JEFFREY A. KLEIN MD, INC.

As a patient being treated in our office you have a right to:

  • Respectful care with concern for patient’s dignity and comfort given by competent personnel in a safe and sanitary environment.
  • Consideration of your personal privacy concerning your own medical care.
  • The names and credentials of all physicians and/or staff directly assisting in your care.
  • Have medical records pertaining to your medical care treated as confidential (except as required by law or third party contractual agreements).
  • Know what rules and regulations in our practice apply to your conduct as a patient.
  • Know provisions for after hours and emergency care.
  • Expect emergency procedures to be implemented without delay; if there is a need to transfer you to another facility, responsible person and the facility will be notified of your condition prior to your arrival.
  • Good quality care and high professional standards of care and infection control continually maintained and reviewed.
  • Know what services are available at this organization.
  • Full information in layman’s terms concerning diagnosis, treatment, prognosis, and possible complications, including written discharge instructions.
  • Be advised of participation in a medical care research program or donor program. (You would be asked to give your informed consent prior to participation in such a program and you may refuse to participate in such program or you may discontinue participation in a program in which you have previously given informed consent without fear of reprisal or discrimination.)
  • Refuse treatment (drugs or procedures) within the confines of the law; and to be informed by a physician of the medical consequences of your refusal.
  • Receive medical, nursing, and ASC services without discrimination based upon age, race, color, religion, national origin, handicap, disability, or source of payment. The ASC is not required to provide uncompensated or free care and treatment unless otherwise required by law.
  • Have access to an interpreter whenever possible.
  • Access to all information contained in your medical record, within a reasonable time, unless access is specifically restricted by your attending physician.
  • Expect good management techniques to be implemented that consider effective use of your time and to avoid unnecessary discomfort.
  • Know fees for services and the organization’s payment policies.
  • Examine and receive a detailed evaluation of your bill.
  • Be informed of right to change physicians if desired if other qualified provider is available.
  • Be free from abuse, neglect, harassment and exploitation.
  • Appropriate and professional care relating to physician orders.
  • Receive information necessary to make informed decisions prior to the start of any procedure or treatment.
  • Personal and data privacy and confidentiality.
  • Be informed of the right for patient rights to be extended to a person appointed under State law to act as the patient’s surrogate or appointed by the patient’s as the patient’s representative.
  • Voice grievances, suggest changes in services, and report alleged violations relating to mistreatment, neglect and other forms of abuse to a person in authority in the ASC; and, to receive a written response within 30 days.

The care a patient receives also depends on the patient; therefore, in addition to these rights, each patient has certain responsibilities which are outlined in the spirit of mutual trust and respect.

  • Provide complete and accurate information to the best of your ability about your health, medications taken (including over-the-counter products and any allergies or sensitivities).
  • Follow the treatment plan prescribed by your provider and participate in your care.
  • Provide a responsible adult to transport you home from the facility and remain with you for 24 hours, as required by your provider.
  • Accept personal financial responsibility for any charges not covered by insurance.
  • Behave respectfully toward all health care professional and staff, as well as to other patients.

Policy on Advance Directives

While we at Jeffrey A. Klein MD, Inc. respect patient rights regarding advance directives, based on organizational conscience the ASC medical team will provide comprehensive resuscitative care to every patient. We will file a copy of your existing advance directive upon your request and document receipt of this document in a prominent and uniform location in your patient record. We can provide information regarding advance directives as well as provide approved State specific forms if you request.

Notice of Financial Interest


Federal and State regulations require that we inform you that Jeffrey A. Klein MD has a financial interest in Jeffrey A. Klein MD, Inc. This involvement helps us to ensure the finest quality surgical care for all patients.

Comments about the Quality of our Services


Jeffrey A. Klein MD, Inc. would like to hear from you if you have any compliments or comments about the quality of our care and services. You may contact us directly at 30280 Rancho Viejo Rd. San Juan Capistrano, CA 92675; our telephone number is (949) 248-1632.

Medicare patients may contact the Omsbudman with their comments at this website address: www.medicare.gov/claims-and-appeals/medicare-rights/get-help/omsbudman.html.

You may contact our accreditation entity, the Accreditation Association for Ambulatory Health Care at 847- 853-6060; their mailing address is 5250 Old Orchard Road Suite 200, Skokie IL 66077.

If you wish to contact the California Department of Health you may contact them at (916) 558-17484. Physicians in California are licensed by the Medical Board of California which may be contacted at (916) 263-2344.

We recognize that you have a choice for your Healthcare services; we are grateful that you have chosen us as your provider.