The right to have a state appointed representative act on your behalf that may exercise any and all rights afforded to you if you have been determined to be incompetent under a state legal process and are not capable of exercising your rights independently.
The Center has the right to refuse care to or dismiss a patient from care in the event they are disruptive, uncooperative, and belligerent or physically threatening to the staff or other patients. Additionally, the Center has the right to refuse care to or dismiss a patient from care in the event the designated responsible driver is incapacitated, disruptive, uncooperative, belligerent, or physically threatening to the staff or other patients.
Pinnacle Surgery Center has established a Patient’s Bill of Rights and Responsibilities, which is provided verbally and in writing in a language and manner the patient, patient’s representative or surrogate understands prior to their procedure. Pinnacle Surgery Center expects that observance of these rights will contribute to more effective patient care and greater satisfaction for patients, physicians and the Center.
I understand that, under the Health Insurance Portability & Accountability Act of 1996 (HIPPA) I have rights to privacy regarding my protected health information. I understand that this information can and will be used to:
A complete copy of Pinnacle Surgery Center’s notice of privacy practice is posted in the Center. I have been informed by this Center of their written Notice of Privacy Practices containing a more complete description of the uses and disclosures of my healthy information. I have been given the right to review such Notice of Privacy Practices from time to time and that I may contact them to obtain a current copy. I understand that I may request in writing that the Center restrict how my private information is used or disclosed to carry out treatment, payment or health care operations. I understand that I may revise this consent in writing at any time, except to the extent that the Center has already taken action relying on this consent.
Pinnacle Surgery Center is privately owned and has informed the patient prior to the procedure that their physician may have a proprietary interest in this facility. I have the right to choose the facility of my choice for health related services. I have been given this option and choose to have my procedure at Pinnacle Surgery Center.
It is the policy of Pinnacle Surgery Center, regardless of any advance directive or instructions from a health care surrogate or power of attorney, that an unexpected medical emergency, which occurs during treatment at this facility, will be aggressively managed with resuscitative or other stabilizing measures followed by emergency transfer to the closest hospital. The receiving hospital will implement further treatment or withdrawal of treatment measures already begun in accordance with patient wishes, advance directive or health care directive or health care power of attorney.
All alleged grievances will be fully documented, investigated and reported to the Administrator of Pinnacle Surgery Center. Any substantiated allegation will be reported to the State of Colorado and/or Local authority. The grievance documentation will be included in the process of how the grievance was addressed and the patient will be provided a written notice of the decision within fifteen (15) days of receipt of the grievance.