Florida law requires that your health care provider or health care facility recognize your rights while you are receiving medical care and that you respect the health care provider's or health care facility's right to expect certain behavior on the part of patients.

You have the right

• To be treated with courtesy and respect, with appreciation of individual dignity, and with protection of the need for privacy and security.
• To a prompt and reasonable response to questions and requests.
• To know who is providing medical services and who is responsible for your care.
• To know what patient support services are available, including whether an interpreter is available if you do not speak English.
• To know what rules and regulations apply to your conduct.
• To be given by your health care provider information concerning diagnosis, planned course of treatment, alternatives, risks and prognosis.
• To consent to or refuse treatment, except as otherwise provided by law.
• To be given full information and necessary counseling on the availability of known financial resources for your care.
• To be given, upon request, prior to treatment, a reasonable estimate of charges for medical care.
• To receive a copy of a reasonably clear and understandable itemized bill and, upon request, to have charges explained.
• To appropriate assessment and management of pain and pain relief measures.
• To participate in resolution of ethical questions which may arise in the course of your care.
• To formulate advance directives, a living will, or appoint a health care surrogate to make decisions on your behalf to the extent permitted by law.
• To expect that all communication and records pertaining to your care will be treated as confidential.
• To know, upon request and in advance of treatment, whether the health care provider accepts the Medicare assignment rate.
• To impartial access to medical treatment and accommodations, regardless of race, national origin, religion, physical handicap or source of payment.
• To treatment for any emergency medical condition which will deteriorate from failure to provide treatment.
• To know if medical treatment is for purposes of experimental research and to give your consent or refusal to participate in such experimental research.
• To be informed about the results of care, including unanticipated outcomes.
• To receive care in a safe setting, free from discrimination, reprisal, and all forms of abuse or harassment.
• To express grievances regarding any violation of your rights, as stated in Florida law, through the grievance procedure of the health care provider which served you and to the appropriate state licensing agency.

You are responsible for

• Providing to your health care provider, to the best of your knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, pain management and other matters relating to your health.
• Asking questions when you do not understand what has been told about your care or what you are expected to do.
• Reporting to your health care provider any perceived risks in your care and any unexpected changes in your condition.
• Following the treatment plan recommended by your health care provider.
• Keeping appointments and, when you are unable to do so for any reason, notifying the health care provider or health care facility.
• The outcomes of your actions if you refuse treatment or do not follow the care, service or treatment plan.
• Following the centre's rules and regulations concerning patient care and conduct.
• Being considerate of the centre's personnel and property.
• Promptly meeting any financial obligation agreed to with this centre.

Arthur G. Handal, M.D., Medical Director, has an ownership interest in Sanctuary Surgical Centre, Inc.. A list of physicians with a financial interest in or ownership of the centre is available on request. You may choose to have your procedure at another facility.

You have the right to make an advance directive, such as a living will or the appointment of a health care surrogate, to the extent permitted by law. Please bring a copy of any advance directive to your pre-operative appointment. Florida advance directive forms are available from the Agency for Health Care Administration.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

A copy of our full Notice of Privacy Practices is available at the front desk or by request to management@sanctuarysurgery.com.

Under the No Surprises Act, if you are uninsured or are not using insurance, you have the right to receive a Good Faith Estimate of the expected charges for your care. Ask for one when you schedule your procedure.

If your bill is at least $400 more than your Good Faith Estimate, you can dispute the bill. For more information, visit cms.gov/nosurprises.

Sanctuary Surgical Centre complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Free language assistance and auxiliary aids are available. Call 561-912-9888.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 561-912-9888.

You may raise any concern with our staff or the Centre Administrator at management@sanctuarysurgery.com or 561-912-9888.

You may also contact the Florida Agency for Health Care Administration, Complaint Administration Unit, at 1-888-419-3456 (TDD 1-800-955-8771), 2727 Mahan Drive, Tallahassee, FL 32308.

Medicare patients may also contact the Medicare Beneficiary Ombudsman at 1-800-MEDICARE (1-800-633-4227) or medicare.gov.