Patient Information

1. Considerate, respectful care at all times and under all circumstances, with recognition of your personal dignity.
2. Personal and informational privacy, within the law.
3. Information concerning your diagnosis, treatment, and prognosis, to the degree known.
4. Receive care in a safe setting.
5. Confidentiality of records and disclosures. Except when required by law, you have the right to approve or refuse the release of records.
6. Participate in and make decisions about medical care, including the right to accept or refuse medical or surgical treatment.
7. Know that the facility does not honor advance directives; however, any advance directive will be noted in the patient medical record and will be communicated to other medical facilities, if a transfer is needed.
8. Receive information on advance directive state health and safety laws and the official state advance directive forms, if requested.
9. Impartial access to treatment regardless of race, color, sex, national origin, religion, sexual orientation, handicap, or disability. (The surgery center adheres to all federal and state rule, regulations and policies to promote a non-discriminatory environment for all of our patients)
10. Receive estimated costs prior to the day of surgery and, as a follow up, receive an itemized bill for all services received.
11. Know that your physician may have financial interests or ownership in the Surgery Center. Physician owner list provided at the bottom of this document.
12. Know the identity and professional status of individuals providing service to you.
13. Report any comments or voice any grievances concerning the quality of services provided to you during the time spent at the facility without being subjected to discrimination or reprisal and receive timely, fair follow-up on your comments.

1. Providing, to the best of your knowledge, accurate and complete information about your present health status and past medical history and reporting any unexpected changes to the appropriate practitioner(s).
2. Following the treatment plan recommended by the primary practitioner involved in your case.
3. Providing an adult to transport you home after surgery and an adult to be responsible for you at home for the first 24 hours after surgery.
4. Indicating whether you clearly understand a contemplated course of action and what is expected of you.
5. Your actions and adverse consequences that may result if you refuse treatment, leave the facility against the advice of the practitioner, and/or do not follow the practitioner′s instructions relating to your case.
6. Assuring that your portion of financial payment is submitted as quickly as possible.
7. Providing information about and/or copies of any living will, power of attorney or other directives that you desire us to know about.
8. Refraining from smoking on campus.

The surgery center has multiple reporting mechanisms in place for expressing concerns or grievances.

• Daniel Weber, Administrator: 971-229-8100
• Oregon Department of Health: 971-673-1222
• Oregon Medical Board Complaints and Concerns: Randy Day 971-673-2700
• Or you may write to: Oregon Department of Health and Human Services Oregon Health Division 800 NE Oregon Street,Suite 64 Portland, OR 97232
• Office of the Medicare Beneficiary Ombudsman 1-800-MEDICARE (1-800-633-4227) http://www.cms.hhs.gov/center/ombudsman.asp

As a free-standing Surgery Center, we are required to inform our patients of our Advance Directive policies. We are happy to speak with you over the phone to clarify our policy or answer any questions you may have. Our front office telephone number is: 971-229-8100

Definition:

An advance directive is a set of instructions that explain the specific health care measures a person wants if he or she should have a terminal illness or injury and become incapable of indicating whether to continue curative and life-sustaining treatment, or to remove life support systems. The person must develop the advance directive while he or she is able to clearly and definitively express him or herself verbally, in writing, or in sign language. It must express the person’s own free will regarding their health care, not the will of anyone else. It does not affect routine care for cleanliness and comfort, which must be given whether or not there is an advance directive.

In Oregon, the Health Care Decisions Act (ORS 127.505 – 127.660 and ORS 127.995) allows an individual to preauthorize health care representatives to allow the natural dying process if he or she is medically confirmed to be in one of the conditions described in his or her health care instructions. This Act does not authorize euthanasia, assisted suicide or any overt action to end the person’s life.

• The existence of an advance directive, or lack thereof, will not determine the patient’s access to care, treatment and services.
• Official Oregon state advance directive forms will be available to patients, if requested, in advance of the date of the procedure at Plaza ASC.
• Patients or patient representatives will be informed prior to the day of surgery of the facilities’ policy on advance directives and the applicable State health and safety laws. Thus allowing those involved to make an informed decision about whether to proceed at the Surgery Center or to seek care at another facility. Patients will always be encouraged to make informed decisions regarding their care.
• If the patient referral to the Surgery Center is made on the same day of surgery, the patient will be informed of our policies the day of the procedure.
• Documentation will be provided in the patient’s medical record and prominently displayed in that record. At a minimum, it will include:
  o That the patient has been informed of the policy and received facility information related to advance directives.
  o Whether or not the patient has accepted the facility policy.
• If the patient were to be in medical distress at this facility, we would take all measures to revive the patient. We would then transport the patient to a hospital where they will adhere to the stipulations of his or her advance directive.