The physician who referred you to this facility may have an ownership interest in this facility. You are free to choose another facility in which to receive the services that have been ordered by your physician.
This facility does not discriminate against any person on the basis of age, sex, race, color, religion, national origin, or disability in
admission, treatment, or participation in its programs, services
or in employment.
The patient and family are encouraged to help the
facility improve its understanding of the patient’s
environment by providing feedback, suggestions, comments
and/or complaints regarding the service needs, and
A complaint or grievance should be registered by
contacting the center and/or a patient advocate at the
Ohio Department of Health or Medicare (numbers listed
The surgery center will respond in writing with notice
of how the grievance has been addressed.
CENTRAL OHIO SURGICAL INSTITUTE
Marcy DelVecchio R.N., Administrator
6520 West Campus Oval
New Albany, OH 43054
Ohio Department of Health Complaint Unit
246 N. High Street, 2nd FL, Columbus 43215
Medicare Beneficiary Ombudsman
www.medicare.gov (ombudsman link is on left
The Joint Commission
One Renaissance Blvd.
Oakbrook Terrace, IL 60181
In accordance with Ohio law, this center must inform
you that we are not required to honor and do not honor
DNR directives. A healthcare power of attorney will be
If a patient should provide his/her advance directive a
copy will be placed on the patient’s medical record and
transferred with the patient should a hospital transfer
be ordered by his/her physician.
At all times the patient or his/her representative will
be able to obtain any information they need to give
informed consent before any treatment or procedure.
In order to assure that the community is served by this
facility, information concerning advance directives is
available at the facility. While the state of Ohio does
not have required a specific form for an advanced
directive, sample forms are available at the center’s
office. To obtain this form and information, please call