PATIENT RIGHTS AND RESPONSIBILITIES

You have the right to:

  1. To receive care regardless of age, race, color, national origin, culture, ethnicity, language, socioeconomic status, religion, physical or mental disability, sex, sexual orientation, or gender identity or expression.
  2. Have a family member (or another chosen representative) notified promptly of your admission to a hospital in case of an emergency.
  3. Know the name of the physician primarily responsible for coordinating your care and the terms and professional relationships of other physicians, physical therapists, and other health care providers who will be involved in your care and treatment.
  4. Make decisions about medical care and receive as much information about any proposed treatment or procedure as you may need to give informed consent or refuse a course of treatment.
  5. Request or refuse treatment to the extent allowed by law. However, this does not give you the right to demand inappropriate or medically unnecessary treatment or services.
  6. If a conflict arises about treatment decisions that cannot be adequately resolved, you have the right to find another provider.
  7. Be fully informed if asked to participate in any clinical research. You have the right to refuse to take part in such research projects.
  8. Reasonable responses to any reasonable requests made for service.
  9. Formulate advance directives to appoint a decision-maker if you become mentally incapacitated or unable to communicate your wishes about care.
  10. Privacy:
    1. Your consultation, examination, and treatment are confidential and should be conducted discreetly.
    2. Confidential treatment of all communications and records about your care and stay in the facility.
  11. Receive care safely, free from mental, physical, sexual, or verbal abuse, neglect, exploitation, or harassment.
  12. Be free from restraints and seclusion of any form as a means of coercion, discipline, convenience, or retaliation by staff.
  13. Reasonable continuity of care and knowing in advance the time and location of appointments and the identity of the person(s) providing the care.
  14. Be informed by the physician, or delegate of the physician, of continuing health care requirements and options following discharge from the facility.
  15. Be informed of which Synergy Orthopedics rules and policies apply to your conduct while you are a patient.
  16. Bring a guest of your choice during your visit.
  17. Have a guest or segregate that will speak on your behalf during your visit.
  18. Examine and receive an explanation of your medical bill, regardless of the payment source.
  19. Request the services of an interpreter at no cost to you if you have limited English skills or are hearing impaired.
  20. Receive information about your health status, diagnosis, prognosis, course of treatment, and prospects for recovery.
  21. Assessment and management of pain, information about pain relief measures, and taking part in pain management decisions.
  22. Have the right to transparency of standard charges under the 2019 CMS guidelines.
  23. Exercise these rights without regard to sex, economic status, educational background, race, color, religion, ancestry, national origin, age, disability, medical condition, sexual orientation, gender identity, gender expression, marital status, registered domestic partner status, or the source of payment for care.
  24. Pets and Service Animals: Only service animals individually trained to do work or provide tasks and under the control of a handler (as defined by the ADA) are allowed during office visits.
  25. Express concerns or share feedback about your care without fear that the quality of your care or future access to care will be affected.
  26. Provide feedback or file a formal complaint about your care at Synergy Orthopedics. Contact info@synergysmg.com or call 858-412-6080.
  27. File a complaint or grievance with the California Department of Public Health (CDPH) regardless of whether you use the facility’s grievance process, in writing or by calling: California Department of Public Health (CDPH) – Licensing and Certification, 7575 Metropolitan Drive, Suite 211, San Diego, CA 92108-4402. (619) 688-6190.
  28. File a complaint or grievance regarding the conduct of a physician with the Medical Board of California, in writing or by calling: Medical Board of California, 2005 Evergreen Street, Suite 1200, Sacramento, CA 95815-2322. (800) 633-2322 www.mbc.ca.gov

You have the responsibility to:

  1. Provision of Information:
    1. Provide accurate and complete information about present complaints and illnesses.
    2. Report unexpected changes in condition to your physician or medical team.
    3. Report whether you understand and accept a proposed treatment plan.
  2. Compliance with Instructions:
    1. Follow the treatment plan you and your practitioner agree upon.
    2. Keep health care appointments and notify the provider if you cannot attend.
    3. Follow all facility rules and regulations that affect patient care and conduct.
  3. Accept responsibility for being informed and ask questions when needed.
  4. Accept responsibility for your actions if you refuse treatment or do not follow the health care practitioner’s instructions.
  5. Cooperate in meeting the financial obligations of your healthcare.
  6. Be considerate of the rights of other patients and facility personnel.
  7. Report any perceived or identified safety issues related to your care.
  8. Synergy Orthopedics is committed to safety and being a healing environment:
    1. WE WILL NOT TOLERATE any threatening or aggressive behavior toward our staff. Assaults and batteries against our staff are crimes and may result in a criminal conviction. All staff have the right to conduct their work without fearing for safety.
    2. We take all forms of aggression and violence seriously. Incidents may result in removal from the facility, dismissal, and prosecution.
    3. Examples of aggressive behaviors include:
      1. Threat
      2. Physical aggression
      3. Verbal harassment, including abusive cursing or sexual language.
      4. Not following instructions from staff members.

If you would like to have a copy of these rights and responsibilities, please inform a staff member or contact:

Synergy Orthopedic Specialists, Inc.
4445 Eastgate Mall, Suite 105, San Diego, CA 92121
Email: info@synergysmg.com
Phone: (858) 412-6080 Fax: 858-430-2591