ADVANCE DIRECTIVE NOTIFICATION

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All patients have the right to participate in their own health care decisions and to make Advance Directives or to execute Powers of Attorney that authorize others to make decisions on their behalf based on the patient’s expressed wishes when the patient is unable to make decisions or unable to communicate decisions. Spine  Sports Surgery Center respects and upholds those rights. 

Our team is dedicated to delivering the highest quality care in a safe environment that places the patient at the center of our care. We respect your rights to participate in make decisions regarding your care and self determination and will carefully consider your requests. After careful consideration and reviewing the applicable state regulation the leadership of the facility has established a policy to initiate resuscitative or other stabilizing measures and transfer you to an acute care hospital for further evaluation. The majority of procedures performed at Spine Sports Surgery Center are considered to be of minimal risk, hence the risk of you needing such measures is highly unlikely. At the acute care hospital, further treatment or withdrawal of treatment measures already begun will be ordered in accordance with your wishes, advance directive, or health care power of attorney.

You have the option of proceeding with care at our facility or having the procedure at another location that may not set the same limitations. Having been fully informed of our Statement of Limitations, you choose to proceed with your procedure at Spine Sports Surgery Center.

If you wish to complete an Advance Directive, copies of the official State forms are available at our facility. 

If you do not agree with this facility’s policy, we will be pleased to assist you in rescheduling your procedure.

PATIENT COMPLAINT OR GRIEVANCE

To report   a complaint or grievance you can 

contact   the facility Administrator by phone at 

408.364.1616 or by mail at:

Spine Sports Surgery Center 

429 Llewellyn Ave

Campbell, CA 95008

Complaints and grievances may also   be filed through:

Health Services Department

Licensing & Cert. Div.

P.O. Box 942732

Sacramento, CA 94234‐7320

800‐822‐6222

916‐445‐6979

OR

State of California, CMS Regional   Office

DHHS/CMS/DSC/CLIA

90 7th Street, Suite 5‐300 (5W)

San Francisco, CA 94103‐6707

(415) 744‐3696

Medicare   beneficiaries may receive information regarding their options under Medicare   and their rights and protections by visiting the website for the Office of   the Medicare Beneficiary Ombudsman at: http://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html 

DISCLOSURE OF OWNERSHIP

Spine Sports Surgery Center is proud to have a number of quality physicians invested in our facility. Their investment enables them to have a voice in the administration of policies of our facility. This involvement helps to ensure the highest quality of surgical care for our patients. Your physician may or may not have a financial interest in this facility