Manhattan Reproductive Surgery Center

65 Broadway, 21st Floor

New York, NY 10006

 

Phone: 212.818.0001  |  Fax: 212.818.0090

PATIENT BILL OF RIGHTS

 

As a patient at Manhattan Reproductive Surgery Center, you have the right to… 
 

  • Receive services(s) without regard to age, race, color, sexual orientation, religion, marital status, sex, national origin, or sponsor.

    • Be treated with consideration, respect and dignity including privacy in treatment.

    • Be informed of the services available at the center.

    • Be informed of the provisions for off-hour emergency coverage.

    • Be informed of the charges for services, eligibility for third-party reimbursements and, when applicable, the availability of free or reduced cost care.
       

  • Receive an itemized copy your account statement, upon request.

    • Obtain from your Physician, or your physician’s delegate, any current information concerning your diagnosis, treatment, and prognosis in terms that you can be reasonably expected to understand.

    • Receive from your physician any information necessary to give informed consent prior to the start of any nonemergency procedure, or treatment, or both. 

      • An informed consent shall include:

        • 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.

    • Refuse treatment to the extent permitted by law and to be fully informed of the medical consequences of your actions

    • Refuse to participate in experimental research.

    • Voice grievances and recommend changes in policies and services to the center's staff, the Medical Director, and/or the New York State Department of Health without fear of reprisal. (See below for your Point of Contact’s). 

    • Privacy and confidentiality of all information and records pertaining to your treatment.

    • Approve or refuse the release or disclosure of the contents of your medical record to any health-care practitioner and/or health-care facility except as required by law or third-party payment contract;

    • Access your medical record, per Section 18 of the Public Health Law, and Subpart 50-3. 

      • Visit the following link for additional information on your rights to view your medical record:

https://www.health.ny.gov/professionals/patients/patient_rights/docs/you_and_your_health_records.htm

    • Authorize those family members and other adults who will be given priority to visit consistent with your ability to receive visitors

    • Make known your wishes regarding anatomical gifts. You may document your wishes in your health care proxy, available at our center. 

 

  • Request a Complaint Investigation:

    • Manhattan Reproductive Surgery Center’s Complaint Investigation Policy allows the patient or his/her designee to express complaints about the care and services provided and to have the center investigate such complaints.

    • If you are concerned that your privacy rights have been violated in any way, you disagree with a decision made about access to your health information, you disagree with a response to a request you made to amend or restrict the use of your health information, or if you would like to have us communicate with you by alternative means or locations, you may contact the Nurse Manager of Manhattan Reproductive Surgery Center.

 

Sarah Musallam, RN

Telephone: (212) 818-0001

Fax: (212) 818-0090

Email: info@manhattanrsc.com

Address: 65 Broadway, 21st Floor

New York, NY 10006

 

    • 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, conducted by the Nurse Manager.

    • 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's Office of Health Systems Management. 

 

New York State Department of Health 

Telephone: (800) 804-5447

 

Medicare Ombudsman

Telephone: (800) 633-4227

http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/notice.html

Facility personnel shall observe these patient rights.

 

 

 

 

PATIENT RESPONSIBILITIES

 

As a patient at Manhattan Reproductive Surgery Center, you are responsible for… 

  • providing accurate and complete information about your health status and past medical history and for reporting any unexpected changes to the appropriate practitioners.

  • following the treatment plan recommended by the primary practitioner.

  • following your pre-operative instructions as supplied by Manhattan Reproductive Surgery Center.

  • keeping appointments and notifying Manhattan Reproductive Surgery Center or your physician if you are unable to keep your appointment.

  • providing an adult to transport you home after surgery and an adult to be responsible for you at home for the first 24 hours after surgery.

  • indicating whether you clearly understand a contemplated course of action and what is expected of you.

  • your actions if you refuse treatment, leave Manhattan Reproductive Surgery Center against medical advice of your physician, and/or do not follow the physician’s instructions relating to care.

  • assuring that the financial obligations of your health care are fulfilled as promptly as possible.

  • behavior which shows respect and consideration for other patients, their personal property, family members, visitors and personnel of Manhattan Reproductive Surgery Center.

  • following the Manhattan Reproductive Surgery Center policies and procedures.