I. The patient shall be informed of his/her rights as evidenced by written documentation of a signed copy of the patient’s bill of rights and a verbal explanation given, in terms that the patient can understand. The signed copy of the Bill of Rights will be placed in the patient’s chart as part of the permanent medical record.

II. The patient will be informed of the services offered at the Union County Surgery Center, the names of the professional staff and their professional status of who is providing and/or responsible for their care.

III. The patient will be informed of the fees and related charges, including the payment, fee, deposit, and refund policy of the Union County Surgery Center and any changes not covered by third-party payers or by the Union County Surgery Center’s basic rate.

IV. The patient will be informed of other health care and educational institutions participating in the patient’s treatment. The patient will be informed of the identity and the function of these institutions, and he/she has the right to refuse the use of such institutions.

V. The patient will be informed, in terms that the patient can understand, of his/her complete medical/health condition or diagnosis, the recommended treatment, treatment options, including the option of no treatment, risks of treatment, and expected results. If this information would be detrimental to the patient’s health, or if the patient is not capable of understanding the information, then the information will be provided to the patient’s next of kin or guardian. This release of information to the next kin or guardian, along with the reason for not informing the patient directly will be documented in the patient’s chart.

VI. The patient will participate in the planning of his/her care, and has the right to refuse such care and medication. Upon refusal it will be documented in the patient’s chart.

VII. The patient will be included in experimental care if the patient has agreed to such and gives written and informed consent to such treatment, or when a guardian has consented to such treatment. The patient also has the right to refuse such experimental treatment, including the investigation of new drugs and medical devices.

VIII. The patient has the right to know the grievance process and to voice grievances or recommended changes in policies and services to the Union County Surgery Center personnel, the governing authority and/or outside representatives of the patient’s choice, free from restraint, interference, coercion, discrimination, or reprisal.

IX. The patient will be free from mental and physical abuse, free from exploitation, and free from use of restraints. Drugs and other medications shall not be used for discipline of patients or for convenience of the Union County Surgery Center’s personnel.

X. The patient will be assured of confidential treatment of information about him/herself. Information in the patient’s medical record shall not be released to anyone outside the facility without the patient’s approval, unless is done according to state and federal law.

XI. The patient will receive courteous treatment, consideration, respect and recognition of the patient’s dignity, individuality and right to privacy, including, but not limited to, auditory and visual privacy. The patient’s privacy shall also be respected when facility personnel are discussing the patient.

XII. The patient has the right to exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices, or any attendance at religious services, shall be imposed upon any patient.

XIII. The patient will not be discriminated against because of age, race, religion, sex, nationality, or ability to pay, or deprived of any constitutional, civil, and/or legal rights solely because of receiving services from the facility.

XIV. The Director of Operations will provide upon request to all patients and/or their families, the names, addresses, and telephone numbers of the following offices where complaints may be lodged:

Division of Health Facilities
Evaluation and Licensing
New Jersey Department
of Health
PO Box 367
Trenton, NJ 08625-0367
(609) 792-9770
State of New Jersey
Office of the Ombudsman for
the Institutionalized Elderly
PO Box 808
Trenton, NJ 08625-808
(609) 624-4262
Union County Surgery Center
950 W. Chestnut St.
Union, NJ 07083
(908) 688-2700

XV . The Director of Operations shall also provide all patients and/or their families, upon request, the names, addresses and telephone numbers of offices where information concerning Medicare and Medicaid coverage may be obtained. Patients have the right to be provided with appropriate information regarding absence of malpractice insurance coverage.

XVI. Addresses and telephone numbers contained in #15 and #16 will be conspicuously posted throughout the facility, including, but not limited to, the admissions waiting room, the patient service area of the business office, and other public areas.

XVII. Patients have the right to optimal pain assessment and management.

XVIII. The patient has the right to address disclosure of physician financial interest in the Union County Surgery Center and advanced directives.


  1. To give complete and detailed information regarding past, present medical and surgical condition.
  2. To inform us of any and all drugs herbal supplements, prescription and non prescription drugs they take and type of untoward reaction they have to drugs or exposure to certain chemicals/ materials.
  3. To assume complete responsibility for payments of services provided.
  4. To be responsible for medical and related consequences resulting from, refusal of treatment or for not following instructions of the physicians/ nurses of the Center.
  5. To be considerate of the assets and employees of the Center.
  6. The patient will have a responsible adult to transport him/her from the facility and remain with him/her for 24 hours.

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