WEST MEMPHIS EYE CENTER, P.A. RIGHTS & RESPONSIBILITIES

Patient Rights and Responsibilities

As a patient or when appropriate, the patient’s representative as allowed by law, you have the right:

  • To be treated with dignity and respect, to privacy and confidentiality;
  • To impartial medical care without discrimination regardless of race, creed, gender, national origin, religion/cultural beliefs, sexual preference, disability, language, or financial status;
  • To information about your diagnosis, condition and treatment in terms that you can understand and to have your questions answered;
  • To the confidentiality of records about your care unless a disclosure is allowed by law;
  • To have the information in your medical record;
  • To have an interpreter with you or if needed, one of our staff will provide language assistance services;
  • To be involved in decisions making of all aspects of your care;
  • To refuse treatment;
  • To have appropriate assessment and management of pain;
  • To an explanation of the bills related to your health care services;
  • To express any concerns or grievances orally or in writing without fear of reprisal.

In compliance of Medicare’s condition of coverage, G. E. Bryant, Jr., M.D. is the sole owner of West Memphis Eye Center, P.A.

As a patient or when appropriate, the patient’s representative is allowed by law, you have the responsibility to:

  • Provide accurate information about your present illness and past medical history, including medications to your doctor and his staff;
  • Follow the care instructions and advice of your health care team;
  • To ask question if you do no understand;
  • To bring an interpreter or ask for language services if necessary;
  • Discuss with your doctor and nurses when you have pain;
  • Be considerate of our physicians, nurses, and staff;
  • Provide us with a current copy of your advanced directive;
  • Pay your bill and provide current information for insurance claims and to work with our business office to make payment arrangements when necessary;
  • Follow the NO smoking and NO cell phone policy of the facility;
  • To express and concerns about the service you are receiving, you may speak to any staff member or call the following, 1-800-462-8859 for a patient representative.  If you wish to submit a written grievance, you may address it to:

West Memphis Eye Center, P.A.
PO Box 2165
West Memphis, AR  72303

or

Arkansas Department of Health
5800 W. 10th Street, Ste. 400
Little Rock, AR  72204
(501) 661-2201

Website for the Office of Medicare Beneficiary Ombudsman:
http://www.cms.hhs.gov/ombudsman/resources.asp

Discrimination is against the law, and West Memphis Eye Center, P.A. complies with applicable Federal Civil Rights Laws as outlined in this notice.  You can file a complaint with the U.S. Department of Health and Human Services, Office of Civil Rights

  • Electrically through the Office of Civil Rights Complaint Portal, available
  • By mail at:
    U.S. Department of Health and Human Services
    200 Independence Ave. SW
    Room 509F HHH Building
    Washington, DC  20201
  • By phone at 1-800-368-1019; 1-800-437-7697 (TDD)

Complaint forms are available

DOCTORS SURGERY CENTER, P.A. RIGHTS & RESPONSIBILITIES

Patient Rights and Responsibilities

As a patient or when appropriate, the patient’s representative as allowed by law, you have the right:

  • To be treated with dignity and respect, to privacy and confidentiality;
  • To impartial medical care without discrimination regardless of race, creed, gender, national origin, religion/cultural beliefs, sexual preference, disability, language, or financial status;
  • To information about your diagnosis, condition and treatment in terms that you can understand and to have your questions answered;
  • To the confidentiality of records about your care unless a disclosure is allowed by law;
  • To have the information in your medical record;
  • To have an interpreter with you or if needed, one of our staff will provide language assistance services;
  • To be involved in decisions making of all aspects of your care;
  • To refuse treatment;
  • To have appropriate assessment and management of pain;
  • To an explanation of the bills related to your health care services;
  • To express any concerns or grievances orally or in writing without fear of reprisal.

In compliance of Medicare’s condition of coverage, G. E. Bryant, Jr., M.D. is the sole owner of Doctors Surgery Center, P.A.

As a patient or when appropriate, the patient’s representative is allowed by law, you have the responsibility to:

  • Provide accurate information about your present illness and past medical history, including medications to your doctor and his staff;
  • Follow the care instructions and advice of your health care team;
  • To ask question if you do no understand;
  • To bring an interpreter or ask for language services if necessary;
  • Discuss with your doctor and nurses when you have pain;
  • Be considerate of our physicians, nurses, and staff;
  • Provide us with a current copy of your advanced directive;
  • Pay your bill and provide current information for insurance claims and to work with our business office to make payment arrangements when necessary;
  • Follow the NO smoking and NO cell phone policy of the facility;
  • To express and concerns about the service you are receiving, you may speak to any staff member or call the following, 1-800-462-8859 for a patient representative.  If you wish to submit a written grievance, you may address it to:

Doctors Surgery Center, P.A.
PO Box 2165
West Memphis, AR  72303

or

Arkansas Department of Health
5800 W. 10th Street, Ste. 400
Little Rock, AR  72204
(501) 661-2201

Website for the Office of Medicare Beneficiary Ombudsman:
http://www.cms.hhs.gov/ombudsman/resources.asp

Discrimination is against the law, and Doctors Surgery Center, P.A. complies with applicable Federal Civil Rights Laws as outlined in this notice.  You can file a complaint with the U.S. Department of Health and Human Services, Office of Civil Rights

  • Electrically through the Office of Civil Rights Complaint Portal, available
  • By mail at:
    U.S. Department of Health and Human Services
    200 Independence Ave. SW
    Room 509F HHH Building
    Washington, DC  20201
  • By phone at 1-800-368-1019; 1-800-437-7697 (TDD)

Complaint forms are available.