DISCLOSURES

Ownership

Powder River Surgery Center is a joint venture with Powder River Physician Holdings, LLC (majority), who is a partnership of physician that also perform procedures at Powder River Surgery Center, and Campbell County Hospital District (minority). Our physician partners are posted in the lobby of the surgery center.

Partners

A list of our partners is listed in the lobby of the surgery center. Partners invest in our center to share our vision of providing high quality patient care to this community, at a lower cost, while continuing to meet the stringent CMS and AAAHC standards.

 

ADVANCED DIRECTIVES

Patient rights - Advanced Directive Policy

Powder River Surgery Center (PRSC) shall comply with state statues and court decisions regarding advance directives. PRSC shall not condition provision of care or otherwise discriminate against an individual based on whether or not individual has executed an advance directive.

Procedure

  • Advance Directives is defined as a written instruction that relates to the provision of health care when the individual is incapacitated, such as a durable power of attorney for health care, a declaration pursuant to the Natural Death Act, or living will.

  • Life sustaining efforts will be initiated and maintained on all patients during their stay at Powder River Surgery Center.

  • Copies of advance directives will accompany any patient being transferred to another facility---where your Living Will will be honored.

  • Upon each patient encounter information regarding any changes to or implementation of an advance directive or living will be obtained from the patient or family member.

 

WYOMING LIVING WILL - ADVANCED DIRECTIVES

Please go to http://livingwillforms.org/wy/ for access to the Wyoming Living Will and the Wyoming Power of Attorney forms at no cost. Copies are available at the center upon request.

The Wyoming Living Will, also called a Health Care Directive Form is representative of US statutes §§35-22-201 to 35-22-416. It is created to allow a patient, also referred to as a principal, to legally choose the medical treatment they get when unable to make these choices at that particular time. This living will document requires two witnesses to sign it to make it legally binding and is invalid if the principal is found to be pregnant.

 

The Wyoming Power Of Attorney For Health Care Decisions form legally permits an appointed person, who is usually referred to as an `Agent, to make medical welfare decisions regarding a patient and on their behalf should the patient become incoherent and unable to do so because of serious illness. The document requires signatures from two witnesses or an oral confirmation in the presence of two witnesses. The document is in accordance with the US Statutes§35-22- 401 to -416.

 

PATIENT RIGHTS & RESPONSIBILITIES

Patient Rights

  • TO be treated with courtesy and respect, with appreciation of his or her individual

  • dignity, and with protection of his or her need for privacy.

  • TO a prompt and reasonable response to questions and requests.

  • TO know who is providing medical services and who is responsible for his or her care.

  • TO know what patient support services are available, including whether an interpreter is available if he or she does not speak English.

  • TO know what rules and regulations apply to his or her conduct.

  • TO be given by the health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.

  • TO refuse any treatment, except as otherwise provided by law.

  • TO be given, upon request, full information and necessary counseling on the availability of known financial resources for his or her care.

  • TO A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment, whether the health care provider or health care facility accepts the Medicare assignment rate.

  • TO receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.

  • TO receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.

  • TO impartial access to medical treatment or accommodations, regardless of race, gender disability, color, ancestry, citizenship, pregnancy, sexual orientation, gender idenity or expression, marital status, vetran status, national origin, religion, handicap, source of payment, or any other basis prohibited by federal, stat, or local law.

  • TO treatment for any emergency medical condition that will deteriorate from failure to provide treatment.

  • TO know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in such experimental research.

  • TO express grievances regarding any violation of his or her rights, as stated in CMS law, through the grievance procedure of the health care provider or health care facility which served him or her and to the appropriate state licensing agency.

Patient Responsibilities

  • FOR providing to the health care provider, to the best of his or her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.

  • FOR reporting unexpected changes in his or her condition to the health care provider.

  • FOR reporting to the health care provider whether he or she comprehends a contemplated course of action and what is expected of him or her.

  • FOR following the treatment plan recommended by the health care provider.

  • FOR keeping appointments and, when he or she is unable to do so for any reason, for notifying the health care provider or health care facility.

  • FOR his or her actions if he or she refuses treatment or does not follow the health care provider’s instructions.

  • FOR assuring that the financial obligations of his or her health care are fulfilled as promptly as possible.

  • FOR following health care facility rules and regulations affecting patient care and conduct.

 

 

PATIENT RIGHTS - GRIEVANCES

Powder River Surgery Center

906 W. 6th Street, Suite C, Gillette WY 82716

Director: 307-696-8240

Website: www.PowderRiver-SC.com

 

Wyoming Department of Health

400 W. Quest of Health, 6101 N. Yellowstone Road, Cheyenne, WY 82002

Phone: 307-777-7123

Email: wdh-ohls@health.wyo.gov

 

Centers for Medicare and Medicaid

Website: www.medicare.gov

Ombudsman: www.cms.hhs.gov/center/ombudsman.asp

 

US Department of Health and Human Services - Discrimination Grievance

Website: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf

Email: OCRMail@hhs.gov

Phone: 800-368-1019

TDD: 800-537-7697

 

Effective as of May 25, 2021