301-330-8170
2 Choke Cherry Road, Suite 125 Rockville, MD 20850

Legal Information

As a patient, it is your right to have certain information provided to you prior to your surgical procedure in writing and verbally.

Please read through this information before your procedure. Contact us directly or speak with your physician about any questions that may arise.

In an ongoing effort to maintain compliance and educate patients, the Surgery Center of Rockville offers the following information to you regarding:

Ownership Disclosure

We are required by law to disclose our ownership to you. The surgeons and anesthesiologists are not employees or agents of the surgery center and they are independent contractors. We recognize that you have the right to choose the provider of your healthcare services. We are pleased that you have chosen the Surgery Center of Rockville.

Thank you on behalf of the Physician owners of the Surgery Center of Rockville.

John Bosworth, M.D.

Craig Colliver, M.D.

Ira Fisch, M.D.

Barry Greene, M.D.

Ernest Hanowell, M.D.

Renee Moneyhun, M.D.

Glenn Sandler, M.D.

Michael Siegel, M.D.

Surgical Care Affiliates (SCA)

Patient’s Rights and Responsibilities

PATIENT’S BILL OF RIGHTS

  1. Considerate, respectful and dignified care and respect for personal values, beliefs and preferences.
  2. Access to treatment without regard to race, ethnicity, national origin, color, creed/religion, sex, age, mental disability, or physical disability. Any treatment determinations based on a person’s physical status or diagnosis will be made on the basis of medical evidence and treatment capability.
  3. Respect of personal privacy.
  4. Receive care in a safe and secure environment.
  5. Exercise your rights without being subjected to discrimination or reprisal.
  6. Know the identity of persons providing care, treatment or services and, upon request, be informed of the credentials of healthcare providers and, if applicable, the lack of malpractice coverage.
  7. Expect the center to disclose, when applicable, physician financial interests or ownership in the center.
  8. Receive assistance when requesting a change in primary or specialty physicians or dentists if other qualified physicians or dentists are available.
  9. Receive information about health status, diagnosis, the expected prognosis and expected outcomes of care, in terms that can be understood, before a treatment or a procedure is performed.
  10. Receive information about unanticipated outcomes of care.
  11. Receive information from the physician about any proposed treatment or procedure as needed in order to give or withhold informed consent.
  12. Participate in decisions about the care, treatment or services planned and to refuse care, treatment or services, in accordance with law and regulation.
  13. Be informed, or when appropriate, your representative be informed (as allowed under state law) of your rights in advance of furnishing or discontinuing patient care whenever possible.
  14. Receive information in a manner tailored to your level of understanding, including provision of interpretative assistance or assistive devices.
  15. Have family be involved in care, treatment, or services decisions to the extent permitted by you or your surrogate decision maker, in accordance with laws and regulations.
  16. Appropriate assessment and management of pain, information about pain, pain relief measures and participation in pain management decisions.
  17. Give or withhold informed consent to produce or use recordings, film, or other images for purposes other than care, and to request cessation of production of the recordings, films or other images at any time.
  18. Be informed of and permit or refuse any human experimentation or other research/educational projects affecting care or treatment.
  19. Confidentiality of all information pertaining to care and stay in the center, including medical records and, except as required by law, the right to approve or refuse the release of your medical records.
  20. Access to and/or copies of your medical records within a reasonable time frame and the ability to request amendments to your medical records.
  21. Obtain information on disclosures of health information within a reasonable time frame.
  22. Have an advance directive, such as a living will or durable power of attorney for healthcare, and be informed as to the center’s policy regarding advance directives/living will. Expect the center to provide the state’s official advance directive form if requested and where applicable.
  23. Obtain information concerning fees for services rendered and the center’s payment policies.
  24. Be free from restraints of any form that are not medically necessary or are used as a means of coercion, discipline, convenience or retaliation by staff.
  25. Be free from all forms of abuse or harassment.
  26. Expect the center to establish a process for prompt resolution of patients’ grievances and to inform each patient whom to contact to file a grievance. Grievances/complaints and suggestions regarding treatment or care that is (or fails to be) furnished may be expressed at any time. Grievances may be lodged with the state agency directly using the contact information provided below
  27. Access to language assistance service, free of charge, by a qualified interpreter for individuals with limited English proficiency or individuals with a disability.

Patients Responsibilities

The partnership nature of health care requires that patients, or their families/surrogates, take part in their care. The effectiveness of care and patient satisfaction with the treatment depends, in part, on the patient fulfilling certain responsibilities.

The following are patient responsibilities:

  1. Being considerate of other patients and personnel and for assisting in the control of noise, smoking and other distractions.
  2. Respecting the property of others and the center.
  3. Identifying any patient safety concerns.
  4. Observing prescribed rules of the center during your stay and treatment.
  5. Providing a responsible adult to transport you home from the center and remain with you for 24 hours if required by your provider.
  6. Reporting whether you clearly understand the planned course of treatment and what is expected of you and asking questions when you do not understand your care, treatment, or service or what you are expected to do.
  7. Keeping appointments and, when unable to do so for any reason, notifying the center and physician.
  8. Providing caregivers with the most accurate and complete information regarding present complaints, past illnesses and hospitalizations, medications, unexpected changes in your condition or any other patient health matters.
  9. Promptly fulfilling your financial obligations to the center, including charges not covered by insurance.
  10. Payment to center for copies of the medical records you may request.
  11. Informing your providers about any living will, medical power of attorney, or other advance directive that could affect your care.

Grievances and Grievance Procedure

  • We strive to maintain a professional and compliant atmosphere. The Grievance Procedure is a means for patients to inquire into issues raised and identify whether action needs to be taken to resolve identified issues and prevent recurrence.
  • The Facility Administrator will record the grievance complaint and conduct a prompt investigation for quick resolution.
  • Any patient and/or support person, visitor, employee, physician, or vendor may lodge a grievance using the Center’s procedure formally to voice complaints, resolve disputes, or to bring attention to possible violations of patient rights.
  • No person shall be punished or retaliated against for using the Grievance Procedure.
  •  Any grievances, comments and complaints are to be addressed to the Center Administrator. Complete details and a copy of the Center’s Grievance Policy as well as a Grievance form may be obtained by contacting the Center.

You may contact the following entities to express any concerns or complaints:

Surgery Center of Rockville
 2 Choke Cherry Road, Suite 125
Rockville, MD 20850
 
Christine Gambrel, RN, BSN,
Administrator 301-330-8170
Email: Christine.Gambrel@scasurgery.com

• You may obtain additional information and / or file a complaint here:
Attn: Barabra Fagan, Manager
Office of Health Care Quality
Ambulatory Care Program
Bland Bryant Building
Spring Grove Hospital Center
55 Wade Avenue
Catonsville, Maryland 21228
1-800-492-6005

Office of the Medicare Beneficiary Ombudsman:
www.medicare.gov/ombudsman/resources.asp
Or call 1-800-MEDICARE (1-800-633-4227)

If you have any questions or comments regarding the content here, you should contact the Administrator by telephone 301-330-8170 or by contacting the listed resources in this brochure.

Advance Directives

An Advance Directive helps to assure your religious and personal beliefs will be respected in the healthcare setting. It is a useful document for an adult of any age to plan for future health care needs.

The Surgery Center of Rockville does not honor Advance Directives. If you have an Advance Directive, please bring it to the center in the unforeseen event of a transfer to another facility. Life sustaining efforts will be initiated and maintained on all patients at the Center following the Code Blue Resuscitation policy and procedure. The patient will be transferred to an acute care facility for follow-up care where their Advance Directive will be honored.

Upon request, we will provide you with contact information and forms to assist in writing an Advance Directive.

Information can also be obtained at:

Attorney General’s Office
200 Saint Paul Place
Baltimore, MD 21202
Phone: 410.576.7000
email: ADForms@oag.state.md.us
www.oag.state.md.us/HealthPol/index.htm

 

HIPAA Notice of Privacy Practices
Usted tiene derecho a lo siguiente:


Atención digna, respetuosa y considerada, y respeto a los valores, las creencias y las preferencias personales.

  1. Acceso a tratamiento sin importar su raza, origen étnico, origen nacional, color, religión/el credo, sexo, identidad de género y edad, ni si tiene alguna discapacidad mental o física. Cualquier determinación de tratamiento según el diagnóstico o el estado físico de la persona se realizará sobre la base de evidencia médica y capacidad de tratamiento.
  2. Respeto a la privacidad personal.
  3. Recibir atención en un entorno seguro y sin riesgos.
  4. Ejercitar sus derechos sin estar sujeto a discriminación o represalia.
  5. Conocer la identidad de las personas que brindan atención, tratamiento o servicios y, cuando se lo solicite, ser informado de las credenciales de los proveedores de atención médica y, si corresponde, de la falta de cobertura en caso de mala praxis.
  6. Esperar que el centro divulgue, cuando corresponda, si el médico es propietario o tiene intereses financieros en el centro.
  7. Reciba ayuda cuando solicite un cambio de médicos generales o especialistas, dentistas o proveedores de anestesia si están disponibles otros médicos, dentistas o proveedores de anestesia calificados.
  8. Recibir información sobre el estado de salud, el diagnóstico, el pronóstico previsto y los resultados de atención esperados, en términos que puedan ser comprendidos, antes de que se realice un tratamiento o un procedimiento.
  9. Recibir información sobre resultados de atención imprevistos.
  10. Recibir información del médico sobre cualquier procedimiento o tratamiento propuesto según sea necesario para brindar o negar consentimiento informado.
  11. Participar en decisiones sobre la atención, el tratamiento o los servicios planificados y rechazar atención, tratamiento o servicios en conformidad con la legislación y los reglamentos correspondientes.
  12. Cuando sea posible, ser informado de sus derechos, o cuando corresponda, que su representante sea informado de ellos (según lo permita la ley estatal) antes de proporcionar atención al paciente o antes de suspenderla.
  13. Recibir información de manera que sea comprensible para usted, incluida la prestación de asistencia interpretativa o dispositivos auxiliares.
  14. Que su familia se involucre en las decisiones de atención, tratamiento o servicios en la medida en que usted o el sustituto responsable de tomar decisiones lo permitan, en conformidad con la legislación y los reglamentos correspondientes.
  15. Recibir una evaluación y una tratamiento del dolor adecuados, información sobre el dolor, medidas de alivio del dolor y participación en las decisiones de tratamiento del dolor.
  16. Dar o rechazar consentimiento informado para realizar o utilizer grabaciones, videos u otras imágenes para fines que no sean la atención, y solicitar el cese de la producción de grabaciones, videos u otras imágenes en cualquier momento.
  17. Ser informado y permitir o rechazar cualquier experimentación humana u otros proyecto educativos/de investigación que afecten la atención o el tratamiento.
  18. Que se garantice la confidencialidad de toda información relativa a la atención y a la estancia en el centro, lo que incluye registros médicos y, con las excepciones que imponga la ley, el derecho a aprobar o rechazar la divulgación de sus registros médicos.
  19. Tener acceso a sus registros médicos o a copias de estos dentro de un período razonable y el derecho a solicitar que sean enmendados.
  20. Obtener información sobre divulgaciones de la información de salud en un plazo razonable.
  21. Obtener una directiva anticipada, como un testamento vital o un poder duradero de atención médica, y a ser informado sobre la política del centro con respecto al testamento vital/la directiva anticipada. Esperar que el centro proporcione el formulario para directiva anticipada oficial del estado si se solicita y cuando corresponda.
  22. Obtener información sobre tarifas para los servicios prestados y sobre las políticas de pago del centro.
  23. Que no se impongan limitaciones de ningún tipo que no sean médicamente necesarias o que sean utilizadas por el personal como medio de coerción, disciplina, conveniencia o represalia.
  24. Esté libre de todas las formas de abuso o acoso.
  25. Acceso al servicio de asistencia de idioma, de forma gratuita, por un intérprete calificado para los individuos con conocimientos limitados del inglés o a personas con discapacidad. Esperar que el centro establezca un proceso para la resolución inmediata de las quejas del paciente e informar a cada paciente con quién debe comunicarse para presentar una queja. Las quejas o reclamaciones y las sugerencias sobre el tratamiento o la atención que sea (o no sea) proporcionada puede expresarse en cualquier momento. Las quejas pueden presentarse directamente a la agencia estatal usando la información de contacto que se encuentra a continuación. Usted es responsable de

Usted es responsable de lo siguiente:


Ser considerado con los demás pacientes y el personal, y colaborar con el control del ruido, el humo de tabaco y otras distracciones.

  1. Respetar la propiedad de los demás y del centro.
  2. Identificar cualquier inquietud de seguridad del paciente.
  3. Observar reglas prescritas del centro durante su estancia y tratamiento.
  4. Contar con un adulto responsable que lo transporte a su hogar desde el centro y permanezca con usted durante 24 horas si así lo solicita su proveedor.
  5. Informar si entiende claramente el tratamiento planeado y lo que se espera de usted, y realizarpreguntas cuando no comprenda su atención, tratamiento o servicio, o lo que se esperade usted.
  6. Cumplir con las citas y, cuando no pueda hacerlo por cualquier motivo, notificar al centroy al médico.
  7. Proporcionar a los cuidadores la información más precisa y completa sobre quejas actuales, enfermedades y hospitalizaciones previas, medicamentos (incluidos medicamentos de venta libre y suplementos alimenticios), y cualquier alergia o sensibilidad, cambios inesperados en su afección o cualquier otro asunto de salud del paciente.
  8. Cumplir de manera oportuna con sus obligaciones financieras con el centro, incluidos los cargos no cubiertos por su seguro.
  9. Realizar el pago al centro por las copias de los registros médicos que solicite.
  10. Informar a sus proveedores sobre cualquier testamento vital, poder médico y otra directiva que pudiera afectar su atención.