Patient Bill of Rights

Patient Bill of Rights  (download)


As a Patient, You Have the Right to:

  • Considerate, respectful care at all times and under all circumstances with recognition of your personal dignity.

  • You have the right to expect services without regard to race, color, national origin, disability, or age, as required by Federal law. If you believe discrimination has happened to you or any specific class of individuals because of race, color, national origin, age, sex, disability or religion by a health care or human services provider (such as hospitals, nursing homes, social service agencies, etc.), you or your representative may file a complaint with the Office for Civil Rights (OCR). Complaints against the U.S. Department of Health and Human Services alleging discrimination in services on the basis of disability may also be filed with OCR. Complaints usually must be filed within 180 days from the date of the alleged discriminatory act. (OCR may extend the 180-period if good cause to do so is shown).

  • Personal and informational privacy.

  • Confidentiality of records and disclosures. Except when required by law, you have the right to approve or refuse the release of records.

  • Information concerning your diagnosis, treatment, and prognosis, to the degree known.

  • The opportunity to participate in decisions involving your healthcare.

  • Competent, caring healthcare providers who act as your advocates.

  • Know the identity and professional status of individuals providing service.

  • Adequate education regarding self-care at home written in language you can understand.

  • Make decisions about medical care, including the right to accept or refuse medical or surgical treatment.

  • You have the right to a translator if you are non-English proficient. Every attempt will be made to find a translator that speaks your language.

No catalog of rights can guarantee the patient the kind of treatment he/she has a right to expect. This facility has many functions to perform, including the prevention and treatment of disease, the education of both health professionals and patients. All these activities must be conducted with an overriding concern for the patient, and, above all, the recognition of his dignity as a human being. Success in achieving this recognition assures success in the defense of the rights of the patient.

As a Patient, You Are Responsible For:

  • Providing, to the best of your knowledge, accurate and complete information about your present health status and past medical history and reporting any unexpected changes to the appropriate practitioner(s).

  • Following the treatment plan recommended by the primary practitioner involved in your case.

  • Providing an adult to transport you home after surgery and an adult to be responsible for you at home for the first 24 hours after surgery.

  • Indicating whether you clearly understand a contemplated course of action and what is expected of you and ask questions when you need further information.

  • Your actions, if you refuse treatment, leave the facility against the advice of the practitioner, and/or do not follow the practitioner’s instructions relating to your care.

  • Ensuring that the financial obligations of your healthcare are fulfilled as expediently as possible.

  • Providing information about any power of attorney.


There are many types of advance directives: the two most common forms are the living will and durable power of attorney. At Great Lakes Eye Surgery Center, we will accept a copy of your advance directives; and if a life threatening situation should occur, we will stabilize you, and send you with your directives to the next level of care. If you disagree, you must address this issue with your physician prior to surgery. If you do have an Advanced Directive, please bring a copy with you the day of surgery.

We are required to inform you that the Great Lakes Eye Surgery Center is owned by:

F. K. Shokoohi, M.D. J. M. O’Grady, M.D. B. D. Dudenhoefer, MD.

D. W. Blodgett, M.D. K. K. Shokoohi, M.D., Ph.D.

GREAT LAKES EYE SURGERY CENTER encourages recognition and correction of any risks to patient safety. Please speak up to help us make your procedure a safe, positive experience. Any concerns or issues regarding your care can be discussed directly with our Manager at (989) 752-6200 or reported directly to the following organizations:

Department of Community Health Joint Commission on Accreditation Bureau of Health Systems for Healthcare Organizations

P. O. Box 30664 One Renaissance Boulevard

Lansing, MI 48909 Oakbrook Terrace, IL 60181

(800) 882-6006 (800) 994-6610 or email to

**Website for the Medicare Beneficiary Ombudsman: or 1-800-4227 or