VALLEY LASER AND SURGERY CENTER, INC.
36 W. Yokuts Avenue, Suite 3 Stockton, CA 95207
(209)952-1189 Fax (209)952-1174
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DISCLOSURE OF OWNERSHIP Stevens Kim, MD, Stephen Lin, MD, Daniel Choi, MD, and Ethan Tittler, MD who perform surgical services at this facility have sole ownership in Valley Laser and Surgery Center, Inc. Kenneth Miselis, MD and Michael Yang, MD conduct their practice as a member of the same medical group as Dr. Kim, Dr. Lin, Dr. Choi, and Dr. Tittler. You have the right to choose the provider of your health services. Therefore, you have the option to use a surgical facility other than Valley Laser and Surgery Center, Inc. |
PATIENT RIGHTS:
Valley Laser and Surgery Center, Inc. and the medical staff have adopted the following statement of patient rights. These rights are explained to the patient or the patient’s representative (as allowed under state law). These rights shall include, but not be limited to, the patient’s right to:
- Become informed of his or her rights as a patient in advance of, or when discontinuing, the provision of care. The patient may appoint a representative to receive this information should he or she so desire.
- Exercise these rights without regard to sex or cultural, economic, educational or religious background or the source of payment for care.
- Considerate and respectful care, provided in a safe environment, free from all forms of abuse, neglect, harassment and/or exploitation.
- Knowledge of the name of the physician who has primary responsibility for coordinating his/her care and the names and professional relationships of other physicians and healthcare providers who will see him/her.
- Receive information about any proposed treatment or procedure he/she may need in order to participate in the development of the plan of care, give informed consent or to refuse the course of treatment and to participate in planning for care after discharge.
- Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved in the treatment, alternate courses of treatment or non-treatment and the risks involved in each and the name of the person who will carry out the procedure or treatment.
- Full consideration of privacy concerning his/her medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. The patient has the right to be advised as to the reason for the presence of any individual involved in his or her healthcare.
- Confidential treatment of all communications and records pertaining to his/her care and his/her stay at the facility. His/her written permission will be obtained before his/her medical records can be made available to anyone not directly concerned with his/her care.
- Access information contained in his or her medical record within a reasonable time frame (usually within 48 hours of the request).
- Reasonable responses to any reasonable request he/she may make for service.
- Leave the facility even against the advice of his/her physician.
- Reasonable continuity of care.
- Be advised of the facility grievance process, should he or she wish to communicate a concern regarding the quality of the care he or she receives. Notification of the grievance process include: whom to contact to file a grievance, and that he or she will be provided with a written notice of the grievance determination that contains the name of the facility’s contact person, the steps taken on his or her behalf to investigate the grievance, the results of the grievance and the grievance completion date.
- Be advised if the facility/personal physician proposes to engage in or perform human experimentation affecting his/her care or treatment. The patient has the right to refuse to participate in such research projects. Refusal to participate or discontinuation of participation will not compromise the patient’s right to access care, treatment or services.
- Full support and respect of all patient rights should the patient choose to participate in research, investigation and/or clinical trials. This includes the patient’s right to a full informed consent process as it related to the research, investigation and/or clinical trial. All information provided to subjects will be contained in the medical record or research file, along with consent form(s).
- Be informed by his/her physician or a delegate of his/her physician of the continuing healthcare requirements following his/her discharge from the facility.
- Examine and receive an explanation of his/her bill regardless of source of payment.
- Know which facility rules and policies apply to his/her conduct while a patient.
- Have all patient’s rights apply to the person who may have legal responsibility to make decisions regarding medical care on behalf of the patient.
- Patients are informed of their right to change their provider if other qualified providers are available.
PATIENT RESPONSIBILITIES:
The care a patient receives depends partially on the patient himself. Therefore, in addition to these rights, a patient has certain responsibilities as well. These responsibilities should be presented to the patient in the spirit of mutual trust and respect:
- The patient has the responsibility to provide accurate and complete information concerning his/her present complaints, pas illnesses, hospitalization, medications and other matters relating to his/her health.
- The patient is responsible for reporting perceived risk in his or her care and unexpected changes in his/her condition to the responsible practitioner.
- The patient and family are responsible for asking questions about the patient’s condition, treatments, procedures, etc.
- The patient and family are responsible for asking questions when they do not understand what they have been told about the patient’s care or what they are expected to do.
- The patient and family are responsible for immediately reporting any concerns or errors they may observe.
- The patient is responsible for following the treatment plan established by his/her physician, including the instructions of nurses and other health professionals as they carry out the physician’s orders.
- The patient is responsible for keeping appointment and for notifying the facility or physician when her/she is unable to do so.
- The patient is responsible for his/her actions should he/she refuse treatment or not follow his/her physician’s orders.
- The patient is responsible for assuring that the financial obligations of his/her care are fulfilled as promptly as possible.
- The patient is responsible for following facility policies and procedures.
- The patient is responsible for being considerate of the rights of other patients and facility personnel.
- That patient is responsible for being respectful of his/her personal property and that of other persons in the facility.
IF YOU HAVE A COMPLAINT OR CONCERN:
The Administration of Valley Laser and Surgery Center, Inc. are committed to protecting patient’s rights and providing quality care. If you have any complaints or concerns, please ask to speak to the Administrator. If you are not able to resolve your concerns, please direct them to the Medical Director at (209) 952-3700. We will respond to all calls as soon as possible. Other sources to file complaints or concerns:
Medical Board of California
2005 Evergreen Street, Suite 1200
Sacramento, CA 95815-3831
(916) 263-2528
www.mbc.ca.gov
Department of Managed Health Care
California Help Center
980 9th Street, Suite 500
Sacramento, CA 95814-2725
1-888-466-2219
TDD 1-877-688-9891
Office of the Medicare Beneficiary Ombudsman
www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html
Medicare
1-800-633-4227
TTY 1-877-486-2048
