A.      Patients are treated with respect, consideration and dignity.

B.      Patients are provided appropriate privacy.

C.      When the need arises, reasonable attempts are made for health care professional and other staff to communicate in the language or manner primarily used by patients.

D.      Patients are provided, to the degree known, complete information concerning their diagnosis, evaluation, treatment and prognosis.  When it is medically inadvisable to give such information to a patient, the information is provided to a person designated by the patient or to a legally authorized person.

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

F.       Information is available to patients and staff concerning:

1.       Patient rights, including those specified in A, B, C, D and E above.

2.       Patient conduct, responsibilities, and participation.

3.       Services available at the organization.

4.       Provisions for after hours and emergency care.

5.       Fees for services.

6.       Payment policies.

7.       Patient’s right to refuse to participate in research.

8.       Advance directives, as required by state or federal law and regulations and official State advance directive forms will be provide, if requested.

An “Advance Directive” is a written document in which people clearly specify how        medical decisions affecting them are to be made in the event they become unable to speak for themselves, and or to authorize a specific person to make such decisions for them. The policy of the PASC states will not honor the Advance Directive. If any adverse event happens during your treatment, PASC staff will initiate resuscitative or other stabilizing measures, and will transfer the patient to an acute care hospital for further treatment.

9.       The credentials of health care professionals.

10.    The absence of malpractice coverage if applicable.

11.    How to voice grievances regarding treatment or care that is (or fails to be) furnished.

12.    Methods for providing feedback, including complaints.

G.      Prior to receiving care, patients are informed of patient responsibilities. These responsibilities require the patient to:

1.       Provide complete and accurate information to the best of his/her ability about his/her health, any medications, including over-the-counter products and dietary supplements and any allergies or sensitivities.

2.       Follow the treatment plan prescribed by his/her provider and participate in his/her care.

3.       Provide a responsible adult to transport him/her home from the facility and remain with him/her for 24 hours, if required by his/her provider.

4.       Accept personal financial responsibility for any charges not covered by his/her insurance.

5.       Be respectful of all health care professionals and staff, as well as other patients.

H.      Patients are informed of their right to change their providers if other qualified providers are available.

I.        Patients are informed about procedures for expressing suggestions, complaints and grievances, including those required by state and federal regulations.

-File a grievance.  If you want to file a grievance with this surgery center, you may do so by writing or by calling Emilie Cheng, Administrator at Pacific Ambulatory Surgery Center, 707 S. Garfield Ave. Suite 101, Alhambra, CA 91801 (626)656-1285.  PASC will review/investigate the grievance and will provide a response in 7 business days after it was received.  PASC will document how the grievance was addressed, as well as provide the patient with written notice of its decision.  The decision will contain the name of the PASC contact person, the steps taken to investigate the grievance, the results of the process and the date it was completed.

-File a complaint/grievance with the state Department of Health Services regardless of whether you used the surgery center’s grievance process.  You can call or write to Supervisor of Los Angeles County, Department of Health Service, phone number is 323-869-8205 and address is 5555 Ferguson Drive, Suite 320, Los Angeles CA 90022.  The website for the Office of the Medicare Beneficiary Ombudsman is


PASC also comply with Medicare Conditions for Coverage


416.50 The PASC informs the patient or the patient’s representative or surrogate of the patient’s rights and will protect and promote the exercise of these rights as set forth in Title 42 CFR 416.50. The PASC also post the written notice of patient rights in the waiting room, likely to be noticed by patients waiting for treatment or by the patient’s representative or surrogate.

416.50(a) The PASC will, prior to the start of the surgical procedure, provide the patient, the patient’s representative, or the patient’s surrogate with verbal and written notice of the patient’s right in a language and manner that ensures the patient, the representative, or the surrogate understand all of the patient’s right set forth in Title 42 CFR 416.50. The PASC’s notice of right includes the address and telephone number of the State agency to which patients may report complaints, as well as the Web site for the Office of the Medicare Beneficiary Ombudsman.

416.50(b) The PASC also discloses, in accordance with Title 42 CFR Part 420, and where applicable, provide a list of physicians who have financial interest or ownership in the PASC. Disclosure of information will be in writing.

416.50(c) The PASC complies with the following requirements:

416.50(c)(1) Provide the patient or, as appreciate, the patient’s representative with written information concerning its policies on advance directives, including a description of applicable State health and safety laws and if requested, official State advance directive forms.

416.50(c)(2) Inform the patient or, as appropriate, the patient’s representative of the patient’s right to make informed decisions regarding the patient’s care.

416.50(c)(3) Document in a prominent part of the patient’s current medical record (preoperative assessment and checklist) whether or not the individual has executed an advance directive.

416.50(d) The PASC establish a grievance procedure for documenting the existence, submission, investigation, and disposition of a patient’s written or verbal grievance to the PASC. The following criteria are met:

416.50(d)(1) All alleged violations/grievances relating, but not limited to, mistreatment, neglect, verbal, mental, sexual, or physical abuse, are fully documented.

416.50(d)(2) All allegations are immediately reported to a person in authority (Nursing Director, Medical Director and or Administrator) in the PASC.

416.50(d)(3) Only substantial allegations will be reported to the State authority or the local authority, or both.

416.50(d)(4) The grievance process also specify timeframes for review of the grievance and the provisions of a response.

416.50(d)(5) The PASC, in responding to the grievance, will investigate all grievances made by a patient or the patient’s representative or the patient’s surrogate, regarding treatment or care that is (or fails to be) furnished.

416.50(d)(6) The PASC will document how the grievance was addressed, as well as provide the patient, the patient’s representative, or the patient’s surrogate with written notice of its decision. The decision will contain the name of the PASC contact person, the steps taken to investigate the grievance, the results of the grievance process, and the date the grievance process was completed.

416.50(e)(1) The patient has the right to the following:

                     (i) Be free from any act of discrimination or reprisal.

                     (ii) Voice grievance regarding treatment or care that is (or fails to be) furnished.

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

416.50(e)(2) If a patient is adjudged incompetent under applicable State laws by the court of proper jurisdiction, the rights of the patient are exercised by the person appointed under State law to act on the patient’s behalf.

416.50(e)(3) If a state court has not adjudged a patient incompetent, any legal representative or surrogate designated by the patient in accordance with State law may exercise the patient’s right to the extent allowed by State law.

416.50(f) The patient has the right to:

416.50(f)(1) Personal privacy.

416.50(f)(2) Received care in a safe setting.

416.50(f)(3) Be free from all forms of abuse or harassment.

416.50(g)  The PASC will comply with the Department’s rules for the privacy and security of individually identifiable health information, as specified at Title 45 CFR parts 160 and 164.