Allied Physicians Surgery Center complies with applicable Federal civil rights laws and does not discrimate on the basis of race, color, national origin, age, disability, or sex.
ATTENTION: We offer language assistance services, free of charge, to patients with limited English proficiency. Call 1-574-647-1368.
Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-574-647-1368.
Chinese: 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-574-647-1368.
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You have the right to:
- Receive verbal and written notice of your rights and responsibilities in advance of receiving care. We will provide this in a language and manner that is easy to understand.
- Exercise your rights without being subject to discrimination or reprisal.
- Have your personal and health information kept private.
- Access care without regard to age, gender, race, color, ancestry, citizenship, religion, sexual orientation, gender identity or expression, national origin, marital status, or any other basis prohibited by federal, state, or local law.
- Be treated with respect, consideration and dignity.
- Receive care in a safe and sanitary setting.
- Receive ethical, high quality, and professional care delivered by properly credentialed and qualified healthcare professionals.
- Know the identity and role of your caregiver (e.g. Doctor, Nurse).
- Request to change providers if you choose and if other qualified providers are available.
- Be free from all forms of abuse, neglect, or harassment from staff, other patients, or visitors.
- Receive information in a way you understand and have the opportunity to participate in decisions involving your health care, except when such participation is contraindicated for medical reasons.
- Obtain complete information to your diagnosis (to the degree known), evaluation, treatment, providers, and expected care outcome in understandable language.
- If it is not medically advisable and/or the patient is unable to understand such information, we will provide the information to the patients’ legally authorized representative or surrogate.
- Depending on the designation the patient has made, the patient’s representative or surrogate may make all health care decisions for the patient during his/her visit, or may act in a more limited role. For example, the representative may serve as a liaison to facilitate communication, understanding, recollection, and coping with the interactions that take place during the visit.
- If a patient is unable to communicate fully with the facility’s staff, then the facility may give patient rights information to the patient’s representative or surrogate.
- Refuse treatment to the extent permitted by law.
- Be familiar with the facility policy on Advance Directives and upon request receive a copy of the Indiana State Board of Health Advance Directive brochure.
- Voice complaints or grievances, without reprisal including the right to submit grievance regarding treatment or care that is (or fails to be) furnished.
- Be informed of the names of physicians who have financial interest in Allied Physicians Surgery Center. A “financial interest” is defined as ownership through equity, debt or other means in Allied Physicians Surgery Center. Any physician who has a financial interest in Allied Physicians Surgery Center is required to inform patients prior to scheduling their procedure at Allied Physicians Surgery Center. You are free to choose Allied Physicians Surgery Center or any other facility for your procedure required, without penalty, subject to any limitations of your health insurance plan. A list of physician investors is available upon request.
- Receive a bill for all services received in a clear and understandable format.
Your Patient Responsibilities:
- Provide, to the best of your knowledge, accurate and complete information about your present health status and past medical history and report any unexpected changes to you appropriate practitioner(s).
- Follow the treatment plan established by your physician, including the instructions of nurses and other health care professionals as they carry out the physician’s orders.
- Question any instructions you do not understand.
- Provide a responsible adult to transport you home from our facility and remain with you for 24 hours after your procedure, unless specifically exempted from this responsibility by your provider.
- Accept responsibility for your actions if you refuse treatment, leave the facility against the advice of the practitioner, and/or do not follow the practitioner’s instructions relating to your care.
- Inform the facility of any medical power of attorney, living will or other directive that could affect your care.
- Be respectful of all health care professionals and staff, as well as other patients.
- Assure that the financial obligations of your health care are fulfilled as expediently as possible.
- Inform the facility of a violation of patient rights or any safety concern, including perceived risk in your care and unexpected changes in your condition.
Allied Physicians Surgery Center values your comments and uses them to improve the quality of services to all patients. If you have questions, concerns, complaints or a grievance about your experience while at Allied Physicians Surgery Center that cannot be resolved promptly by the staff members who are assisting you, please contact the Medical Director by calling 574-807-8633 or the Executive Director at 574-807-8667.
Our Management Team will promptly investigate all grievances related to (but not limited to): mistreatment, neglect, verbal, mental, sexual and/or physical abuse or any other serious allegations of harm. Any substantiated allegations will be reported to either the State or local authority, or both.
If your concern cannot be resolved with the Allied Physicians Surgery Center Management Team, you may also contact the Indiana State Department of Health by calling 1-800-246-8909 or sending a written complaint to:
Indiana State Department of Health, Division of Long Term Care, 2 North Meridian Street, Indianapolis, Indiana 46204.
Medicare beneficiaries should know that the role of the Medicare Beneficiary Ombudsman is to ensure that Medicare beneficiaries receive this information and help you to understand your Medicare options and rights.
You can contact the Office of the Medicare Beneficiary Ombudsman by calling 1-800-MEDICARE or via the internet: https://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html
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