Patient “Bill of Rights” and Responsibilities

• Patients and their property are treated with consideration, dignity and respect, without harassment, abuse, discrimination, reprisal, retribution or denial of care.
• Patients have the right to be protected from abuse and neglect, and have access to protective services.
• Patients have the right to appropriate privacy, confidentiality, security, spiritual care, and communication,
  provided in a safe setting, and in a sanitary environment. In the event that communications restrictions are
  present, such as language barriers, Dermatology of Seattle Surgery Center will make reasonable attempts to
  communicate in the manner primarily used by the patient.
• Patient disclosures and records are treated confidentially, and patients are given the opportunity to approve
  or refuse their release, except when release is required by law.
  Patients are provided, to the degree known, complete information concerning their diagnosis, evaluation,
  treatment and prognosis. When it is medically inadvisable to give such information to a patient, the
  information is provided to a person designated by the patient or to a legally authorized person. Family input
  in care decisions will be provided in compliance with existing legal directives of the patient or existing
  court-issued legal orders.
• Patients are given the opportunity to participate in decisions involving their healthcare, including right to
  refuse care and treatment, and ability to resolve problems with care decisions, except when such
  participation is contraindicated for medical reasons.
• Patients have a right to know the services available, agree to their care and be fully informed about their
  treatment and expected outcome. The patient have a right to be informed of unanticipated outcomes.
• Patients have a right to be informed of provisions for after-hour and emergency care if needed.
• Patients have a right to know the facility fees for services and payment policies.
• Patients have a right to be informed of patient rights, conduct and responsibilities.
• Patients have a right to refuse to participate in experimental research. Patient’s access to care will not be
  hindered by refusal to participate in research.
• Patients will be provided informed consent for any research,
  investigation and clinical trials.
• Patients have a right to be notified of the center’s policy on Advance Directives, as required by state of
  federal law and regulations.
• Patients have a right to know the name and credentials of health care professionals providing their care.
• Patients have the right to change their provider if other qualified providers are available.
  If a patient is not competent to make decisions regarding their care, a legal representative or surrogate
  designated by the patient may exercise the patient’s rights, to the extent of the laws of our state.
• Patients are informed about procedures for expressing suggestions, complaints and grievances, including
  those required by state and federal regulations.
• Patients have a right to timely complaint resolution. The timeframe for resolution of all grievances at
  Dermatology of Seattle Surgery Center is defined as 14 days or less.

Patients have the right to file grievances regarding treatment or care that fails to be furnished. Please contact one of the following if you have complaints or grievances:

• Dermatology of Seattle Surgery Center Administrator 206-988-6836;
• Dermatology of Seattle Surgery Center Owner, Elie Levy MD,PC, 206-248-5020;
• [email protected] PO Box 47857, Olympia, WA 98504-7857 TTY Users dial 711 for
  the Washington Relay
• Service HSQA Complaint Intake: Phone: 1-800-633-6828; Fax: 360-236-2626;
• Office of the Medicare Beneficiary Ombudsman Phone: 1-800-MEDICARE
• The Medicare Beneficiary Ombudsman is available to help patients understand their rights, protections and options. www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman/html

Patient (and/or surrogate) Responsibilities require the patient to:

• Provide complete and accurate information to the best of his/her ability about his/her health, any
  medications, including over-the-counter products and dietary supplements and any allergies or sensitivities.

• Follow the treatment plan prescribed by his/her provider.
• Provide a responsible adult to transport him/her home from the facility and remain with him/her for 24
  hours, if required by his/her provider.
• Inform his/her provider about any living will, medical power of attorney, or other advance directive that
  could affect his/her care.
• Accept personal financial responsibility for any charges not covered by his/her insurance.
• Be respectful of all the health care providers and staff, as well as other patients.
  
  

NOTICE TO ALL PATIENTS: OUR POLICY ON ADVANCED DIRECTIVES

FINANCIAL POLICY

• I understand that I am financially responsible for all charges whether or not paid by insurance.
• Insurance coverage is NOT a guarantee of payment for services provided by my healthcare provider including
  preventive, routine screening, vaccinations, or procedures considered cosmetic in nature.
• It is my responsibility to understand my insurance benefits.
• It is my responsibility to pay any deductible amount, co-insurance, or any other balance not paid for by my insurance.
• Co-payments mandated by my insurance company may not be printed on my insurance card. I understand that co-
  payments are due at the time of service. It is my responsibility to notify the receptionist upon arrival that a co-
  payment is due. Exceptions to co-payments are at the discretion of the Practice Administrator.
  I have been informed that payment is due upon the receipt of my monthly statement.
• Should I have no insurance I understand that payment in full is due at the time of service.
  
  
  

PRE-SURGICAL INSTRUCTIONS

• Q-tips
• Vaseline OR Aquaphor ointment
• Hydrogen Peroxide
• Dressing materials such as Non-adherent Gauze (e.g. Telfa) and Paper Tape

• During the 1-2 weeks after surgery, there is a high risk of stitches popping open with strenuous activity, as well as bleeding, wound healing complications, and a poor scar appearance if the activity restriction is not followed.
• Physical activity includes but is not limited to things such as golf, hiking, swimming, tennis, construction, gardening, and running. Walking is okay.
• You will not be able to swim in a pool or use a hot tub until your sutures are removed or dissolved, or else otherwise instructed by your team.
• For surgeries on the lower extremities in which sutures are placed, you will need to keep off your feet as much as possible for the first 2 weeks after your surgery. We recommend at least 5- 7 days off manual labor.

POST-SURGICAL INSTRUCTIONS

• Please keep the pressure dressing dry and intact for 48 hours (or 2 days). PLEASE DO NOT GET THE BANDAGE WET.
• Elevate: slightly elevate the involved surgical site to decrease pain and swelling.
• Ace bandage (if applied): you may loosen the ace bandage at night, but continue to use during the day.

• 
  Remove the outer pressure dressing.
• Wash the wound with MILD (or fragrance free soap) & water. If there is dry crust you can gently remove with hydrogen peroxide.
• Gently pat the wound dry with a clean washcloth/towel.
• Apply a generous amount of bland ointment (vaseline or aquaphor) and re-bandage.
• Repeat DAILY or twice a day until sutures are removed.
  • Special circumstances:
    • Steri-strips: if placed over the sutures, please leave steri-strips in place. You can wash normally then pat the area dry. There is no need to apply ointmentor re- bandage. Steri-strips will be removed at suture removal. If steri-strips fall off before, please follow steps 2-5 above.
    • Skin grafts: if placed, please leave the yellow bolster intact. You can wash normally then pat the area dry. There is no need to apply ointment or re-bandage.
    • Granulating wounds (wounds not repaired): there may be dry crusty after you remove the pressure bandage. Do not be alarmed. THIS IS NORMAL.
    • Dissolvable sutures: they take 7-21 days to dissolve depending on what suture is used. If the sutures are still present call the office to schedule an appointment for further evaluation.
    • Swelling and bruising are common following Mohs Surgery, particularly when surgery is performed around the eyes and nose. This usually occurs within two to seven days after surgery and may be decreased using an ice pack for 10-20 min every hour during the first 24-48 hours. THIS IS NORMAL and will resolve.

• Most patients do quite well taking extra strength acetaminophen (Tylenol)- follow directions on bottle.
• Although uncommon, a small number of patients may experience some bleeding post- operatively -This can usually be controlled by the use of pressure. To minimize the chances of this occurring, patients are advised to be as minimally active for at least 1 week after surgery as possible. This includes activity restrictions such as:
  • No bending or heavy lifting
  • No rigorous exercise or exertion
  • Do not make important plans in the days immediately following your surgery

• At times, the area surrounding your wound will be numb to the touch. This may persist for
  weeks or months, and in some instances, can be permanent. This is due to trauma to the small
  nerve endings in the skin surface that occurs during removal of the tumor.
• In most instances, you will return to our office in two weeks for removal of the sutures/stitches from the chest down and a post operative check. You will return to our office in 1 week for removal of the sutures/stitches on face and a post-operative check.
• With any surgical procedure, there is a chance of complications. Although every effort will be made to offer the best possible cosmetic result, you will be left with a scar. Proper wound care at home will help the healing process and minimize scarring. If necessary, reconstructive surgery following removal of your skin cancer can result in a more pleasing cosmetic outcome
• Infection is also a possibility following surgery, but it occurs only in one to two percent of patients. Often a small red area may develop surrounding your wound. This is normal and does not necessarily indicate infection. However, if this redness does not subside, and if the wound begins to drain pus or becomes swollen or very tender, you should notify us immediately.
• Please keep in mind that it often takes months before final wound healing is complete and the best cosmetic result is obtained. PLEASE BE PATIENT.
• If you notice any signs or symptoms of a new skin cancer growth at any time, seek consultation with your referring physician immediately. We will gladly schedule an appointment to see you back in our office.
• Finally, skin cancer can recur. The cure rate with Mohs Surgery is greater than 95% but, unfortunately, not 100%. Occasionally, the cancer may come back in the same location.
• Patients should be seen on a yearly basis for a full skin exam.

• Malignant Melanoma: Every 3 months for the next two years
• Squamous Cell Carcinoma: Every 4 months for the next two years
• Basal Cell Carcinoma: Every 6 months