Statement of Patient's Rights and Responsibilities

It is the mission of Northwest Florida Surgery Center to provide quality health care to people requiring outpatient surgical services. These services will be delivered in a safe, timely, professional, economical, and patient-friendly manner, ensuring the patient will receive the care necessary to help regain or maintain their maximum state of health.

Northwest Florida Surgery Center believes that each human being is a unique individual and we recognize that there are certain basic rights and responsibilities belonging to each individual. Our facility employees and medical staff provide quality health care without regard to age, race, sex, national origin, religion, or physical disability and will be readily accessible to disabled individuals.

Patient Rights Include:

  1. Considerate, respectful care at all times while being provided with privacy and dignity before, during and after medical treatments/procedures as much as possible while maintaining patient safety.
  2. When the patient does not speak or understand the English language they should have access to an interpreter.
  3. Being provided complete information concerning diagnosis, evaluation, treatment and prognosis, and the right to participate in decisions regarding your medical care. You have the right to refuse treatment, be informed of the consequence of such refusal and not to be subjected to any procedure, including any research or experimental studies, without your voluntary, competent, and understanding consent or that of a legally authorized representative.
  4. To express grievances, complaints, &/or suggestions regarding treatment or care at all times without being subjected to discrimination or reprisal. Suggestions to improve our services may be given verbally to the Receptionist or Business Office Manager, or in writing to the Administrator, or written on a Satisfaction Survey Form available upon request from the Receptionist. Comments and suggestions may be made anonymously.
  5. To know the identity and professional status of individuals providing service to them and to change primary or specialty physicians or podiatrists if other qualified physicians or podiatrists are available All physicians and podiatrists must be credentialed to provide services at the Northwest Florida Surgery Center.
  6. To be free from all forms of verbal or physical abuse, or harassment by staff, other patients or visitors while at this facility.
  7. To expect that any discussion or consultation involving their cases will be conducted discreetly and will not involve individuals not directly involved in their care. Facility personnel will keep adequate records and will treat with confidence all personal matters that relate to the patient.
  8. To be fully informed of services available in the facility, provisions for after-hour and emergency care, related fees for services rendered and payment policies.
  9. To approve or refuse the release of medical records to any individual outside the facility, except in the case of transfer to another health facility, or as required by law or third-party payment contract. Per federal HIPAA guidelines, patient records and disclosures are treated confidentially.

Patient Responsibilities Include:

  1. Providing complete and accurate information regarding present or past medical history and related health matters.
  2. Following the treatment plan prescribed by your provider.
  3. Providing a responsible adult to transport you home from the facility and remain for 24 hours, if required by physician.
  4. Being responsible for payment for services when due.
  5. Being respectful and considerate of the rights toward other patients, visitors and facility personnel.
  6. Being prompt for appointments and giving advance notice when appointments must be cancelled. Also, please wear appropriate attire as recommended by the nursing staff.

Grievance Procedures:

  1. Should a patient or their family member have any questions regarding their rights, they may request a meeting with the Business Office Manager or Director of Nursing.
  2. Any patient or representative of the patient who feels that their patient rights have been violated may direct a written or verbal complaint to the Administrator within three (3) days of the alleged incident. The Administrator will address the concern of the affected individual within five (5) days from the date of receipt of the complaint.
  3. Should the patient’s complaint not be resolved through the Administrator, he or she may request further action through the facility’s Board of Directors.
  4. You may also phone toll-free (888) 419-3459 or mail your concerns to:
    Complaint Administration Unit Manager
    Agency for Health Care Administration
    2727 Mahan Dr.
    Tallahassee, FL 32308

For more information, Medicare patients may also visit the Office of Medicare Beneficiary Ombudsman via the internet at: