Plastic Surgical Center of Rapid City
3615 5th Street, Suite 100
Rapid City, SD 57701
(605) 343-6714

The staff of Plastic Surgical Center of Rapid City appreciates the trust that you have placed in us by having your procedure done at our center. We will strive to make your experience at our center a positive one. Plastic Surgical Center of Rapid City encourages patients and their families to have a clear understanding and participate in matters and decisions related to their medical care. If there is anything that we can do to improve our services or the care that you receive, please let us know.

Patient Rights and Responsibilities:

• A patient has the right to respectful, considerate and dignified care given by competent personnel.
• A patient has the right, upon request, to be given the name of his/her attending practitioner, the names of all other practitioners directly participating in his/her care, and the names and functions of other health care persons having direct contact with the patient.
• A patient has the right to have records pertaining to his/her medical care treated as confidential, except as otherwise provided by law.
• A patient has the right to the opportunity to approve or refuse release of his/her medical care records prior to submission to any party, including third parties based on contractual arrangements, except as otherwise provided by law.
• A patient has the right to consideration of privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are considered confidential and shall be conducted discreetly.
• A patient has the right to expect emergency procedures to be implemented without unnecessary delay.
• A patient has the right to know what ambulatory surgery facility rules and regulations apply to his/her conduct as a patient.
• A patient has the right to be given the opportunity to participate in decisions involving his/her health care, except when such participation is contraindicated for medical reasons.
• A patient has the right to good quality care and high professional standards that are continually maintained and reviewed.
• A patient has the right to full information in layman’s terms, concerning diagnosis, evaluation, treatment and prognosis, including information about alternative treatments and possible complications. When it is not medically advisable to give the information to the patient, the information shall be given on his/her behalf to the responsible person.
• A patient has a right, except in cases of emergency, to supply the necessary informed consent to the practitioner prior to the start of a procedure.
• A patient, or, if the patient is unable to give informed consent, a person responsible for the patient, has the right to be advised when a practitioner is considering the patient as he/she has previously given consent.
• A patient has the right to refuse drugs or procedures, to the extent permitted by statute, and a practitioner shall inform the patient of the medical consequences of the patient’ refusal of drugs or procedures.
• A patient has the right to medical and nursing services without discrimination based upon age, race, color, religion, gender, national origin, handicap, disability or source of payment.
• A patient who does not speak English shall have access, when possible, to an interpreter.
• A patient who is blind shall have alternative communicative assistance available to them.
• A patient, or patient designee, upon signed consent by the patient, shall have access to information contained in his/her medical records at the ambulatory surgical facility.
• A patient has the right to expect good management techniques to be practiced within the facility. These techniques shall make effective use of the patient’s time and shall avoid personal discomfort of the patient.
• A patient has the right to be transferred to another facility, with notification to the patient’s responsible party, when an emergency occurs and requires transfer to a location capable of providing emergency services.
• A patient has the right to examine and receive a detailed explanation of his/her bill.
• A patient has the right to expect that the facility will provide information for continuing health requirements following discharge and the means for meeting them.
• A patient has the right, without recrimination, to voice comment, suggestions, complaints, and grievances regarding care; to have those complaints reviewed and when possible, resolved; and when not resolved, to obtain information regarding external appeals, as required by state and Federal law and regulations.
• A patient has the right to be informed of his/her rights, responsibilities, and expected conduct by the facility at the time of admission.
• A patient has the right to information covering the services available at the facility, the fees related to those services, and the payment policies governing restitution for services rendered.
• A patient has the right to information on the provision of after hours and emergency services for care.

Patient's Rights and Responsibilities and Non Discrimination Statement

• A patient has the right to information on advanced directives, as required by state or Federal law and regulations. Plastic Surgical Center of Rapid City does not honor “Advanced Directives” (Living Wills), life support will be offered at all times.
• A patient has the right to be provided, upon request, information pertaining to the process of credentialing of the practitioners rendering care and treatment at the facility.
• A patient has the right to be informed of the right to change primary or specialty physicians if other qualified physicians are available.
• A patient has the right to be provided with information regarding the absence of malpractice insurance coverage.
• A patient has the right not to be misled by the organization’s marketing or advertising regarding their competence and capabilities.
• A patient has the right to be free from mental and physical abuse, free from exploitation, and free from use of restraints unless they are authorized by a physician for a limited period of time to protect the patient or others from injury.
• A patient has the right to not be required to perform work for the facility unless the work is part of the patient’s treatment and is performed voluntarily by the patient.
• A patient has the right to obtain the names, addresses, and telephone numbers from the Director, or designee, of the governmental offices where complaints may be lodged.

Patient Responsibilities:

• The ambulatory surgery facility expects that a patient will provide accurate and complete information about matters relating to his/her health history in order for the patient to receive medical treatment.
• For general anesthesia or local anesthesia with monitored anesthesia care the patient will be required to stay within a 25 mile radius of Rapid City, SD.
• A patient is responsible for reporting whether he/she clearly comprehends a contemplated course of action and what is expected of them.
• The ambulatory surgery facility expects that the patient will cooperate with all ambulatory surgery facility personnel and ask questions if directions and/or procedures are not clearly understood.
• A patient is expected to be considerate of other patients and ambulatory surgery facility personnel and to observe the no smoking policy of the facility. A patient is also expected to be respectful of the property of other persons and the property of the ambulatory surgery facility.
• A patient, or patient designee, is expected to help the physician, nurses and other medical personnel in their efforts to care for the patient by following their instructions and medical orders.
• A patient assumes financial responsibility of paying for all services rendered whether through third part payors (his/her insurance company) or being personally responsible for payment for any services that are not covered by his/her insurance policies.
• A patient will not take any drugs that have not been prescribed by his/her attending physician and administered by the ambulatory surgery facility staff.

NOTICE INFORMING INDIVIDUALS ABOUT NONDISCRIMINATION AND ACCESSIBILITY REQUIREMENTS NONDISCRIMINATION STATEMENT:

Discrimination is Against the Law:

Plastic Surgical Center of Rapid City Prof LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Plastic Surgical Center of Rapid City Prof LLC does not exclude people or treat them differently because of race, color, national origin, age disability, or sex.

Plastic Surgical Center of Rapid City, Prof., L. L. C. erfüllt geltenden bundesstaatliche Menschenrechtsgesetze und lehnt jegliche Diskriminierung aufgrund von Rasse, Hautfarbe, Herkunft, Alter, Behinderung oder Geschlecht ab.

Plastic Surgical Center of Rapid City, Prof., L. L. C. cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo

PATIENT'S RIGHTS AND RESPONSIBILITIES AND NON DISCRIMINATION STATEMENT

Plastic Surgical Center of Rapid City Prof LLC:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-605-343-6714 (TTY: 1-888-781-4262).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-605-343-6714 (TTY: 1-888-781-4262).

If you need these services, contact the Director.

If you believe that Plastic Surgical Center of Rapid City Prof LLC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: the Director of Plastic Surgical Center of Rapid City Prof LLC, 3615 5th Street, Rapid City, SD 57701 (605)-343-6417 Toll Free: 866-568-9780 (605) 343-2130 FAX; email: This email address is being protected from spambots. You need JavaScript enabled to view it.

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, the Director is available to help you.

You can also file a civil rights complaint with the US Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

US Department of Health and Human Services
200 Independence Avenue SW
Room 509F, HHH Building
Washington, DC 20201
1-800-368-1019, 1-800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Plastic Surgical Center of Rapid City Prof LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.