Patient Information

Your Privacy

This Privacy Notice describes how we may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your right to access and control your protected health information. Your “protected health information” means any written or oral information about you, including demographic data that can be used to identify you, created or received by your health care provider, which relates to your past, present and future physical, mental health or condition.

Good Faith Estimates

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1.800.985.3059.

Hospital Partner

Disclosure of Physicians Ownership Interest

Due to your physician’s concern over improving the quality and reducing the cost of medical procedures, along with a number of other physicians, he or she may have invested in North Garland Surgery Center, LLP, DBA Baylor Scott & White Surgicare – North Garland. Your physician’s ownership interest in North Garland Surgery Center does however mean that your physician may benefit from choosing to perform your surgical procedure at this facility. The investment provides your physician an opportunity to retain quality control over your medical procedures, and to ensure that your medical costs are reasonable.

Your physician hereby advises you that you have the right to choose to be treated at another facility and select a doctor that is not invested in the hospital.

We are proud to be affiliated with Baylor Scott & White Health.

*Joint Venture between Baylor Scott & White Health Baylor Scott and White Health and United Surgical Partners International, Inc.

Please feel free to request more information about this partnership by calling 214.703.1800.

Quality Care and Safety

Baylor Scott & White Surgicare – North Garland is accredited by The Joint Commission.

Baylor Scott & White Surgicare – North Garland is fully accredited by The Joint Commission. The Joint Commission evaluates and accredits more than 15,000 health care organizations and programs in the United States. An independent, not-for-profit organization, The Joint Commission is the nation’s preeminent standards setting and accrediting body in health care. Since 1951, The Joint Commission has maintained standards that focus on improving the quality and safety of the care health care organizations provide.

The Joint Commission’s comprehensive accreditation process evaluates an organization’s compliance with these standards and other requirements. The Joint Commission accreditation is recognized internationally as a symbol of quality and reflects an organization’s commitment to meeting performance standards. To earn and maintain the JC’s Gold Seal of Approval, an organization undergoes an unannounced, on-site survey by a Joint Commission survey team at least every three years.

For more information please visit the website, email or call:

Website: jointcommission.org

Email: [email protected]

Phone: 1.800.994.6610

Your Rights and Responsibilities

Texas Department of State Health Services

Health Facility Licensing and Compliance Division Customer Service Representative

PO Box 149347

Austin, Texas 78714-9347

Phone 512.458.7111 or 1.888.963.7111

TDD 1.800.735.2989

The Office of the Medicare Beneficiary Ombudsman

http://www.cms.gov/Center/Special-Topic/Ombudsman-Center.html

A complainant may provide his/her name, address and phone number to the department. Anonymous complaints may be registered. All complaints are confidential.

Complaints about physicians as well as other licensees and registrants of the Texas Medical Board, including physician assistants and acupuncturists, may be reported for investigation at the following address:

Texas Medical Board

Investigations Department, MC-263

PO Box 2018

Austin, TX 78768-2018

1.800.201.9353