Patient Rights

Decision Making

You or your representative(s) have the right to:

  • Be informed before care is given or discontinued whenever possible.
  • Receive accurate and current information regarding your health status in terms you can understand, allowing you to make informed decisions.
  • Participate in planning for your treatment, care and discharge recommendations. A surrogate of your choice may represent you if you cannot make your own decisions according to state law.
  • Receive an explanation of proposed procedure or treatment, including risks, serious side effects and treatment alternatives, including request for second opinion or specific treatment.
  • Participate in managing your pain effectively.
  • Receive emergency care or transfer to higher level of care (hospital) should this be necessary, providing full explanation of the need based on your medical condition & without needing to wait for authorization and without any financial penalty.
  • Have persons of your choice promptly notified of hospital admission.
  • Write a Living Will, Medical Power of Attorney, and/or a CPR Directive.
  • Accept, refuse or discontinue a treatment or drug to the extent permitted by law and to be informed of the consequences of such refusal.
  • Accept, refuse or withdraw from clinical research.
  • Accept, refuse or withdraw from diagnostic or therapeutic procedures.
  • Choose or change your healthcare provider.

Equality of Care

You have the right to:

  • Respectful treatment, which recognizes and maintains your dignity and personal values without discrimination on the basis of race, color, national origin, sex age or disability.
  • Accurate information about facility where services are received and credentials of health care personnel involved in your care.
  • Interpreters and/or special equipment to assist with language needs.
  • Information on how to obtain auxiliary aids or services should these be required.
  • Information on names and function of persons involved in your direct care,
  • Information about continuing healthcare requirements following discharge, including how to access care after hours.
  • If a patient is adjudged incompetent under applicable state laws by a 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.
  • 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 rights to the extent allowed by state law.

Confidentiality and Privacy

You have the right to:

  • Personal privacy and care in a safe setting free from abuse, harassment, discrimination or reprisal.
  • Personal information being shared only with those who are involved in your care.
  • Confidentiality of your medical and billing records.
  • Notification of privacy practices.
  • Notification of breach of unsecured personal health information.

Grievance Process

You or your representative has the right to:

  • Fair, fast, and objective review of any complaint you have against your health plan, physician or healthcare personnel without fear of reprisal.
  • Submit a formal complaint either verbally or in writing as shown below. You will receive a written notice of decision within 15 business days from when the complaint was made known.

Access to Medical Records

You have the right to:

  • Speak privately with health care providers knowing your health care information is secure.
  • Review and receive a copy of your Medical Records (including electronic format) upon written request and received within 30 days by secure transmission.

Seclusion and Restraints

You have the right to:

  • Be free from seclusion or restraint for behavioral management unless medically necessary to protect your physical safety or the safety of others.


You have the right to:

  • Information specific to fees for services and payment policies prior to date of services.
  • Payment privacy when you choose to opt out of insurance coverage, in accordance with federal regulations.

Patient Responsibilities

Providing Information

You have the responsibility to:

  • Provide accurate and complete information about present complaints, past illnesses, hospitalizations, current use of prescribed or OTC medications, and nutritional supplemental products and other health-related matters.
  • Report perceived risks in your care and unexpected changes in your condition.
  • Provide an Advanced Directive if you have one.
  • Provide accurate and updated demographic and contact information for insurance and billing.



You have the responsibility to:

  • Participate in your plan of care and follow the recommended treatment plan.
  • Ensure you have a designated responsible adult to provide transportation and assist with your care for 24 hours.


Respect and Consideration

You have the responsibility to:

  • Act in a respectful and considerate manner toward healthcare providers, other patients, and visitors; physical or verbal threats or conduct which is disruptive to business operations will not tolerated.
  • Be respectful of the possessions or property of others.
  • Be mindful of noise levels.


Insurance Billing

You have the responsibility to:

  • Know the extent of your insurance coverage.
  • Know your insurance requirements including pre-authorization, deductibles and co-payments are expected at time of services.
  • Call the billing office with questions or concerns regarding your bill.
  • Fulfill your financial obligations as promptly as possible.
Administrator of ASC serving as Compliance Officer:  832-472-2028

Colorado Department of Health 303-692-2904 or email:

Department of Regulatory Agency 303-894-7800 or email:   

CMS Ombudsman  CMS 1-800-MEDICARE (1-800-633-4227)

Office of Inspector General  OIG 800-447-8477 or US Department of Health & Human Services, Attn:  OIG Hotline Operations, P.O.BOX 23489, Washington D.C. 20026

Office of Civil Rights 

Lafayette Surgery Center came to existence through its founding partner Good Samaritan Medical Center. Its bold leadership, innovation and comprehensive commitment to quality led the opening of this 12,000 square-foot facility with four operating rooms. With a mission to provide compassionate and exceptional outpatient surgical services while delivering positive outcomes for the health of the communities we serve, Lafayette Surgery Center offers outpatient surgical services for General Surgery, Gynecology, Orthopaedics, Otolaryngology/Ear, Nose and Throat (ENT), Plastic Surgery, and Podiatry.