Patient Rights Notice & Advance Directive Information
AMBULATORY SURGERY CENTER
Notice
PolicyThis notice is provided to every patient prior to any surgical or procedural visit.
YOUR RIGHTS AS A PATIENT (42 CFR §416.50)
Rights- ✔ Dignity & Respect — To be treated with respect and consideration.
- ✔ Privacy — Personal privacy at check-in and in treatment areas.
- ✔ Informed Decisions — To participate in and be fully informed about your care.
- ✔ Interpreter Services — Available if you do not speak English.
- ✔ Voice Grievances — To file a complaint without fear of retaliation.
- ✔ Financial Disclosure — Written notice of physician ownership in this ASC.
- ✔ Confidentiality — HIPAA-protected treatment of your medical information.
- ✔ Change Providers — To change your provider if others are available.
HOW TO FILE A COMPLAINT
ContactYou may report concerns about your care to any of the following:
Where to Report Concerns
Texas Health &
Human Services
(State Agency)
📮 P.O. Box 149347, Austin TX 78714
Legent ASC Facility Contact
Ask any staff member for the charge nurse, facility administrator, or Quality Staff. You may file a concern at any time without fear of affecting your care.
ADVANCE DIRECTIVES — YOUR RIGHTS & OUR POLICY
DirectivesAn advance directive is a legal document stating your healthcare wishes and/or designating someone to make medical decisions for you if you are unable to do so. Texas law provides:
Directive to Physicians
(Living Will) — States wishes about life-sustaining treatment if you have a terminal or irreversible condition.
Medical Power of Attorney
Designates a healthcare agent to make medical decisions on your behalf if you lose capacity to communicate.
Out-of-Hospital DNR
Instructs EMS not to attempt resuscitation outside a hospital. Must be signed by a physician.
What to Do
Have an advance directive? Bring it on the day of your procedure. A copy will be placed in your chart.
No advance directive? You are not required to have one. Staff will ask and document YES or NO in your record.
Want to create one? Free official Texas forms: texasattorneygeneral.gov
Facility Resuscitation Policy
Facility Resuscitation Policy: If an adverse event occurs during your treatment, our medical team will initiate resuscitative and stabilizing measures and, if necessary, transfer you to an acute care hospital. If you have a DNR order, your surgeon and anesthesia provider will discuss the perioperative implications with you before your procedure. You may choose to proceed, modify the DNR for the duration of the procedure, or have the procedure performed at another facility.