As a patient in the State of New York you have the right to:
1. Receive service(s) without regard to age, race, color, sexual orientation, religion, marital status, sex, gender identity, national origin or sponsor;
2. Be treated with consideration, respect and dignity including privacy in treatment;
3. Be informed of the services available at the center.
4. Be informed of the provisions for off-hour emergency coverage.
5. Be informed of and receive an estimate of the charges for services, view a list of the health plans and the hospitals that the center participates with, eligibility for third-party reimbursements and, when applicable, the availability of free or reduced cost care.
6. Receive an itemized copy of his/her account statement upon request.
7. Obtain from his/her health care practitioner, or the health care practitioner’s delegate, complete and current information concerning his/her diagnosis, treatment and prognosis in terms the patient can be reasonably expected to understand.
8. Receive from his/her physician information necessary to give informed consent prior to the start of any nonemergency procedure or treatment or both. An informed consent shall include as a minimum, the provision of information concerning the specific procedure or treatment or both, the reasonably foreseeable risks involved, and alternatives for care or treatment, if any, as a reasonable medical practitioner under similar circumstances would disclose in a manner permitting the patient to make a knowledgeable decision;
9. Refuse treatment to the extent permitted by law and to be fully informed of the medical consequences of his/her action;
10. Refuse to participate in experimental research;
11. Voice grievances and recommend changes in policies and services to the center’s staff, the operator and the New York State Department of Health without fear or reprisal;
12. Express complaints about the care and services provided and to have the center investigate such complaints. The center is responsible for providing the patient or his/her designee with a written response within 30 days if requested by the patient indicating the findings of the investigation. The center is also responsible for notifying the patient or his/her designee that if the patient is not satisfied by the center response, the patient may complain to the New York State Department of Health;
13. Privacy and confidentiality of all information and records pertaining to the patient’s treatment;
14. Approve or refuse the release or disclosure of the contents of his/her medical record to any health-care practitioner and/or health-care facility except as required by law or third-party payment contract;
15. Access to his/her medical record per Section 18 of the Public Health Law, and Subpart 50-3.
16. Authorize those family members and other adults who will be given priority to visit consistent with your ability to receive visitors;
17. When applicable, make known your wishes in regard to anatomical gifts. Persons sixteen years of age or older may document their consent to donate their organs, eyes and/or tissues, upon their death, by enrolling in the NYS Donate Life Registry or by documenting their authorization for organ and/or tissue donation in writing in a number of ways (such as health care proxy, will, donor card, or other signed paper.) The healthcare proxy is available from the center;
18. View a list of the health plans and the hospitals that the center participates with; and
19. Receive an estimate of the amount that you will be billed after services are rendered.
Complaints and concerns may be addressed in any one of the following ways: • Discuss your concerns with your physician. • Discuss concerns with the Administrator of our Center: 716-250-6520 ext. 1449
• Write or call: New York State Department of Health, Centralized Hospital Intake Program, Mailstop: CA/DCS, Empire State Plaza, Albany, NY 12237 1-800-804-5447
• File electronic complaint form: apps.health.ny.gov/surveyd8/facility-complaint-form
• Write or call to the Medicare Peer Review, IPRO, Inc., Beneficiary Outreach Department, 1979 Marcus Avenue, 1st floor, Lake Success, New York 11042, (800)331-7767.
• Visit the website for the Medicare Beneficiary Ombudsman at www.cms.hhs.gov/center/ombudsman.asp
• Call or write our Accreditation Agency: AAAHC 5250 Old Orchard Rd., Suite 200 Skokie, IL 60077 Phone: (847)853-6060 Email: Info@aaahc.org
• We are committed to ensuring that our patients receive appropriate medical care. You can get information regarding your rights and how to report professional misconduct at https://www.health.ny.gov/professionals/doctors/conduct
BUFFALO SURGERY CENTER PATIENT RESPONSIBILITIES
You, your family, and visitors are responsible for following the rules involving patient care and conduct while at Buffalo Surgery Center:
1. You are responsible for providing a complete and accurate medical history. This history should include all prescribed and over-the-counter medications that you are taking, along with any allergies or sensitivities.
2. You are responsible for informing the Center about all treatments and interventions that you are involved in.
3. You are responsible to consider and follow the suggestions and advice prescribed in a course of treatment by your healthcare providers.
4. You are responsible for being respectful of other patients, Center personnel and property.
5. You are responsible for providing information about unexpected difficulties you have involving your health care.
6. You are responsible for making it known whether you clearly understand your plan of care and the things you are asked to do.
7. You are responsible for providing us with the correct information about insurance and accept personal financial responsibility for any charges not covered by your insurance.
8. You are responsible for providing a responsible adult to transport you home from the facility and remain with you for 24 hours, if required by your physician.
9. You are responsible for providing us with any living will, medical power of attorney or other directive that might affect your care.
Ownership As required by the Centers for Medicare & Medicaid Services under 42 CFR Part 416 section 416.50 “Condition for Coverage – Patient Rights” below are listed the owners of the Buffalo Surgery Center
Adam Burzynski, MD • Kevin Krautsak, MD • Kory Reed, MD • Bryan Butler, MD • Daniel Leberer, MD • Andrew Stoeckl, MD • John Callahan, MD • Joseph Leberer, MD • Daniel Vargo, MD • Matthew Cywinski, MD • Matthew Mann, MD • Nicholas Violante, DO • Lisa Daye, MD • Timothy McGrath, MD • Jeffrey Visco, MD • Mark Falvo, MD • Jehad Miqdadi, MD • Ryan Wilkins, MD • Peter Gambacorta, DO • Michael Ostempowski, MD • Matthew Zinno, MD • Alok Gupta, MD • David Pula, MD • James Kelly, DO • Abha Rani, MD