We respect the dignity and pride of each individual we serve. We comply with applicable Federal civil rights laws and do not discriminate on the basis of age, gender, disability, race, color, ancestry, citizenship, religion, pregnancy, sexual orientation, gender identity or expression, national origin, medical condition, marital status, veteran status, payment source or ability, or any other basis prohibited by federal, state, or local law. Each individual shall be informed of the patient's rights and responsibilities in advance of administering or discontinuing patient care.
Respetamos la dignidad y el orgullo de cada persona que atendemos. Cumplimos con las leyes y derechos civiles federales y no discriminamos por cuestiones de edad, sexo, discapacidad, raza, color, ascendencia, ciudadanía, religión, embarazo, orientación sexual, identidad o expresión de género, nacionalidad, estado de salud, estado civil, condición de veterano, fuente o capacidad de pago o cualquier otra causa prohibida por la ley federal, estatal o local. Cada individuo será informado de los derechos y las responsabilidades del paciente antes de administrar o discontinuar la atención del paciente.
The care a patient receives depends partially on the patient him/herself. Therefore, in addition to the above rights, a patient has certain responsibilities. These should be presented to the patient in the spirit of mutual trust and respect.
Introduction:
We value your privacy and are committed to protecting your personal information. This privacy policy outlines how we collect, use, and protect your data in compliance with 10DLC regulations.
Information Collection:
We collect personal information such as your name, phone number, and email address when you opt-in to receive messages from us.
Use of Information:
Your information is used to provide customer support and improve our services. No phone/mobile number information will be shared with third parties or affiliates for marketing or promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.
Data Security:
We implement security measures to protect your personal information from unauthorized access or disclosure.
User Rights:
You have the right to access, correct, or delete your personal information. Please contact us if you wish to exercise these rights.
Purpose of SMS Communication:
Our practice offers SMS notifications for appointment reminders and patient communication only. This service is not used for marketing purposes, and your phone number will not be shared with third parties. By signing this form, you consent to receive text messages related to your appointments and other necessary patient communications.
Consent and Opt-In:
By providing your phone number, you agree to receive appointment reminders and necessary communications via SMS from our practice. Standard message and data rates may apply. Message frequency may vary. Reply STOP to opt out at any time.
Methods of Obtaining Consent
We obtain consent for SMS communications through the following methods:
Opt-Out Mechanism:
You can opt out of receiving SMS messages at any time by replying STOP to any messages received. If you have questions or need further assistance, you may contact our office directly.
Contact Information:
If you have any questions or concerns about this privacy policy, please contact us at 316-334-1500.
Advance directives include written or verbal directions a patient gives in advance to state choices for health care or name someone to make those choices for the patient if the patient is unable to make decisions for himself/herself. A living will states what kinds of medical treatments would be acceptable at the end of life. You can find DPOA forms and Living Will forms below.
If a patient, who is to receive a procedure at the facility, presents the staff with a living will, the patient must be advised that the policy is to always attempt to resuscitate and to transfer any patient requiring resuscitation or emergency care to the hospital. The hospital can then determine when to implement the living will.
To report a patient rights concern, please contact any of the following:
RN Clinical Director
Erin Schueller, RN, BSN
1540 N Lindberg Circle
Wichita, KS 67206
Phone: (316) 334-1500
State Reporting Agency
Kansas Dept. of Health and Environment, Health Facilities Program
1000 SW Jackson Street, Suite 330
Topeka, KS 66612
Phone: (785) 296-1258
Medicare Ombudsman
File a complaint at Medicare.gov
Accrediting Organization
The Joint Commission
1 Renaissance Blvd.
Oakbrook Terrace, IL 60181
General inquiries: (630) 792-5800
Patient Rights and Notification of Physician Ownership (pdf)
DownloadSurgical Informed Consent (pdf)
DownloadAnesthesia Consent (pdf)
DownloadPremium Lens Consent (pdf)
DownloadPost-Op Instructions for Cataract Surgery (pdf)
DownloadReceipt Notice of Privacy Practice & Patient Communication Form (pdf)
DownloadAdvanced Directives (pdf)
DownloadDurable Power of Attorney - English (pdf)
DownloadDurable Power of Attorney - Spanish (pdf)
DownloadLiving Will - English (pdf)
DownloadLiving Will - Spanish (pdf)
DownloadNondiscrimination Statement (pdf)
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