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Sansum Clinic / Foothill Surgery Center at Sansum Clinic / Surgery Patient Information / Patient Rights & Responsibilities

Patient Rights & Responsibilities

Foothill Surgery Center at Sansum Clinic and its medical staff have adopted the following list of patient’s rights and responsibilities. These rights and responsibilities will help you to understand what you can expect from your health care experience.

View or download Derechos y responsibilidades del paciente y ética organizacional y Español. 

Patient Rights

You have the right to:

  1. Exercise these rights without regard to gender or culture, economic, educational, or religious background or the source of payment for your care.
  2. Considerate and respectful care delivered in a safe environment free from all forms of abuse or harassment.
  3. Know the name of the physician who has primary responsibility for coordinating your care and the names and professional relationships of other physicians and non-physicians involved in your care.
  4. Receive information about your illness, course of treatment, and prospects for recovery in terms, and in a language that you can understand.
  5. Receive as much information about any proposed treatment or procedure as you may need in order to give informed consent or to refuse this course of treatment. Except in emergencies, the information shall include a description of the procedure or treatment, the medically significant risks involved in the treatment, alternate course of treatment or no-treatment and the risks involved in each, and know the name of the person who will carry out the procedure or treatment.
  6. Participate actively in decisions regarding your medical care. To the extent permitted by law, this includes the right to refuse treatment.
  7. Full consideration of privacy concerning your medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discretely.
  8. Confidential treatment of all communications and records pertaining to your care and, except as required by law, the right to approve or refuse the release of your medical records.
  9. Timely responses to any reasonable requests you may make for service.
  10. Leave the facility even against the advice of your physician.
  11. Continuity of care and to know in advance the time and location of your appointment as well as the physician providing the care.
  12. Be advised if your physician proposes to engage in or perform human experimentation affecting your care or treatment. You have the right to refuse to participate in such research projects.
  13. Examine and receive an explanation of your bill regardless of source of payment.
  14. Receive information about the Clinic, its services, and its providers, and about patient rights and responsibilities, as well as about the Clinic’s compliance programs with respect to state law and federal regulations.
  15. Voice recommendations, complaints or appeals about Sansum Clinic, the care it provides, or its Patient Rights and Responsibilities policy to Sansum’s Quality Management Department and/or your health plan.
  16. Have all patient’s rights apply to the person who may have legal responsibility to make decisions regarding your medical care.
  17. Be provided with information for accessing care during office hours, after hours, and emergency care.
  18. Have an advance directive, such as a living will or durable power of attorney for healthcare, and be informed as to the Clinic’s policy regarding advance directives/living will.
  19. Receive assistance when requesting a change in your provider.
  20. Appropriate assessment and management of pain, information about pain, pain relief measures and participation in pain management decisions.
  21. Give or withhold informed consent to produce or use recordings, film, or other images for purposes other than care, and to request cessation of production of the recordings, films or other images at any time.
  22. Access to and/or copies of your medical records within a reasonable time frame and the ability to request amendments to your medical records.
  23. Obtain information on disclosures of health information within a reasonable time frame.
  24. Receive information about unanticipated outcomes of care. 

Patient Responsibilities

You have the responsibility to:

  1. Make it known whether you clearly comprehend the course of your medical treatment and what is expected of you.
  2. Supply information that the Clinic and its providers need in order to provide you with optimum care.
  3. Follow the treatment plan established by your physician, including the instructions of nurses and other health professionals as they carry out the physician’s orders.
  4. Keep appointments and notify the Clinic or physician when you are unable to do so.
  5. Be accountable for your actions should you refuse treatment or not follow your physician’s orders.
  6. Assure that the financial obligations of your care are fulfilled as promptly as possible.
  7. Follow Clinic policies and procedures.
  8. Provide a responsible adult to transport you home from the Clinic and remain with you for 24 hours if required by your provider.
  9. Inform your providers about any living will, medical power of attorney, or other advance directive that could affect your care.
  10. Behave respectfully toward all healthcare professionals and staff as well as other patients and visitors. 

What to do if you have an inquiry, complaints or unresolved patient quality of care concerns.

  • It is the policy of Sansum Clinic to address all concerns and complaints promptly and thoroughly. If you would like to voice a concern or complaint, you may complete a Patient Feedback form, found in all registration areas or online (Patient Feedback Form), or contact the Quality Management Department at (805) 681-7742. 
  • Patients with unresolved patient quality of care or safety concerns can submit them directly to your health plan or to the Medical Board of California, 2005 Evergreen Street, Suite 1200 Sacramento, CA 95815 California; www.mbc.ca.gov; Toll-Free line 1-800-633-2322; (916) 263-2382; Fax (916) 263-2435.

Medicare Beneficiaries: If you need help with a Medicare-related inquiry, there are several
ways you can get help.

  • Call your plan. If your inquiry is related to your Medicare Part D or Medicare Advantage (Part C) plan, contact your plan first using the phone number on your plan member ID card. Your plan is the best resource to resolve plan related issues.
  • Call 1-800-MEDICARE. Call 1-800-633-4227, TTY users should call 1-877-486-2048. If your concern is related to Original Medicare, or if your plan was unable to resolve your inquiry, contact 1-800-MEDICARE for help.
  • Contact the SHIP. The State Health Insurance Assistance Programs (SHIPs) are state programs that provide free local health insurance counseling to people with Medicare regarding their benefits, coverage, appeals and complaints. Find your local SHIP: https://www.shiptacenter.org/
  • Contact the Medicare Beneficiary Ombudsman (MBO). If you have been unable to resolve your
    concern with your plan or 1-800-Medicare, ask a 1-800-MEDICARE representative to submit your
    complaint or inquiry to the MBO. The MBO will help to ensure that your inquiry is resolved
    appropriately. The MBO website is:https://www.cms.gov/center/special-topic/ombudsman/medicare-

     

Revised 12/5/23

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