Patient Information

Dear Lecanto Surgery Center Patient,

It is our pleasure to be able to assist in your surgical care. This information is being provided to you in advance of your scheduled procedure so that you may review the information and have the opportunity to ask any questions that may arise on or before the day of your procedure.

This is considered advanced notification of pertinent information about your upcoming visit at Lecanto Surgery Center and is a nationwide requirement by agencies that oversee Ambulatory Surgery Centers through the state of Florida and the United States of America.

In the event prefer an audio format, you may call 352-527-0385 before the date of your procedure to listen to a brief summary of:

  • Your Rights as a Patient
  • Advanced Directives
  • Disclosure of Physician Ownership
  • Suggestion/Grievance Policies
  • Privacy Policies

Once your procedure is scheduled, you will get a phone call message from Lecanto Surgery Center regarding the completion of an online medical health history. It is essential for this to be completed PRIOR to the day of your procedure. Please log onto www.onemp.com, select Lecanto Surgery Center from the drop down list and complete this important information. If you do not have internet access, a nurse will contact you by phone to obtain the information. If you are a returning patient, simply log in to the website and update your information. If you have any questions, please call the Lecanto Surgery Center at 352-527-0102.

Patient Forms

Below is a list of patient forms click on a link to download the form.

Lecanto Surgery Center – Payment Policy

Lecanto Surgery Center- Statement of Financial Responsibility

Patient History


Are you scheduled for surgery?

One week BEFORE your procedure, enter your health history online:

www.onemedicalpassport.com

Patient Notifications

NOTICE OF POLICY REGARDING

ADVANCED DIRECTIVES

To maintain compliance with Federal and State laws (PSDA-Patient Self Determination Act; FL Statute 765.110) regarding Advance Directives, Lecanto Surgery Center requires the folowwing notice to be signed by each patient prior to the scheduled procedure.

Advance Directives are statements that indicate:

  • The type of medical treatment wanted or not wanted in the event an individual is unable to make those determinations.
  • And who is authorized to make those decisions.

The Advance Directives are made and witnessed prior to serious illness or injury.

LIVING WILLS

These generally state the type of medical care an individual wants or does not want if he/she becomes unable to make his/her own decision.

DURABLE POWER OF ATTORNEY

FOR HEALTH CARE

This is a signed, dated and witnessed paper naming another person as an individual’s agent or proxy to make medical decisions for that individual f he/she should become unable to make his/her own decisions.

Each patient may present an Advanced Directive to keep on file within the medical records.

In the ambulatory care setting of Lecanto Surgery Center, if a patient should suffer a cardiac or respiratory arrest or other life-threatening situation arise, the signed consent implies consent for resuscitation and transfer to a higher level of care (i.e.: either Citrus Memorial Hospital or Seven River’s Regional Medical Center).

In the event of a life-threatening event, the physician’s and staff of Lecanto Surgery Center will make all reasonable efforts to stabilize and transfer the patient to the acute care facility of the patient’s choice (as indicated on the surgical consent) where actions can be taken to comply with their directive or treatment decisions. If you disagree with this policy, you MUST address this with your physician prior to your surgical procedure.

PATIENT RIGHTS AND RESPONSIBILITIES

  • To be treated with courtesy and respect, with appreciation of his/her individual dignity and with protection of his/her needs for privacy.
  • To receive impartial access to medical treatment or accommodations, regardless of race, age, national origin or sponsor, religion, disability, sexual orientation, marital status, or source of payment.
  • To be free from mental, physical, sexual and verbal abuse, neglect, harassment and exploitation.
  • To an environment that is safe and secure for self/property.
  • To confidentiality and protection of personal health information (PHI), including access to copies of your PHI, notification of a breach of PHI or options to prevent disclosure of PHI for marketing, fundraising or advertising.
  • To prompt and reasonable response to questions and requests.
  • To know who is providing and is responsible for his/her care as well as their credentials.
  • To change primary or specialty physician if other qualified physicians are available.
  • To know what patient support services are available, including whether an interpreter is available if he/she does not speak English.
  • To know what rules and regulations apply to his/her conduct.
  • To be given by the health care provider information concerning the diagnosis, the planned course of treatment, alternatives, risks and prognosis.
  • To refuse treatment, except as otherwise provided by law.
  • To be given, upon request and prior to treatment, a reasonable estimate of charges and necessary counseling on the availability of known financial resources for his/her care.
  • To receive a copy of an itemized bill and, upon request, to have all charges explained and to be able to request health plan non-disclosure when full-payment is made by pt.
  • To know, upon request, and in advance of treatment, whether the health care provider or health care facility accepts the Advance Directive.
  • To receive treatment for any emergency medical condition that will deteriorate from failure to provide such treatment.
  • To know if medical treatment is for purposes of experimental.research or trials, and to give his/her consent or refusal to participate in such treatment.
  • To designate a patient representative or surrogate who he/she would like to authorize for the disclosure of his/her medical information.
  • To express grievances regarding any violation of their rights, according to Federal and State law, through Lecanto Surgery Center’s grievance procedure and to the appropriate state-licensing agency.
  • To participate in all aspects of his/her health care decisions unless contraindicated by concerns for immediate health.
  • To appropriate assessment and management of pain.

NOTICE OF DISCLOSURE OF OWNERSHIP INTEREST

Lecanto Surgery Center is owned by a group of local physicians, one of whom may be your physician. The physicians that maintain ownership of Lecanto Surgery Center are Paresh Desai, M.D., Michael Desautel, M.D., Udaya Kumar, M.D. and Manuel Seneriz, M.D. These physicians have become owners as a result of their commitment to quality healthcare and service to their patients.

Under current Florida law, a physician owned facility may not provide services to a patient unless the patient signs a written notice disclosing these matters. You will be asked to sign this notice in your admission paperwork.

A schedule of typical fees for services provided by the facility is available at your request.

You have the right to choose where to receive services, including an entity in which your physician may have a financial relationship. Two reasonable alternatives for your procedure are Citrus Memorial Hospital and Seven Rivers Regional Medical Center.

SUGGESTIONS, COMPLAINTS, APPRECIATION – PLEASE LET US KNOW!

It is the mission of our organization to provide the level of care we wish for our loved ones or ourselves. We welcome suggestions and complaints, as well as appreciation. Your feedback is IMPORTANT to help us improve patient care and our environment. You may express your concern or complaint at any time to a staff member, department head, or administrator. The administrator reviews all complaints and attempts to rectify any issue within 48 hours of receipt. You will receive a written notice within 7 days that will describe notice of our decision, the steps taken to investigate the grievance, the results of the grievance process and the date of completion. Please contact our Administrator anytime at 352-527-0102. You may also contact the Florida Department of Health or Medicaid/Medicare at www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html.

Anesthesia

Below is a patient form click on the link to download the form.

Citrus Anesthesia Providers – Financial Policy

For billing inquiries or payment options, please contact our billing office at:

364 Private Road 8581
Winnsboro, Texas 75494

(Call) 903-725-3595
(Fax) 903-725-3599

Urodynamics

Advanced Urology Specialists is well known throughout Central Florida for our commitment to excellence in urology. We are the region’s most trusted resource for specialized care of male and female urological conditions.

Our urologists are specialists trained in the latest techniques for treatment of urologic problems with emphasis on minimally invasive procedures. Each of our physicians – urologists, pathologists and radiation oncologists – are board certified and will work with you to find the most effective treatment to meet your individual needs, allowing you to be treated with minimal interruption to your lifestyle.

Advanced Urology – Inverness

Advanced Urology – Homosassa