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
L V
ER
IFY Y
OU
R
INSU
RA
NC
E B
EN
EFIT
S PRIO
R T
O Y
OU
R
PRO
CE
DU
RE
, BU
T T
HE
RE
MA
Y B
E
INFO
RM
AT
ION
NO
T A
VA
ILA
BL
E T
O U
S AS
TH
E PR
OV
IDE
R. IN
FOR
MA
TIO
N G
IVE
N IS
NO
T A
GU
AR
AN
TE
E O
F PAY
ME
NT
. IT
WO
UL
D B
E IN
YO
UR
BE
ST IN
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RE
ST T
O
CA
LL
YO
UR
CA
RR
IER
AN
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ET
TH
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RM
INA
TIO
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F TH
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VE
RE
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TH
E SU
RG
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EN
TE
R SO
TH
AT
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OU
HA
VE
AL
L IN
FOR
MA
TIO
N A
VA
ILA
BL
E
TO
DE
TE
RM
INE
YO
UR
FINA
NC
IAL
R
ESPO
NSIB
ILIT
Y (IN
CL
UD
ING
CO
PAY
ME
NT
S
FOR
AN
AM
BU
LA
TO
RY
SUR
GE
RY
CE
NT
ER
, D
ED
UC
TIB
LE
S, AN
D C
O-IN
SUR
AN
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).
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