PATIENT RIGHTS
Each patient receiving services shall have the following rights:
1. To be informed of these rights, as evidenced by the patient's written acknowledgement, or by documentation by staff in the medical record, that the patient was offered a written copy of these rights and given a written or verbal explanation of these rights, in terms the patient could understand. The facility shall have a means to notify patients of any rules and regulations it has adopted governing patient conduct in the facility;
2. To be informed of services available in the facility, of the names and professional status of the personnel providing and/or responsible for the patient's care, and of fees and related charges, including the payment, fee, deposit, and refund policy of the facility and any charges for services not covered by sources of third-party payment or not covered by the facility's basic rate;
3. To be informed if the facility has authorized other health care and educational institutions to participate in the patient's treatment. The patient also shall have a right to know the identity and function of these institutions, and to refuse to allow
their participation in the patient's treatment;
4. To receive from the patient's physician(s) or clinical practitioner(s), in terms that the patient understands, an explanation of his or her complete medical/health condition or diagnosis, recommended treatment, treatment options, including the option of no treatment, risk(s) of treatment, and expected result(s). If this information would be detrimental to the patient's health, or if the patient is not capable of understanding the information, the explanation shall be provided to the patient's next of kin or guardian. This release of information to the next of kin or guardian, along with the reason for not informing the patient directly, shall be
documented in the patient's medical record;
5. To participate in the planning of the patient's care and treatment, and to refuse medication and treatment. Such refusal shall be documented in the patient's medical record;
6. To be included in experimental research only when the patient gives informed, written consent to such participation, or when a guardian gives such consent for an incompetent patient in accordance with law, rule and regulation. The patient may refuse to participate in experimental research, including the investigation of new drugs and medical devices;
7. To voice grievances or recommend changes in policies and services to facility personnel, the governing authority, and/or outside representatives of the patient's choice either individually or as a group, and free from restraint, interference, coercion, discrimination, or reprisal;
8. To be free from mental and physical abuse, free from exploitation, and free from use of restraints unless they are authorized by a physician for a limited period of time to protect the patient or others from injury. Drugs and other medications shall not be used for discipline of patients or for convenience of facility personnel;
9. To confidential treatment of information about the patient.
i. Information in the patient's medical record shall not be released to anyone outside the facility without the patient's approval, unless another health care facility to which the patient was transferred requires the information, or unless the release of the information is required and permitted by law, a third-party payment contract, or a peer review, or unless the information is needed by the Department for statutorily authorized purposes.
ii. The facility may release data about the patient for studies containing aggregated statistics when the patient's identity is masked;
10. To be treated with courtesy, consideration, respect, and recognition of the patient's dignity, individuality, and right to privacy, including, but not limited to, auditory and visual privacy. The patient's privacy shall also be respected when facility personnel are discussing the patient;
11. To not be required to perform work for the facility unless the work is part of the patient's treatment and is performed voluntarily by the patient. Such work shall be in accordance with local, State, and Federal laws and rules;
12. To exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices, or any attendance at religious services, shall be imposed upon any patient;
13. To not be discriminated against because of age, race, religion, sex, nationality, or ability to pay, or deprived of any constitutional, civil, and/or legal rights solely because of receiving services from the facility; and
14. To expect and receive appropriate assessment, management and treatment of pain as an integral component of that person’s care according to N.J.A.C 8:43 E-6.
TO FILE A GREIVANCE: Hotline: 1-877-582-6995
NJV&CSC NJ DOH
Cindy Naguib P.O. Box 360
973-243-9729 Trenton, NJ 08625
Office of Medicare Beneficiary Ombudsman
www.medicare.gov/Ombudsman/activities.asp
Centers for Medicare & Medicaid services
7500 Security Blvd
Baltimore, MD 21244
SECTION 1557 NON-DESCRIMINATION NOTICE
New Jersey Vein & Cosmetic Surgery Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. NJVCSS does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
New Jersey Vein & Cosmetic Surgery Center
• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
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Qualified sign language interpreters
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Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as:
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Qualified interpreters
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Information written in other languages If you need these services, contact Harold Mast, MD- Medical Director
If you believe that New Jersey Vein & Cosmetic Surgery Center has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
Cindy Naguib, Administrator
Civil Rights Coordinator,
741 Northfield Ave, suite 105, West Orange, NJ 07052
@973-243-9729 or cnaguib@practice-alt.com.
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Cindy Naguib, Administrator, is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW Room 509F
HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
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Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Dr Shoenfeld
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ध्यान द�: य�द आप �हदी बोलते ह � तो आपके िलए मुफ्त म� भाषा सहायता सेवाएं उपलब्ध ह। Dr. Sarvaiya
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�ચુ ના: જો તમે�જરાતી બોલતા હો, તો િન:�લ્કુ ભાષા સહાય સેવાઓ તમારા માટ�ઉપલબ્ધ છ. Dr Sarvaiya
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