Patient Grievance and Advance Directive
Patient Rights - Notice of Filing a Complaint or Grievance
Village SurgiCenter recognizes that the patient, or their representative, has the right to express a grievance or complaint with regard to their visit at this Facility.
To file a complaint or grievance you have the right to contact any of the follow:
- Village SurgiCenter – Richard Bloxdorf, MHA, Administrator; John Desser, RN,CNOR, Clinical Nurse Manager; Cindy Martin, RN, Patient Safety Officer; or Bonnie Sturdivant, Business Office Manager
5473 Village Common Drive, Suite 100
Erie, PA 16506
814-836-0770 - Pennsylvania Department of Health:
Complaint Hotline: 1-800-254-5164
PA Dept of Health Division of Acute and Ambulatory Care
625 Forster Street
Harrisburg, PA 17120-0701 - Quality Insights of Pennsylvania – 1-800-322-1914
www.qipa.org - Centers for Medicare and Medicaid Services – CMS- Office of Medicare Beneficiary Ombudsman
1-800-MEDICARE (633-4227); TTY 1-877-486-2048
www.cms.hhs.gov/center/ombudsman.asp
Advance Directive
Patients will be informed of their rights to formulate an ADVANCED DIRECTIVE. They are not required to have an ADVANCED DIRECTIVE in order to received treatment at this facility. It is the intent that the employees of Village Surgicenter are familiar with advance directives, and in the event a patient has an advanced directive it will be placed in the chart.
Village SurgiCenter will not honor any patient or family requests of a “NO CODE”, or “DO NOT RESUSITATE (DNR)” directive for any procedure scheduled at Village SurgiCenter. Village SurgiCenter provides full resuscitative services for all patients requiring emergency life saving/support measures. Advanced life support will be instituted in every instance and the patient will be transported to a higher level of care.
Physician Financial Interest in the Village SurgirCenter (if applicable)
I have been informed that my surgeon, as a partner in Village SurgiCenter of Erie, does have a financial interest in this surgery center.
Download Patient Grievance and Advance Directive
- Patient Grievance and Advance Directive (26.52 KB)
