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Patient Rights & Responsibilities

Protect Your Rights, Know Your Responsibilities

Every team member at the Jackson Siegelbaum Endoscopy Center upholds high standards to protect your rights and privacy as a patient. As health care professionals, it is a duty we take seriously.

As a patient, you also have an obligation to yourself and your care team to uphold certain standards. These responsibilities help protect your rights and privacy, and also help ensure you receive the best possible treatment while you’re in our care.

Please take a few moments to review your Patient Rights and Responsibilities below.

Patient Information

Advance Directives

A written document that tells health professionals what care a patient would like to receive or not receive should he or she become unable to express his or her wishes. The West Shore Endoscopy Center will accept an advance directive if it is properly completed and authorized by the patient. The patient must be a capacitated person who is at least 18 years of age or is an emancipated minor. The physician will decide if he or she can follow the wishes of the advance directive subject to the limitations, on the basis of conscience, by the Center.  As specialists, providing outpatient care in an ambulatory setting, it is the policy of The West Shore Endoscopy Center to stabilize the patient and transport him/her to the hospital, should an untoward event occur.  A copy of the advance directive will accompany the patient, if provided to the center at the time of admission. If the physician cannot honor the advance directive, the patient may be transferred to another physician or facility. Pennsylvania advance directive forms are available if requested or online at

Nondiscrimination Notice

Services provided by The West Shore Endoscopy Center will be provided without discrimination due to a person’s race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, medical conditions, including but not limited to mental disability, HIV or AIDS, genetic information or disability.

Informed decisions

As the patient or the patient’s surrogate, you have the right to make informed decisions regarding your care, and we at the West Shore Endoscopy Center value and promote the exercise of these rights.

Federal and PA Regulations

State that patients need to be aware of their patient rights in advance of their procedure. West Shore Endoscopy Center is dedicated to protect and promote the rights of our patients.

Your Physician

May have a financial interest in this facility, and you are free to choose an alternate facility for your procedure.

Patient’s Rights

  1. A patient has the right to respectful care given by competent personnel.
  2. A patient has the right, upon request, to be given the name of his attending practitioner, the name of all other practitioners directly participating in his care and the names and functions of other health care persons having direct contact with the patient.
  3. A patient has the right to obtain a copy of their PHI, in the format of their choosing (i.e. electronic format or printed) within 30 days from the date the initial request is made.
  4. A patient has the right to consideration of privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are considered confidential and shall be conducted discreetly.
  5.  A patient has the right to be notified in the event of a breach of the individual’s health information.
  6. A patient has the right to have records pertaining to his medical care treated as confidential except as otherwise provided by law or third party contractual agreements.
  7. A patient has the right to request that a health plan not be informed of treatment that was paid for in full by the individual.
  8. A patient has the right to know what ambulatory surgery facility rules and regulations apply to his conduct as a patient.
  9. The patient has the right to expect emergency procedures to be implemented without unnecessary delay.
  10. The patient has the right to good quality care and high professional standards that are continually maintained and reviewed.
  11. The patient has the right to full information in layman’s terms, concerning diagnosis, treatment and prognosis, including information about alternative treatments and possible complications. When it is not medically advisable to give information to the patient, the information shall be given on his behalf to the responsible person.
  12. Except for emergencies, the practitioner shall obtain the necessary informed consent prior to the start of a procedure.
  13. A patient or, if the patient is unable to give informed consent, a surrogate, has the right to be advised when a practitioner is considering the patient as part of medical care research program or donor program, and the patient, or surrogate, shall give informed consent prior to the actual participation in the program. A patient, or surrogate, may refuse to continue in a program to which he has previously given informed consent.
  14. A patient has the right to refuse drugs or procedures, to the extent permitted by statute, and a practitioner shall inform the patient of the medical consequences of the patient’s refusal of drugs or procedures.
  15. A patient has the right to medical and nursing services without discrimination based upon age, race, color, religion, sex, national origin, handicap, disability or source of payment.
  16. The patient who does not speak English shall have access, when possible, to an interpreter.
  17. The ambulatory surgery facility shall provide the patient, or surrogate, upon request, access to the information contained in his medical records, unless access is specifically restricted by the attending practitioner for medical reasons.
  18. The patient has the right to expect good management techniques to be implemented within the ambulatory surgery facility. These techniques shall make effective use of the time of the patient and avoid the personal discomfort of the patient.
  19. When an emergency occurs and a patient is transferred to another facility, the surrogate shall be notified. The institution to which the patient is to be transferred shall be notified prior to the patient’s transfer.
  20. The patient has the right to examine and receive a detailed explanation of his bill.
  21. A patient has the right to expect that the ambulatory surgery facility will provide information for continuing health care requirements following discharge and the means for meeting them.
  22. A patient, or their surrogate, has the right to be informed of his rights at the time of admission.
  23. Other uses and disclosures of PHI not described in this Notice will be made only with authorization from the individual. Specifically, PHI will not be used or sold for fundraising or marketing purposes.

The patient has the right to exercise his or her rights without being subjected to discrimination or reprisal, voice grievances regarding treatment or care that is or fails to be furnished, be fully informed about a treatment or procedure and the expected outcome before it is performed.

If, when you are a patient here, you feel your rights have been violated, please contact:

West Shore Endoscopy Center
423 N. 21st Street, Suite 100
Camp Hill, PA  17011


PA Dept. of Health
Department of Acute & Ambulatory Care
Health & Welfare Building,
Room 532
625 Forster Street
Harrisburg, PA 17120
(717) 783-8980
Web site:


The office of the Medicare Beneficiary Ombudsman
Please contact 1-800-MEDICARE
Web site:


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