Decision Making

You or your representative has the right to:

• Be informed of your rights before patient care is given or discontinued whenever possible
• Receive complete and current information regarding your health status in terms you can understand
• Participate in care planning treatment and discharge recommendations
• Receive an explanation of any proposed procedure or treatment; including risks, serious side effects and treatment alternatives
• Make informed decisions regarding care and treatment
• Participate in managing your pain effectively
• Request a specific treatment
• Refuse or discontinue a treatment to the extent permitted by law and to be informed of the consequences of such refusal
• Request a second opinion
• Have persons of your choice and your physicians 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
• Receive care and/or a referral according to the urgency of your situation
• And when medically stable, you may be transferred to another facility (hospital) after the need has been fully explained
• Exercise by the person appointed under State law to act on the patient’s behalf, if adjudged incompetent under applicable State health and safety laws by a court of proper jurisdiction

Quality of Care

You have the right to:

• Respectful treatment, which recognizes and maintains your dignity and values
• Care in a safe setting
• Identification of all healthcare providers
• Know who is primarily responsible for your care
• Pastoral and/or spiritual support
• Interpreters and/or special equipment to assist language needs
• Information about continuing healthcare requirements following discharge
• be free from all forms of abuse or harassment
• exercise his or her rights without being subjected to discrimination or reprisal

Confidentiality and Privacy

You have the right to:

• Personal privacy
• Personal information being shared only with those who are involved in your care
• Confidentiality of your medical and billing records

Grievance Process

You and your representative have the right to:

• Voice a complaint to your healthcare providers and administrators without a fear of reprisal
• Contact the Management Representative at 715.843.1019 to file a formal grievance
• Receive a timely response with the results of your complaint (when issued to the Surgery Center directly; unresolved complaints are directed to the Center Director within 3 days and are responded to within 7 days

Access to Medical Records

You have the right to:

• Review and get a copy of your Medical Records at any time upon written request

Seclusion and Restraints

You have the right to:

• Be free of any sort of restraint unless medically necessary
• Be free from seclusion or restraint for behavioral management unless there is a need to protect your physical safety or the safety of others

Billing

You have the right to:

• A complete explanation of your bill

Advance Directives

You need to be aware that Pine Ridge 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

 

Please know that we support you in meeting your responsibilities during your stay.

Providing Information

You have the responsibility to:

• Provide accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other health-related matters to include over-the-counter products and dietary supplements, allergies or sensitivities
• Report perceived risks in your care and unexpected changes in your condition
• Understand your treatment plan and ask questions when needed
• Provide accurate and updated information for insurance and billing

Involvement

You have the responsibility to:

• Actively participate in your treatment by following your recommended treatment plan
• Provide a responsible adult to accompany me the day of surgery, drive me home and provide my postoperative home care as directed

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 will not be tolerated
• Respect the 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
• Fulfill your financial obligations as promptly as possible
• Contact our Business Office at 715.843.1019 if you have any questions or concerns

This ambulatory Surgery Center is a joint venture with Aspirus Wausau Hospital:

Benjamin Battino, M.D.

Robert Brebrick, M.D.

D. Jamie Costa, M.D.

Jennie Larson, M.D.

Jeremiah Olson, M.D.

Laura Sherrill, M.D.

Cecilia Stroede, M.D.

Gary Sweet, MD

Mark Thomas, D.P.M.

Joel Tikalsky, D.P.M.

James Tracey, MD

Steve Weiland, M.D.

William Wilfley, MD