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Please bring the following with you to Tri City Surgery Center: - page 10 / 15





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Tri City Surgery Center Patient Bill of Rights

Refusal to participate or discontinuation of participation will not compromise the patient’s right to access care, treatment or services

  • Upon patient request, examine and receive a detailed explanation of your bill including an itemized bill for services received, regardless of sources of payment.

  • Know the facility’s rules and regulations that apply to your conduct as a patient.

  • Be advised of the facility grievance process, should he or she wish to communicate a concern regarding the quality of the care he or she receives or if he or she feels the determined discharge date is premature. Notification of the grievance process includes: who to contact to file a grievance, and that he or she will be provided with a written notice of the grievance determination that contains the name of the contact person, the steps taken on his or her behalf to investigate the grievance, the results of the grievance and the grievance completion date.

  • Complaint or criticisms will not serve to compromise future access to care at this facility. Staff will gladly advise you of procedures for registering complaints or to voice grievances including but not limited to grievances regarding treatment or care that is (or fails to be) furnished.

  • Access and copy information in the medical record at any time during or after the course of treatment. If patient is incompetent, the record will be made available to his/her guardian.

  • Expect to be cared for in a safe setting regarding: patient environmental safety, infection control, security and freedom from abuse or harassment.

  • Receive care, free of restraints unless medically reasonable issues have been accessed and pose a greater health risk without restraints.

  • Participate in the development, implementation and revision of his/her care plan.


  • Complaints may be directed to the following Facility Contact(s):

Administrator 5430 Distinction Way Prescott, AZ 86301

    • (928)


  • Complaints may be directed to the following State Agency: Arizona Department of Health Services 150 North 18th Avenue Phoenix, Arizona 85007

    • (602)


  • Web site for the Medicare Beneficiary Ombudsman: www.medicare.gov or 1-800-633-4227 or


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