The care a patient receives depends partially on the patient himself. Therefore, in addition to these rights, a patient has certain responsibilities as well. These responsibilities should be presented to the patient in the spirit of mutual trust and respect:

1. Provide accurate and complete information about present complaint, past illnesses, hospitalizations, any medications, including over-the-counter products and dietary supplements and any allergies or sensitivities, and other matters related to your health status.
2. Make it known whether course of treatment and what is expected of the patient is clearly understood.
3. Follow the treatment plan established by the physician, including the instructions of nurses and other health professionals as they carry out the physician’s orders.
4. Provide a responsible adult to transport the patient home from the ASC and remain with the patient for 24 hours if required by the physician.
5. Keep appointments and notify the ambulatory surgery center or physician when unable to keep an appointment.
6. Accept responsibility for any actions resulting from the refusal to follow treatment or physician’s orders.
7. Inform the physician about any living will, medical power of attorney, or other directive that could affect the patient’s care.
8. Accept and ensure that the financial obligations of care are fulfilled as promptly as possible.
9. Follow ambulatory surgery center polices and procedures.
10. Be considerate of the rights of other patients and ambulatory surgery center personnel.
11. Be respectful of personal property and that of other persons in the ambulatory surgery center.

Orthopedic and Sports Surgery Center strives to provide excellent patient care and service. If you should have a concern or complaint, please tell us so we can work to satisfy your needs. Ask to speak to the Director of Quality.

You also have the right to contact the Wisconsin Division of Quality Assurance at 1-800-642-6552 or contact The Office of the Medicare Beneficiary Ombudsmen at 1-800-633-4227 or online at www.medicare.gov.