Cleveland Eye

and

Laser Surgery Center

As a patient, you have a right to:

Excellent medical care and treatment without regard to race, color, sex, sexualpreference, sexual preference, national origin, handicap or source of payment. Good care and high professional standards that are continuously maintained andreviewed. A surrogate (parent, legal guardian, person with medical power of attorney) exercisethe Patient Rights when you are unable to do so, without coercion, discrimination orretaliation. Confidential records that protect your protected health information; you have theright to approve or refuse the release of clinical records. Good health care management techniques that make the most effective use of yourtime and still provide for your comfort and convenience. Information concerning your physician, diagnosis, treatment and prognosis, to thedegree known. High degree of privacy. Case discussions, consultations, examinations andtreatment plans are confidential and will be conducted discreetly. Make decisions about medical care, including the right to accept or refuse medical orsurgical treatment after being adequately informed of the benefits, risks andalternatives, without coercion, discrimination or retaliation. Competent, caring healthcare providers who act as your advocates and treats yourpain as effectively as possible. Care is provided in a language that you understand. Refuse any particular procedure or treatment. Know the reason for a transfer insideand outside the facility. Examine and receive a detailed explanation of your bill. File a grievance with the facility by contacting the Director of Nursing, via telephoneor in writing, when you feel your rights have been violated.

Jeannine Arcuri

Cleveland Eye and Laser Surgery Center

22715 Fairview Center DriveFairview Park, OH 44126

440-777-8400

  File a complaint of suspected violations of health department regulationsand/or patient rights. Complaints may be filed at:Ohio Department of HealthComplaint Unit246 North High StreetColumbus, OH 43215Phone: 1‐800‐342‐0553Fax: (614) 564‐2422E‐mail: [email protected] of the Medicare Beneficiary Ombudsmanhttp://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html

AS A PATIENT, YOU ARE RESPONSIBLE FOR:

 Cooperate in the treatment program your doctor prescribes for you. Ask questions immediately if you do not understand instructions concerning yourhealth or if you feel you cannot follow the instructions Keep all scheduled appointments or to contact the office when you cannot keep anappointment Bring information with you regarding past illnesses, hospitalizations, medicationsand other matters relating to your health. Show consideration for the privacy and comfort of other patients and medicalpersonnel and to assist in the control of noise. Be respectful of the property of other persons and the property of the surgery center. Duly authorized members of your family are expected to be available to ASCpersonnel for review of your treatment in the event you are unable to communicatewith the physicians or nurses. Your care may involve sedation, analgesia or anesthesia. You have a responsibilityto help us reduce your risk of injury by following the safety guidelines provided byour medical staff. You have a responsibility to provide information necessary for insurance processingof your bills, to be prompt about payment of your bills and to ask any questions youmay have concerning your bills.