Welcom

e

to the

Digestive H

ealth

Center of

H

untington

an Am

bulatory

Endoscopy C

enter

195 East M

ain Street Huntington, N

ew

York 11743T

el: 631-385-8677 Fax: 631-385-0611

Website: w

ww

.dhchuntington.com

Patients’ B

ill of Rights for D

iagnostic & T

reatment

Centers (C

linics)

As a patien

t in a Clin

ic in New

York State, you

have th

e righ

t, consisten

t with

law, to:

1.

Receive services(s) w

ithou

t regard to age, race, color, sexu

al orientation, religion

, marital

status, sex, n

ational origin

or sponsor;

2.

Be treated w

ith consideration, respect an

d dign

ity inclu

ding privacy in treatm

ent;

3.

Be inform

ed of the services available at th

e cen

ter; 4

. B

e informed of th

e provisions for off-h

our

emergen

cy coverage; 5

. B

e informed of th

e charges for services,

eligibility for third-party reim

bursem

ents an

d, w

hen

applicable, the availability of free or redu

ced cost care; 6

. R

eceive an item

ized copy of his/h

er accoun

t statem

ent, u

pon request;

7.

Obtain from

his/h

er health

care practitioner,

or the health care practitioner’s delegate,

complete an

d curren

t inform

ation con

cernin

g h

is/her diagn

osis, treatmen

t and progn

osis in

terms th

e patient can

be reasonably expected

to un

derstand;

8.

Receive from

his/h

er physician

inform

ation n

ecessary to give inform

ed consen

t prior to th

e start of any n

onemergen

cy procedure or

treatment or both

. An in

formed con

sent sh

all in

clude, both

, the reason

ably foreseeable risks in

volved, and altern

atives for care or treatm

ent, if any, as a reasonable m

edical practition

er un

der similar circu

mstan

ces w

ould disclose in a m

anner perm

itting the

patient to m

ake a know

ledgeable decision;

9.

Refu

se treatmen

t to the extent perm

itted by law

and to be fu

lly informed of th

e medical

consequ

ences of h

is/her action;

10

. R

efuse to participate in

experimen

tal research

; 1

1.

Voice grievan

ces and recom

men

d chan

ges in

policies and services to th

e center’s staff, the

operator and N

ew Y

ork Departm

ent of Health

with

out fear of reprisal; 1

2.

Express complaints abou

t the care and

services provided and to h

ave the cen

ter in

vestigate such com

plaints. Th

e center is

responsible for providin

g the patient or

his/h

er designee w

ith a w

ritten respon

se w

ithin 30

days if requested by th

e patient

indicatin

g the fin

dings of the in

vestigation. Th

e center is also respon

sible for notifyin

g the

patient or h

is/her designee that if the patient

is not satisfied by the cen

ter response, th

e patien

t may com

plain to N

ew Y

ork State D

epartmen

t of Health

’s Office of P

rimary

Health System

s Man

agement;

13

. P

rivacy and con

fidentiality of all in

formation

an

d records pertainin

g to the patient’s

treatment;

14

. A

pprove or refuse th

e release or disclosure of

the con

tents of h

is/her m

edical record to any h

ealth-care practitioner an

d/or health

-care facility except as requ

ired by law or th

ird-party paym

ent contract; 1

5.

Access to h

is/her m

edical record per Section

18 of th

e Pu

blic Health Law

, and Su

bpart 50-3.

For additional in

formation

link to:

http://w

ww

.health.n

y.gov/publications/1

449

/section_1

.htm#

access 1

6.

Au

thorize th

ose family m

embers an

d other

adults w

ho w

ill be given priority to visit

consisten

t with you

r ability to receive visitors; an

d 1

7.

Make kn

own you

r wish

es in regard to an

atomical gifts. Y

ou m

ay docum

ent your

wish

es in your health care proxy or on a don

or card, available from

the cen

ter.

Notice to all Patients of D

igestive Health

Center of Huntington:

Because of concerns that there m

ay be conflict of interest w

hen a physician refers a patient to a healthcare facility in w

hich the physician has a financial interest, The C

enter for Medicare

and Medicaid along w

ith New

York State has

passed certain criteria for disclosure to the patients scheduled for procedures at the D

igestive Health C

enter. The condition set forth is that I disclose this financial interest. This disclosure is intended to help you m

ake a fully inform

ed decision regarding your healthcare. If you require any other inform

ation regarding alternative providers, please consult the staff of D

igestive Health

Center.

Sincerely, Paul B

ermanski, M

D

Richard Fried, M

D

David Purow

, MD

M

ichaels Moseson, M

D

Mark D

obriner, MD

Zvi A

lpern, MD

N

orthwell H

ealth

ADVAN

CE DIRECTIVE PO

LICY

• D

igestive Health C

enter of Huntington is an

outpatient surgery center that is limited to

elective surgery only and performs no high-

risk surgical procedures.

• It is the policy of D

igestive Health C

enter of H

untington to recognize the Health C

are A

gent of the patient should circumstances

require, but in the event of an emergency the

patient will be stabilized and transferred to a

hospital as soon as possible.

• Therefore the D

igestive Health C

enter of H

untington will not acknow

ledge DN

R (D

o N

ot Resuscitate) orders on any patient w

hile in this A

mbulatory Surgical C

enter.

• For inform

ation on advance directives, reference: http://w

ww

.noah-health.org/en/rights/endoflife/adform

s.html

(By state)

If you have any concerns, please do not hesitate to contact the billing departm

ent 631-385-8677

BIL

LIN

G IN

FOR

MA

TIO

N

Please B

e advised that the Digestive H

ealth Center of

Huntington, Inc. (D

HC

), an article 28 Am

bulatory Endoscopy C

enter. WIL

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