Our Physicians and Staff at Fullerton Surgery Center would like to take this opportunity to welcome you to our facility. As your providers of health care, we look forward to serving you. We hope that, together, we can build the kind of relationship that will ensure that you receive quality of care and good service.

In order to maximize your benefits, it is very important that you familiarize yourself with the systems, policies, and benefits outlined in this letter or ask our courteous staff if you have any further questions. Failure to follow the system and unfamiliarity with your benefits coverage may result in delays in receiving necessary health care and in unnecessary costs to you.

The following is important information you should know:

Hours of operation

Office hours are:

Mon- Sat: 7:00 AM to 7:00 PM, call 773-237-2900

Scheduling appointments:

Our appointment desk may be reached at (773)237-2900 from 7:00 AM to 7:00 PM, Monday – Saturday and every other Sunday.

Be sure to identify yourself and have your ID number available.

If you need to cancel an appointment, please call the appointment desk as soon as possible.

You Have Certain Rights

1. You have the right to be treated with respect, consideration, and dignity.

2. You have the right to high-quality medical care delivered in a safe, timely, efficient and cost-effective manner, and the right to be assured that the expected results can be reasonably anticipated.

3. You have the right to privacy to the extent possible.

4. You have the right to know the services available at the facility

5. You have the right to know your treatment opinions and take part in decisions about your care. Parents, guardians, family members, or surrogates that you select can represent you if you cannot make your own decision according to the state law. If a patient is adjudged incompetent under applicable state health and safety laws by a court of proper jurisdiction, the rights of patient are to be exercised by the person appointed under state law to act on your behalf.

6. You have the right to have your disclosures and records treated confidentially and, except when required by law, those disclosures and records will not be released without your approval.

7. You have the right to be provided, to the degree known, complete information concerning your diagnosis, evaluation, treatment and prognosis.

8. You have the right to copies of your medical records at a nominal cost and, if you request it, those records will be transferred to another practitioner in a timely manner.

9. You have the right to be informed of all reasonable options or alternatives for care and/ or treatment and of the potential advantages and disadvantages of each including the advantages or disadvantages and the alternatives to having the procedure performed in an office or other out-patient facility.

10. You have the right to participate in decisions regarding all aspects of care.

11. No procedure or treatment will be undertaken without your informed consent after the alternatives mentioned in #9, above have been discussed with you.

12. You have the right to refuse any diagnostic procedure or treatment and to be advised of the likely medical consequences of such refusal.

13. You have the right to know all of your rights as outlined above.

14. You have the right to know the conduct expected of you in the facility and the consequences of failure to comply with these expectations.

15. You have the right to know the provisions for after-hours and emergency care.

16. You have the right to know if any of the planned procedures or treatments is part of a research study and the right to refuse to participate in that study.

17. You have the right to know whether or not your providers are insured.

18. You have the right to know how to go about expressing suggestions to the facility and the policies regarding grievance procedures and external appeals in the event that you are dissatisfied with your treatment.

19. You have the right to know the name of your provider.

20. You have the right to know what fees are expected and what the payment policies are.

21. You have the right to know what your provider’s credentials are.

22. You have the right to change providers.

You Also Have Certain Responsibilities

1. You have the responsibility to accurately and completely provide all clinical personnel with the health information they need including any medications you are taking.

2. You have the responsibility to follow the directions of the nurse or physician with regard to diet and/or medication.

3. You have the responsibility to abstain from using any drugs that have not been prescribed for you and that you have not revealed to your nurse or physician.

4. You have the responsibility to abstain from the use of alcohol as directed by your nurse or physician.

5. You have the responsibility to inform the nurse or physician of you do not understand any directions, or you do not understand the course of treatment planned for you.

6. You have the responsibility to pay, in a timely manner, all medical bills which are not in dispute and to forward to us any monies you receive from any insurance company for our services.

7. You are responsible to participate in your plan of care & provide an Advance Directive if you have one.

8. You have the right to be informed that Fullerton Surgery Center DOES NOT honor Advanced Directives.

9. For your safety and security we will require your photo id and insurance card when you arrive the day of your surgery.

Advance directive

Advance Directives will not be honored at Fullerton Surgery Center in the case of deterioration. We will do everything to stabilize you, the patient, and arrange for immediate transfer to a nearby hospital. If indeed a need did arrive, we will try any life saving measures to stabilize you for transport. If you do not have an Advance Directive and would be interested in completing one, we are happy to supply you with information.

Complaint resolution

We at Fullerton Surgery Center strive to provide you with excellent quality of care. We highly believe in changes to improve, and welcome an opportunity to listen to your suggestions and complaints. Please contact Administrator or the Medical Director to get further information on our complaint resolution policy. In case of any complaint, you will receive a written notice of decision within 14 calendar days describing the steps taken to investigate, the results, and the completion date.

You also have the right to contact:

The Joint Commission: 630-792-5636

Email: complaint@jcaho.org


The State of Illinois Department of Regulations

Phone: 312-814-4500

Email: www.idfpr.com



Phone: 1-800-MEDICARE

Facility ownership disclosure

Fullerton Surgery Center is owned and operated by Dr. Naser Rustom, M.D.

Should you have any questions, feel free to call us at 773-237-2900. We look forward to serving you.