Lake Ridge Ambulatory Surgery Center recognizes that all patients have fundamental rights to information, fair treatment and autonomy over medical decisions, among other rights. When patients understand and accept their rights and responsibilities, they become partners in care with the health care team. As a patient of Lake Ridge Ambulatory Surgery Center, you have the right to receive information in advance of the date of the procedure.
Patients’ Bill of Rights
Every patient, patient’s representative or surrogate has the right to be treated as an individual with his/her rights respected. The facility and medical staff have adopted the following list of patient’s rights:
- To receive treatment without discrimination as to race, color, religion, sex, national origin, disability, or source of payment.
- To be treated with respect, consideration, and dignity in receiving care, treatment, procedures, surgery, and/or services.
- To be provided privacy and security of self and belongings during the delivery of patient care services.
- To receive information from his/her physician about his/her illness, his/her course of treatment and his/her prospects for recovery in terms that he/she can understand.
- To receive as much information about any proposed treatment or procedures as he/she may need in order to give informed consent prior to the start of any procedure or treatment.
- When it is medically inadvisable to give such information to a patient, the information is provided to a person designated by the patient, or to legally authorized person.
- To make decisions regarding the health care recommended by your physician. Accordingly, the patient may accept or refuse any recommended medical treatment. If treatment is refused, the patient has the right to be told what effect this may have on their health, and the reason shall be reported to the physician and documented in the medical record.
- To be free from mental and physical abuse, free from exploitation, and free from use of restraints. Drugs and other medications shall not be used for discipline of patients or for convenience of facility personnel.
- Full consideration of privacy concerning his/her medical care program. Case discussion, consultation, examination and treatment are confidential and shall be conducted discretely.
- Confidential treatment of all communications and records pertaining to his/her care and his/her stay in the facility. His/her written permission shall be obtained before his/her medical records can be made available to anyone not directly concerned with his/her care. The facility has established policies to govern access and duplication of patient records.
- Leave the facility even against the advice of his/her physician.
- Reasonable continuity of care and to know in advance the time and location of appointment, as well as the physician providing the care.
- Be informed by his/her physician or a delegate of his/her physician of the continuing health care requirements following his/her discharge from the facility.
- To know the identity and professional status of individuals providing services to them, and to know the name of the physician who is primarily responsible for coordination of his/her care.
- Know the facility rules and policies apply to his/her conduct while a patient.
- Have all patients’ rights apply to the person who may have legal responsibility to make decisions regarding medical care on behalf of the patient. All personnel shall observe these patient’s rights.
- To be informed of any research or experimental treatment or drugs and to refuse participation without compromise to the patient’s usual care. The patient’s written consent for participation in research shall be obtained and retained in his/her patient record.
- Examine and receive an explanation of his/her bill regardless of source of payment.
- To appropriate assessment and management of pain.
- To have the right to exercise his/her rights without being subjected to discrimination or reprisal.
Each patient treated at this facility has the responsibility to:
- Provide the surgery center staff with complete, accurate health information concerning present complaints, past illnesses, hospitalizations, any medication including over-the-counter products, dietary supplements, any allergies or sensitivities and other matters relating to his/her health.
- Patients are responsible for participating in decisions and for asking questions when they do not understand the information provided.
- Patients have the responsibility to be considerate of others, including the health care providers and respect their rights, privacy, and property.
- Follow the treatment plan prescribed by his/her provider and participate in his/her care.
- Provide a responsible adult to transport the patient home from the facility and remain with him/her for 24 hours if required by his/her provider.
- Inform the corresponding provider about any advanced directive (such as a living will or medical power of attorney) that could affect his/her care.
- Accept personal financial responsibility for any charges not covered by his/her insurance carrier.
- Be respectful of all healthcare providers, staff, and other patients.
- Inform a facility staff member regarding any of the following:
- If they feel that their privacy has been violated
- If their safety is being threatened
- If they feel a need/desire to file a grievance
Rights and Respect for Property and Person
The patient has the right to:
- Exercise his or her rights without being subjected to discrimination or reprisal.
- Voice grievance regarding treatment of care that is or fails to be furnished.
- Be fully informed about a treatment or procedure and the expected outcome before it is performed.
Privacy and Safety
The patient has the right to:
- Personal privacy
- Receive care in a safe setting
- Be free from all forms of abuse or harassment
- Confidentiality of personal medical information
You have the right to information on the Center’s policy regarding Advance Directives. The surgery center will suspend the use of an Advance Directive on the day of surgery. If an adverse event or unexpected deterioration occurs during your treatment at this facility we will initiate resuscitative, stabilizing measures and transfer you to an acute care hospital for further evaluation. At the acute care hospital further treatment or withdrawal of treatment measures already begun will be ordered in accordance with your wishes, Advance Directive or Health Care POA. Your agreement with this policy does not revoke or invalidate any health care directive or health care power of attorney. If you do not agree, we are pleased to assist you to reschedule the procedure.
If you request, an official state Advance Directives Form will be provided to you.
Advance Directives 1-800-522-3402 www.vda.virginia.gov/advmedir.asp
Submission and Investigation of Grievances
You have the right to have your verbal and written grievances submitted, investigated and to receive a written notice of the Center’s decision.
You may contact:
12825 Minnieville Road Suite 204
Woodbridge, VA 22192 (703) 357-9568
You may also contact your state agency to report a complaint:
Virginia Department of Health 1-800-955-1819
Office of Licensure and Certification
9960 Mayland Drive Suite 401 Henrico, VA 23233
Medicare Ombudsman Website:
If you need a translator, please let us know and one will be provided for you. If you have someone who can translate confidential, medical, and financial information for you, please make arrangements to have them accompany you on the day of surgery.
Physician Financial Interest and Ownership
The center is physician owned. The physician(s) who referred you to this Center and who will be performing your procedure(s) may have a financial and ownership interest. Patients have the right to be treated at another health care facility of their choice. We are making this disclosure in accordance with federal regulations.
Dr. Richard Layfield, Dr. Paymaun Lotfi, Dr. Cyrus Press, Dr. Wylie Lowery, Dr. Ryan Jander, Dr. Melissa Yadao, Dr. Daniel Hampton, Dr. Chee-Hahn Hung, Dr. Ramin Ipakchi, Dr. Alidad Arabshahi, Dr. Alex Cheng, Dr. Stephen Bane, and Dr. Alexander Sailon.