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This Patient’s Statement of Rights and Responsibilities describes your rights and responsibilities as a patient of the University of Texas Health Science Center at San Antonio (also known as “UT Health Outpatient and Surgery Center at Kyle Seale Parkway”).  Please review it carefully.  

UT Health Outpatient and Surgery Center at Kyle Seale Parkway treats all patients and does not discriminate on the basis of a patient’s age, race, ethnicity, gender, gender identity, sexual orientation, national origin, veteran status, religion, culture, physical or mental disability, personal values or belief systems. 

Your Rights.   A patient, patient representative or surrogate has the right to:

• Receive information about rights, patient conduct and responsibilities in a language and manner the patient, patient representative or surrogate can understand.

• Be treated with respect, consideration, and dignity.

• Be provided appropriate personal privacy in accordance with the Notice of Privacy Practices. 

• Have disclosures and records treated confidentially and be given the opportunity to approve or refuse record release except when release is required by law.

• Be given the opportunity to participate in decisions involving their health care, except when such participation is contraindicated for medical reasons.

• Receive care in a safe setting.

• Be free from all forms of abuse, neglect, or harassment.

• Voice complaints and grievances, without reprisal.

• Be provided, to the degree known, complete information concerning diagnosis, evaluation, treatment and know who is providing services and who is responsible for the care. When the patient’s medical condition makes it inadvisable or impossible, the information is provided to a person designated by the patient or to a legally authorized person.

• Exercise of rights and respect for property and persons, including the right to:

  • Voice grievances regarding treatment or care that is (or fails to be) furnished.

  • Be fully informed about a treatment or procedure and the expected outcome before it is performed.

  • Have a person appointed under State law to act on the patient’s behalf if the patient is adjudged incompetent under applicable State health and safety laws by a court of proper jurisdiction. If a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with State law may exercise the patient’s rights to the extent allowed by State law.

• Refuse treatment to extent permitted by law and be informed of medical consequences of this action.

• Know if medical treatment is for purposes of experimental research and to give his consent or refusal to participate in such experimental research.

• Have the right to change providers if other qualified providers are available.

• A prompt and reasonable response to questions and requests.

• Know what patient support services are available, including whether an interpreter is available if the patient does not speak English.

• Receive, upon request, prior to treatment, a reasonable estimate of charges for medical care and know, upon request and prior to treatment, whether the facility accepts the Medicare assignment rate.

• Receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have charges explained.  Formulate advance directives and to appoint a surrogate to make health care decisions on the patient’s behalf to the extent permitted by law and provide a copy to the facility for placement in the patient’s medical record. 

• Know UT Health KSP Ambulatory Surgery Centers (ASC) policy on advance directives.
• Be informed of who has ownership in the facility.
• Have properly credentialed and qualified healthcare professionals providing patient care.
• Know your provider has malpractice insurance, as required by the state.

Your Responsibilities.  A patient, patient representative or surrogate is responsible for:

• Providing a responsible adult to transport the patient home from the facility and remain with them for 24 hours, unless specifically exempted from this responsibility by the provider.

• Providing to the best of the patient’s knowledge, accurate and complete information about the patient’s health, present complaints, past illnesses, hospitalizations, any medications, including over-the-counter products and dietary supplements, any allergies or sensitivities, and other matters relating to the patient’s health.

• Accept personal financial responsibility for any charges not covered by the patient’s insurance.

• Following the treatment plan recommended by the patient’s health care provider.

• Be respectful of all the health providers and staff, as well as other patients.

• Providing a copy of information that you desire us to know about a durable power of attorney, health care surrogate, or other advance directive.

• The patient’s actions if the patient refuses treatment or does not follow the health care provider’s instructions.

• Reporting unexpected changes in the patient’s condition to the health care provider.

• Reporting to the patient’s health care provider whether the patient comprehends a contemplated course of action and what is expected of the patient.

• Keeping appointments.

COMPLAINTS

We want to provide you with excellent service, including answering your questions and responding to your concerns. Please contact us if you have a question or concern about your rights or responsibilities. You can ask any of our staff to help you contact the Administrative Director at the UT Health KSP Ambulatory Surgery Center or you can call (210) 567-9100.

You may also choose to contact Texas Health and Human Services Commission by sending a letter to the Health and Human Services Commission, Complaint and Incident Intake, Mail Code E-24, PO Box 14903, Austin, TX 78714-9030, calling 1-800-458-9858, Option 5, emailing hfc.complaints@hhsc.state.tx.us, or visiting .

If you are covered by Medicare, you may choose to contact the Medicare Ombudsman at 1-800- MEDICARE (1-800-633-4227) or online at . The role of the Medicare Beneficiary Ombudsman is to ensure that Medicare beneficiaries receive the information and help you need to understand your Medicare options and to apply your Medicare rights and protections.