1. You have the right to considerate and respectful care.
2. You have the right to personal privacy and to receive care in a safe setting free from all forms of abuse, harassment, discrimination, or reprisal.
3. You have the right to know the name of the physician/surgeon who has primary responsibility for coordinating your care and the names and professional relationships of other physicians/surgeons who will be involved with your plan of care.
4. You have the right to be fully informed about your treatment or procedure and expected outcome before it is performed in easy to understand terminology.
5. You have the right to receive as much information prior to any proposed treatment or procedure as you need in order to give informed consent or to refuse this course of treatment.
6. You have the right to participate in your plan of care that includes providing consent or refusal of medical or surgical interventions, trials of any kind, as well as the plan of care after discharge from the surgery center. Parents, guardians, family members, or surrogates that you select can represent you if you cannot make your own decisions according to state law.
7. You have the right to full consideration of privacy concerning your medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discreetly. You have the right to know the reason for the presence of any individual.
8. You have the right to confidential treatment of all communications and records pertaining to your care and your stay in the ASC. Your written permission shall be obtained before medical records can be made available to anyone not directly concerned with your care.
9. You have the right to reasonable responses of reasonable requests made for services.
10. You have the right to leave the ASC even against the advice of your physician/surgeon.
11. You have the right to continuity of care and to know in advance the time and location of appointment as well as the physician/surgeon providing the care.
12. You have the right to be advised if ASC/personnel or physician/surgeon proposes to engage in or perform human experimentation affecting his/her care or treatment. You have the right to refuse to participate in any such research projects.
13. You have the right to be informed by your physician/surgeon or their delegate of your continuing health care requirements following your discharge from the surgery center.
14. You have the right to change providers if other qualified providers are available.
15. You have the right to voice grievances regarding treatment or care that is (or fails to be) furnished.
16. If a patient is adjudged incompetent under applicable State laws by a court of proper jurisdiction, the rights of the patient are exercised by the person appointed under State law to act on the patient’s behalf.
17. If a State court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with State law may exercise the patient’s rights to the extent allowed by State law.
18. You have the right to request a copy of your electronic medical record in electronic form, if electronic records are maintained by the provider.
19. You have the right, when paying for services in full out-of-pocket, to request the provider refrain from sharing information about your treatment with your health care plan.

The Health Facilities Division of the Illinois Department of Public Health

535 W. Jefferson St.

Springfield, Il. 62761

or by phone at 217-782-4977

Office of Medicare Beneficiary Ombudsman Online or by phone at 1-800-MEDICARE

You have the right to submit a grievance either verbally or in writing to:

Michele Cheshareck, BSN, RN, Patient Rights Advocate

Deerpath Ambulatory Surgical Center, LLC

1051 W. Rt. 6, Morris, IL 60450

Phone: 815-318-5666.

You will receive a written notice of decision within 30 calendar days describing the steps taken to investigate, the results, and the completion date.

You have the responsibility to provide accurate and complete health information, to the best of your knowledge.

You are responsible for participation in your plan of care and providing an Advance Directive if you have one.

You are responsible for following the treatment plan recommended.

You are responsible for making known whether or not you clearly understand the medical treatment plan.

You must have a responsible adult to provide you transportation and assist with your care for the first 24 postoperative hours.

You are expected to be considerate of other patients and Center personnel and to observe the No Smoking Policy of the Center. You are also expected to be respectful of the property of other persons and the property of the Center.

It is understood that a patient assumes the financial responsibility of paying for all services rendered whether through third party payors (his/her insurance company) or being personally responsible for payment for any services that are not covered by his/her insurance policies.

Deerpath Ambulatory Surgical Center honors all Advanced Directives, as required by law. Click here to read the State of Illinois law on Advanced Directives and DNR orders.