Lowcountry Outpatient Surgery Center •Quality Service •Positive Outcomes Privacy Compassion 1

1. Lowcountry Outpatient Surgery Center • Quality Service • Positive Outcomes • Privacy •  Compassion •  Comfort Lowcountry Outpatient Surgery Center •Quality Service •Positive Outcomes Privacy Compassion1 Comfort

2. Welcome to Lowcountry Outpatient Surgery Center We are dedicated to providing the highest quality care to our patients. Our team of highly skilled and caring physicians and staff are committed to providing our patients with an exceptional surgical experience. Lowcountry Outpatient Surgery Center was designed and built to provide premier ambulatory surgical care to the residents of the Lowcountry. We strive to provide a friendly, comfortable environment for our patient’s elective surgery needs. Our facility is modern with attention given to every detail for patient safety and comfort.

3. Our friendly and attentive staff will treat you as a guest from the moment you enter the facility until you return home. Our team is committed to working together to provide exceptional care to all patients and families. We would like to thank you for putting your trust in our staff. We will make every attempt to honor the confidence that you have placed in us by providing the highest level of medical care you deserve. We are dedicated to making your stay as pleasant as possible and encourage any comments or suggestions you would like to share. We are approved for Medicare and received our accreditation through The Accreditation Association for Ambulatory Health Care (AAAHC), and meet all the state and federal licensing standards for quality and safety.

4. Prior the procedure A pre-operative nurse from the facility will call you before your scheduled procedure. During this call we will review your health history, medications, past surgeries, allergies and other information about your current health status. If you have any additional questions we will be happy to answer them for you. The following instructions are very important and MUST be followed or your procedure may be rescheduled. If you feel you cannot comply with these guidelines, please call the pre-operative nurse to discuss your concerns. • Take all your regular medications the day of your procedure unless otherwise instructed by your physician. If you have any questions about taking your medication, please call the facility and ask for the pre-operative nurse. •  Stop Aspirin or Aspirin products 5 days prior to your procedure. • Stop blood thinners prior to your procedure as directed by your physician. •    You may have a light meal before your procedure unless instructed otherwise. • Please make arrangements for a responsible adult to drive you to the facility, stay at the center during your procedure and drive you home. You cannot drive yourself or be left alone for the first 24 hours following your procedure. • Notify the facility or your physician prior to your procedure date if you have any changes in your health, such as a cold, illness, fever, sore throat, rash or flu.

5. Day of your procedure · Please bathe the morning of your procedure. Please do not wear any perfumes or lotions. · Leave all valuables including jewelry at home. We will not be responsible for any lost or damaged items. · Any non prescription or prescription medication that you are currently taking should be brought with you the day of your procedure. · Be prepared to sign a consent form for your procedure. If the patient is under age 18, a parent or legal guardian must accompany the patient to sign the consent. Guardians are required to present proof of legal guardianship · Please arrive at the scheduled time for your procedure. · Wear comfortable loose clothing and shoes. · We will check your temperature, blood pressure, pulse and ask you to empty your bladder. · Your family member or the adult staying during your procedure will be asked to wait in our waiting area. We will reunite you and your family as soon as possible.

6. After your procedure ·Instructions specific to your procedure will be sent home with you. It is very important that you follow these instructions. If you have any questions or concerns, please call your doctor . · You may resume your normal diet after your procedure. Please do not drink any alcoholic beverages for 24 hours after your procedure. · You may feel sleepy or lightheaded after your procedure. Do not drive or operate machinery for at least 24 hours after your procedure. · Our staff members have been carefully selected for their experience, training and dedication. They take a personal interest in you before, during and after your surgery. A nurse from the facility will be calling you at home to check on your progress.

7. Continuity of care by assistance in locating alternate services and/or • continuing health care requirements, if any, following discharge. • The identity, upon request, of all personnel authorized to assist in your treatment. • The right to change primary or specialty care physicians if other qualified physicians are available. • Refusal to participate in research. Human experimentation affecting care or treatment shall be provided only with your informed consent. • Upon request, examine and receive an itemized explanation of your bill, • regardless of source of payment. • Treatment without discrimination as to race, color, religion, sex, belief or handicap. • Your physician may have a financial interest in Lowcountry Outpatient Surgery Center, and you have the right to have your procedure performed elsewhere. • Patients are informed of their rights both verbally and in writing prior to the day of their procedure. AS A PATIENT OF LOWCOUNTRY OUTPATIENT SURGERY CENTER YOU HAVE THE RIGHT TO: • Dignity as an individual • Considerate and respectful care • Privacy to the extent consistent with adequate medical care. • Results of examination and treatment will be confidential. • Current information concerning your diagnosis, treatment and prognosis in terms you can understand. • When it is not medically advisable to give information to you, it shall be made available to an appropriate person in your behalf. • Sufficient information from your physician, before any procedure, to form the basis of a reasonable request for such procedure. • Except in emergencies, such information should include the procedure, the significant risks involved and the probable duration of incapacitation. • Refusal of treatment and information on the medical or other consequences of your action. • Privacy and confidentiality of all records pertaining to your treatment, except as otherwise provided by law or third party payment contract.

8. South Carolina Department of Health & Environmental Control Division of Health Licensing 2600 Bull Street Columbia, SC 29201 (803)545-4370 Website & Phone number for Medicare Beneficiary Ombudsman www.cms.hhs.gov/center/ombudsman.asp 1-800-633-4227 If you did not watch the video or receive these rights verbally, please call (843)285-6091 to hear a pre-recorded message.

9. Advance Directive Policy Lowcountry Outpatient Surgery Center is dedicated to performing outpatient surgical procedures. Lowcountry Outpatient Surgery Center will not honor advance directives, including Do Not Resuscitate. Please inform the facility and/or your physician if you are in disagreement with this policy so that your procedure can be scheduled at another facility. A copy of the official State advance directives forms is available upon request. Grievance Policy: · Lowcountry Outpatient Surgery Center maintains the following policy to allow any person to file a complaint. · Any person or family member who wishes to file a grievance or complaint regarding the quality of care or services at Lowcountry Outpatient Surgery Center should contact the Administrator of Lowcountry Outpatient Surgery Center at (843)285-6065. · When the complaint is received, the appropriate department supervisor, the Medical Director, and Quality Assurance Coordinator will be contacted. These parties will work together to thoroughly investigate each grievance or complaint. · Lowcountry Outpatient Surgery Center will take prompt action to rectify any problem.. Furthermore, will respond to every legitimate grievance within 1 week of completion of investigation of the grievance. · Lowcountry Outpatient Surgery Center stresses to all of its employees that the act of filing a complaint in no way effects a patient’s future access to care or the quality of care or services which he/she receives.

10. Financial & Billing Information: · Please bring a photo I.D. and copy of your insurance card with you so we may submit your claim correctly. · Prior to the day of your procedure, you will be notified of your estimated responsibility i.e, co-insurance, deductible, and co-payment. Any specific questions regarding your insurance coverage, we suggest you contact your insurance company. · Your assistance in ensuring prompt payment from your insurance company is appreciated. Since the contract is between you and your insurance company, any unpaid balances remain your responsibility or the person who signs for financial responsibility of the account. · If your procedure is not covered by insurance, or if you are required to pay a portion of your bill, payment will be requested prior to the day of your procedure. We do accept Visa, MasterCard and Discover. · You may receive other fees related to your procedure that are NOT part of the facilities charges. These may include fees from your physician, pathologist and testing performed at other facilities.

11. Summerville Map TROLLEY ROAD Springview Lane Summerville Medical Center Springview Lane DORCHESTER ROAD MIDLAND PARKWAY Benton Lodge Movies 8 Theater Sears Storage HESS LADSON ROAD To HWY 78 • Lowcountry Outpatient Surgery Center • 93 A Springview Lane • MRI • Office • Surgery Center