WWSC Patient Information Handout - West Wichita Family ...

WESTWICHITASURGERYCENTERWest Wichita Family Physician Clinic hasexpanded services to patients with the additionof the West Wichita Surgery Center.the clinic facility adjacent to Building A and isequipped to provide endoscopy, pain managementand minor surgical procedures. Parking is availablenorth of the building entrance.Patients scheduled at the West Wichita SurgeryCenter are asked to present the following at time ofcheck-in:• current insurance card• drivers license/photo id• list of current medications, (including herbalsupplements) including dosages and frequencyCENTRALWEST WICHITAFAMILY PHYSICIANSSOCORAPATIENTPARKINGSURGERYCENTERENTRANCEWest Wichita Surgery Center isaccredited by the American Associationof Ambulatory Healthcare Inc., andtrained in ambulatory services.West WichitaSurgery CenterOn the day of the procedure, patients are askedto wear comfortable clothing and all personalbelongings including jewelry should be minimal(please no necklace, metal chains or bracelets).Female patient’s younger than age 55 and who havenot had a hysterectomy will be asked to provide aurine sample for pregnancy testing.WOODCHUCKAn adult must be present to drive the patienthome following the procedure.WWSC is owned, operated, and managed by the PhysicianPartners of West Wichita Family Physicians, P.A.Additional information or instructions regardingthe scheduled procedure are enclosed. Please readand follow all instructions carefully. If you haveany questions, please contact the Surgery CenterMonday through Friday.Accredited by theACCREDITATION ASSOCIATIONfor AMBULATORY HEALTH CARE, INC.8200 W. Central Ave., Ste. 3Wichita, KS 672128200 W. Central Ave., Ste. 3Wichita, KS 67212(316) 491-6300(316) 491-2949wwfppa.comAccreditation is a voluntary process through which an organizationis able to measure the quality of its services and performance againstsymbol to others that an organization has committed to providing highqualitycare and that it has demonstrated it’s commitment by measuringup to the Accreditation Association’s high standards.(316) 491-6300(316) 491-2949wwfppa.com

PATIENT RIGHTSAs a patient of West Wichita Surgery Center,you have the right to:• Become informed of your rights as a patient in advanceof your procedure. You may appoint a representative towill apply to the person legally responsible for health caredecisions on your behalf.• Be treated with dignity, considerate and respectful care,given by competent personnel and provided in a safeenvironment, free from all forms of abuse, neglect,harassment and/or exploitation.• Receive, to the degree known, complete informationconcerning your diagnosis, evaluation, proposed treatmentor procedures to be performed, potential complicationsand prognosis as you may need in order to give informedinformation may be given to a legally authorized person orto a person designated by you.• Participate in the development and implementation of yourplan of care and actively participate in decisions regardingyour medical care. To the extent permitted by law, thisincludes the right to request and/or refuse treatment and beinformed of the medical consequence of refusal.• Maintain personal privacy and security of self andbelongings during the delivery of patient care services.• Receive information in a manner that you understand.WWSC will make a reasonable response to the need/of language or disability.• Access information contained in your medical record atWWSC within a reasonable timeframe within the limits ofstate law.• Be informed of the continuing healthcare requirementsfollowing your discharge from WWSC.•receive an explanation of your bill.• Receive a copy of Notice of Rights to Privacy.•and are given the opportunity to approve or refuse therelease of such information except when required by law.• Be informed of your responsibilities as a patient prior toreceiving care.•available.• Information concerning: your rights as a patient, patientconduct and responsibilities, services available at theWWSC, provisions for after hours and emergency care, feefor services, payment policies, and credentials of WWSChealthcare professionals and policies on advance directives.• Be informed of policies and procedures that relate toyour care, treatment and resources for resolving disputes,expressing suggestions, and exercising your rights withoutbeing subjected to discrimination or reprisal.• Voice grievances regarding treatment or care that is (or failsto be) furnished.• Refuse to participate in research.• Be informed that WWSC is owned, operated, andmanaged by the Physician Partners of West Wichita FamilyPhysicians, P.A.• Formulate advance directives, under Kansas statute thisincludes, Living Will Declaration, Durable Power ofAttorney for Health Care or Do Not Resuscitate Directive.More information including forms on advance directives areavailable upon request.ADVANCE DIRECTIVENOTIFICATIONIn the state of Kansas, all patients have theright to participate in their own health caredecisions and to make Advance Directives orto execute Powers of Attorney that authorizeothers to make decisions on their behalfbased on the patient’s expressed wishes whenthe patient is unable to make decisions orunable to communicate decisions. WestWichita Surgery Center respects and upholdsthose rights.However, unlike in an acute care hospitalsetting, West Wichita Surgery Center doesnot routinely perform “high risk” procedures.Most procedures performed in this facility areconsidered to be of minimal risk. Of course,no surgery is without risk. You will discussthe specifics of your procedure with yourphysician who can answer your questions asto its risks, your expected recovery, and careafter your surgery.PATIENTRESPONSIBILITIESAs a patient of West Wichita Surgery Center,you have the responsibility to:•well as other patients.• Provide complete and accurate information to the best ofyour ability about your health, any medications, includingover-the-counter products and dietary supplements and anyallergies or sensitivities.• Follow the treatment plan prescribed by your provider.• Provide a responsible adult to transport you home from theWWSC and remain with you for 24 hours, if required byyour provider.• Inform your provider about any advance directivesincluding: living will, durable power of attorney for•covered by your insurance.• Follow surgery center rules, including the “NOSMOKING” and “NO WEAPONS” policy.•• Make your concerns and complaints known.Reporting of Abuse, Neglect or Exploitationreporting any incidents of abuse, neglect, or exploitation of anypatient including children.Grievances/ComplaintsA process for handling complaints or grievances pertaining toyour healthcare service at WWSC is strictly followed by theWWSC. You may direct grievances/complaints to the WWSCRisk Manager 316-491-6340 or Risk Manager-8200 W. CentralAmbulatory Healthcare 847-853-6060,www.cms.hhs.gov/center/ombudsman.aspMedicare options and to apply their Medicare rights and protections.Or, contact the Kansas Department of Health and EnvironmentJoseph Kroll, Director1000 SW Jackson, Suite 200Topeka, Kansas 66612-1365Phone: 785-296-1240contents of any Advance Directive orinstructions form a health care surrogate orattorney-in-fact, that if an adverse eventoccurs during your treatment at this facility,we will initiate resuscitative or otherstabilizing measures and transfer you to anacute care hospital for further evaluation. Atthe acute care hospital, further treatments orwithdrawal of treatment measures alreadybegun will be ordered in accordance withyour wishes, Advance Directive, or healthcare Power of Attorney. Your agreement withthis facility’s policy will not revoke orinvalidate any current health care directive orhealth care power of attorney.If you wish to complete an AdvanceDirective, copies of the official State formsare available at our facility.