1300 North Arlington Heights Road
Suite 150
Itasca, Il 60143

Patient Rights | HIPAA Privacy

You Have the Right…

1. To have Ophthalmology Surgery Center of Illinois respond to your requests and needs for treatment or service provided that the space is available, and to receive the care that reflects your interests and that has been determined by your physician, and respects your advance directives or your rights to formulate advance directives.

2. To be informed of the right to care that is respectful, recognizes dignity and is private to the extent possible.

3. To have patient information treated confidentially based on applicable laws and regulations.

4. To be involved in making decisions regarding your care, including assessment and management of pain.

5. To be given information in the language you understand or to have information interpreted.

6. To give informed consent, that is, to make decisions in collaboration with your physician that involve your healthcare. Consent may be given by the patient or the patient’s legal representative. In order to give consent, the patient will be provided information to include:

a. An explanation of recommended treatments or procedures in terms which are understandable.

b. An explanation of the risks and benefits of treatment, including the chance of success, mortality risk and serious side-effects.

c. An explanation of the alternatives and the risks and benefits of such.

d. An explanation of the likely consequences if no treatment is pursued.

e. An explanation of the recuperative period, including anticipated problems and anticipated length of recuperation.

f. An explanation that the patient or his/her legal representative is free to withdraw consent and discontinue participation in treatment.

g. A disclosure statement that the patient’s physician is participating in teaching, research, experimental or education projects relating to the patient’s case.

7. To an explanation of admission procedures, that shall include disclosure upon admission, of the facility’s policy statement on patient rights, which shall include:

a. The right to participate in all decisions involving care of treatment, consistent with state and federal statutes.

b. The right to refuse any drug, test, treatment, procedure or treatment consistent with state and federal statutes.

c. The right to receive considerate and respectful care in a clean and safe environment, free of unnecessary restraint.

d. The right to be informed of the facility’s rules and regulations applicable to the patient.

e. The right to be informed of the facility’s grievance procedure. The Administrator may be reached by calling 630.634.2980.

f. The right to file a grievance with the appropriate state agency.

8. To know the name, professional status and experience of the staff providing care or treatment.

9. To be informed prior to the initiation of general billing procedures:

a. Prior to the initiation of non-emergency treatment, upon request, the patient has the right to be informed of routine, usual customary charges or estimated charges for service based on an average patient with diagnosis similar to the tentative admission diagnosis of the patient.

b. If you have questions, please call 630.634.2980 for estimated medical cost information between the hours of 8 am and 4 pm on weekdays.

c. Based upon insurance information provided by the patient, the facility shall provide assistance as needed with estimates of co-payments, deductibles or other charges that must be paid by the patient. Such assistance may be obtained weekdays between 8am and 4pm by calling the facility billing manager at 630.634.2980.

d. The facility may include a disclaimer with disclosure of any charges. Such disclaimer may include further variables, which may alter any disclosed charge. Any charges prohibited by law or third party payer contract will include a no charge disclaimer in the disclosure.

10. To be provided with information regarding teaching, research, educational or experimental projects related to your care. You have the right to refuse to participate in such projects.

11. To have your medical records maintained in confidence and in accordance with the medical staff bylaws, rules and regulations. You have the right to have access to a copy of your medical record by contacting the facility at 630.634.2980.

You Have the Responsibility…

1. The patient has the responsibility to provide, to the best of his/her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other matters relating to his/her health.

2. The patient and family are responsible for reporting perceived risks in their care and unexpected changes in the patient’s condition. The patient and family help the surgery center to improve its understanding of the patient’s environment by providing feedback about service needs and expectations.

3. The patient is responsible for reporting whether he/she clearly understands a contemplated course of action and what is expected of him/her.

4. The patient is responsible for following the care, service, or treatment plan developed and recommended by the practitioner(s) primarily responsible for his/her care, including nurses and allied health professionals carrying out the coordinated plan of care.

5. The patient and family are responsible for understanding the consequences of the treatment, alternatives, and of not following the proposed course. The patient is also responsible for his/her actions if he/she refuses treatment or does not follow the practitioner’s instructions.

6. The patient is responsible for assuring that the financial obligations for his/her health care are fulfilled as promptly as possible.

7. The patient is responsible for following the facility rules and regulations concerning patient care and conduct.

8. The patient is responsible for being considerate of the rights of other patients and surgery center personnel and for assisting in the control of noise, smoking, and the number of visitors allowed.

9. The patient is responsible for being respectful of the property of other persons and of the facility.

10. The patient is expected to discuss pain management and pain relief options with his/her physician/clinician.