Dothan Surgery Center provides medical treatment without regard to race, creed, sex, nationality, gender or source of payment. As our patient, you are entitled to safe, considerate, respectful and dignified care at all times.

As our patient at Dothan Surgery Center, you have the right to:

• Receive care in a safe setting, free from any form of abuse or harassment.

• Receive appropriate assessment and management of pain.

• Have a family member or representative of  your choice and your personal physician promptly notified of your admission to the hospital.

• Receive treatment free from restraints or seclusion unless clinically necessary to provide acute medical, surgical or behavioral care.

• Change your provider if other qualified providers are available.

You are entitled to personal and informational privacy as required by law. This includes your right to:

• Know the identity, professional status, role and business relationship of all those
involved in your care.
• Undergo examinations in reasonably private visual and auditory surroundings.

• Request that a person of your own gender be present during physical examinations.

• Review or obtain copies of your medical records and financial records.

• Obtain a list of certain disclosures of your medical information made in accordance with state and federal laws.

• Request an amendment to your medical records if you believe information is not correct.

• Have your medical records read and discreetly discussed only by those directly involved with or related to your care, by anyone to whom you have given permission, or by those who have legal custody,
or other authorized individuals.

• Experience confidentiality in all aspects of your care and payment sources. Dothan Surgery Center will involve only those acting in an official capacity for the Center, and will exclude any individuals you choose to
exclude.

• Protective privacy when necessary to provide for your personal safety or for the safety of other patients, visitors, and staff.

• Preservation of the safety and security of your personal belongings from search or seizure, except for reasonable cause.

As a patient at Dothan Surgery Center, you have the right to:

• Be involved in all aspects of your care and to participate in decisions regarding your care. This includes your right to be informed of the diagnosis and prognosis of your condition. When it is medically
inadvisable to give such information to you, it will be provided to a person designated by you or to a legally authorized person.

• Be informed of appropriate treatment options, including their risks and benefits, alternative treatment options, the consequences of no treatment, and the result of medical care provided – including any
unanticipated adverse outcomes.

• Request restrictions on how your medical and financial records are used and shared. However, Dothan Surgery Center may choose not to accept these restrictions if necessary to your care.

• Have access to appropriate staff for the purpose of reporting suspected child abuse or adult abuse.

• Communicate with individuals outside the Center.

• Have access to interpreter services at no cost to you, if you are not fluent in English.

• Have access to auxiliary aids if you have an impairment which requires use of these.

• Refuse treatment (to the extent permitted by law).

• Examine and receive an explanation of all bills regardless of the source of payment.

• Request for Dothan Surgery Center to communicate with you at an alternative telephone number or address.

You will not be transferred to another facility or location without a complete explanation of the necessity for such an action.

You and your family/guardian have the right to express dissatisfaction regarding the quality of care without jeopardizing future care.

You have the right to expect plans for reasonable continuity of care after discharge so that continuing health care needs may be met.

This facility does not honor Advance Directives. Information is available upon request.

As a patient, you are encouraged to promote your own safety by becoming an active, involved and informed member of your health care team. This includes your right to:

• Ask questions if you are concerned about your health or safety.

• Verify the site/side of the body that will be operated on prior to the procedure.

• Remind staff to check your ID before medications are given, blood samples are obtained or prior to an invasive procedure.

• Remind the caregivers to wash their hands prior to giving care.

• Be informed about which medications you are taking and why you are taking them.

• Look for an identification badge to be worn by all Dothan Surgery Center employees.

As a patient at Dothan Surgery Center, you are responsible for providing accurate and complete information about present complaints, past illnesses, hospitalizations, medications, allergies and other matters relating to your health.

As a patient at Dothan Surgery Center, it is your responsibility to:

• Provide a responsible adult to transport you home from the facility and remain with you for 24 hours, if required by your physician.

• Ask questions.

• Follow the treatment plan recommended by your caregivers.

• Accept personal responsibility if you refuse treatment.

• Observe the Center’s rules.

• Adhere to Dothan Surgery Center’s Tobacco Free Policy.

• Recognize and respect the rights of other patients, families and staff.

• Report perceived risks and unexpected changes in your condition to your health care provider.

• Fulfill your financial obligations.

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

You are encouraged to ask questions about any of these rights that you do not understand. If you would like to express concerns regarding the quality of care you received at Dothan Surgery Center, please contact the Director of Nursing or the Administrator. If you have concerns regarding your insurance or financial responsibility, please contact the Business Office Team Leader or Administrator. You will receive a personal response.

In the event you are not satisfied with the results  the following agencies may be contacted:

Alabama Department of Public Health
201 Monroe Street
Montgomery, AL 36104
1-800-356-9596

Regional IV Office of Civil Rights
U.S. Department of Health
and Human Services
Atlanta Federal Center Suite 3B7061
Forsyth Street SW
Atlanta, GA 30303-8909
1-800-368-1019

Medicare Beneficiary Ombudsman at
cms.hhs.gov/center/ombudsman

• This information is available in verbal format calling 334-836-1143.

Information on Advance Directives is available upon request.

• Solicite la versión en español de esta información

The following physicians have a financial interest or ownership in this facility.

Robert P. Albares, M.D.
David W. Alford, M.D.
Jason D. Beaver, M.D.
Gregory C. Bess, DMD, M.D.
Orvis H. Chitwood III, M.D.
Jeffrey J. Crittenden, M.D.
James P. DeHaven, M.D.
Steven M. Fendley, M.D.
Ryan Pflugner, M.D.
Timothy H. Gannon, M.D.
Patrick Guin, M.D.
R. Bruce Hall, M.D.
Daniel F. Jackson III, M.D.
Jonathan Jennings, M.D.
R. Dean Lolley, M.D.
J. Paul Maddox, M.D.
Bradley T. Marker, M.D.
William D. McLaughlin, M.D.
Brent McKinley, M.D.
Judson B. Moore, M.D.
F. Kent Nunnally, M.D.
Scott B. Robbins, M.D.
Christopher E. Robinson, M.D.
Travis Rutland, M.D.
J. Bret Simpson, M.D.
Jonathan L. Skinner, M.D.
Joe Frank Smith, M.D.
Joseph H. Sugg, Jr., M.D.
Samuel J. Tarwater, M.D.