisconsin.gov/forms/AdvDirectives/index.htm

PATIENT RESPONSIBILITIES

Providing Information

 You have the responsibility to:

• Provide accurate and complete information about present complaints, past illnesses, hospitalizations, current use of prescribed or OTC medications, nutritional supplemental products and other health-related matters.
• Report perceived risks in your care and unexpected changes in your condition.
• Provide an Advance Directive if you have one.
• Provide accurate and updated demographic and contact information for insurance and billing.

Involvement

You have the responsibility to:

• Participate in your plan of care and follow the recommended treatment plan.
• Ensure you have a designated responsible adult to provide transportation and assist with your care for 24 hours.

Respect and Consideration

You have the responsibility to:

• Act in a respectful and considerate manner toward healthcare providers, other patients, and visitors. Physical or verbal threats or conduct which is disruptive to business operations will not be tolerated.
• Be respectful of the possessions or property of others.
• Be mindful of noise levels.

Insurance Billing

You have the responsibility to:

• Know the extent of your insurance coverage.
• Know your insurance requirements such as pre-authorization, deductibles and co-payments.
• Call the billing office with questions or concerns regarding your bill.
• Fulfill your financial obligations as promptly as possible.
• Contact our Business Office at 715.358.8600 if you have any questions or concerns.

 Your physician may have a financial interest in the Northwoods Surgery Center. Northwoods Surgery Center is a joint venture with Aspirus Wausau Hospital, Mark Balas, M.D. and Michel Gelinas, M.D.