This document is meant to inform our patients of their rights and responsibilities while undergoing medical care. To the extent permitted by law, patient rights may be delineated on behalf of the patient to his or her guardian, next of kin, or legally authorized responsible person if the patient: a) has been adjudicated incompetent in accordance with the law, b) is found to be medically incapable of understanding the proposed treatment or procedure, c) is unable to communicate his or her wishes regarding treatment, or d) is a minor.  If there are any questions regarding the contents of this notice, please notify any staff member.


We, at Cedar Park Surgery Center, an ambulatory surgery center, present a Patient’s Bill of Rights and Responsibilities with the expectation that they will contribute to more efficient patient care and greater satisfaction for the patient, family, physician and center organization.


Patients shall have the following Rights and Responsibilities without regard to age, race, sex, religion, culture, physical handicap, and personal values or beliefs.



  • You, the patient, have the right to accept or refuse medical care or treatment to the extent of the law.  You will be informed of the medical consequences of such refusal.  You are responsible for your actions should you refuse treatment or fail to follow your physician or surgery center’s instructions.  You will be requested to sign a release of responsibility form.
  • You have the right to approve or refuse the release of your medical record to an individual outside the surgery center.  The exceptions being in case of a transfer to another medical facility, required by law or third party payment contract (your insurance company).
  • You and or your designated representative have the right to be fully informed before transfer to another facility.
  • The care rendered reflects consideration of you as in individual with personal values and a belief system.  You are allowed to express your spiritual beliefs and cultural practices that do not harm others or interfere with your planned care/medical interventions.
  • Your designated representative has the right to participate in the consideration of ethical issues that arise during your care.
  • You will be treated with consideration, respect, and full recognition of individuality, including privacy and safety in treatment and care.  The surgery center will keep records and all personal matters that relate to you confidential.
  • You will be provided with complete information to the extent of the physician’s knowledge regarding diagnosis, treatment, and prognosis as well as alternative treatments for procedures and the possible risks and side effects associated with the treatment process prior to undergoing such treatment or procedure.
  • You will be informed about pain and pain relief measures.  You can expect a concerned staff who are committed to pain prevention and effective pain management who believe your reports of pain and who respond quickly to your reports of pain.
  • You or a designated representative will be fully informed of the services and provisions for after-hours and emergency care available at the surgery center.
  • You have the right to information regarding fees, payment policies, and may request an explanation of your bill regardless of the source of payment.
  • You have the right to inquire about the professional status of individuals providing your care.  And to receive care of a safe setting.
  • You have the right to be free from all forms of abuse or harassment.
  • You have the right to express grievances/complaints and suggestions at any time.
  • You will receive the care needed to help you regain or maintain your maximum state of health.
  • You have the right to present an Advance Directive, such as a living will or healthcare proxy.  A copy of any Advance Directive may be provided to the surgery center and physician.  However, it is our policy that if an adverse event occurs during your treatment at this surgery center we will initiate resuscitative or other stabilizing measures and transfer you to an acute care hospital.
  • You have the right to exercise these rights without being subjected to discrimination or reprisal





  • You have the responsibility to observe the rules and regulations of the center for your stay and treatment.  If the instructions by the surgery center staff are not followed, you may forfeit the right to care at the center and you will be responsible for your own outcomes.
  • You are responsible for promptly fulfilling your financial obligation to the surgery center.
  • You have the responsibility to be considerate of other patients, families, and personnel by assisting in the control of noise, smoking, and other distractions.  You and your family are expected to respect the property of others.
  • You are responsible for reporting to the staff whether or not you understand the planned course of your treatment and what is expected of you.
  • You have the responsibility to ask your doctor or nurse any questions you have concerning pain management or pain relief options and to assist your doctor or nurse in assessing your pain.  You are expected to tell your doctor or nurse about any concerns you have about taking pain medication.
  • You are responsible for notifying the center or your physician if you can not keep your appointment.
  • You and your family are responsible for providing the caregivers with accurate and complete information regarding present conditions, past illnesses, hospitalizations, medications, or any other pertinent medical history.
  • It is your responsibility to fully participate in decisions involving your care and to accept the consequences of these decisions.
  • You are expected to follow up on your doctor’s instructions, take medications when prescribed, and ask questions concerning your health care that you feel are necessary.



Please feel free to ask any questions or talk about any concerns with your health care team.  If you are not satisfied, please call our Patient Representative Department at 512-498-9006.  Also, you have the right to contact an agency listed below:


Accreditation Association for Ambulatory Health Care

5250 Old Orchard Road, Suite 200

Skokie, IL 60077

Tel:  847/853-6060

Fax:  847/853-9028



Texas Department of State Health Services

P.O. Box 149347

(Physical address: 1100 W. 49th Street)

Austin, TX 78756

Toll Free 1-888-963-7111 or 512-458-7111

TDD Relay 1-800-735-2989



Medicare Ombudsman

Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850

Toll Free 1-800-MEDICARE (1-800-633-4227)

TTY 1-877-486-2048


You are the center of your health care team.

No question is insignificant.  Ask about anything you don’t understand.