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The packet mandates having a verified escort to accompany patients home and explains arrangements if a care partner is needed. 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Complete pages 5-8, 11-12, and 17-18. Bring this entire patient packet with you on the day of your  \nappointment along with your ID and insurance cards.  \nSignatures from a Patient Representative are only valid if Patient can provide proof of Power of  \nAttorney/Health Care Proxy.  \nPlease complete page 9 ONLY if your procedure is related to an Accident/Injury.  \nBrooklyn Surgery Center  \n6010 Bay Parkway, 4th Floor Brooklyn, NY 11204-2569  \nTel: 718 259-4272  \nFax: 718 259-1582  \n[www.brooklynsurgerycenter.com](www.brooklynsurgerycenter.com)  \nPlease complete pages 5-8, 11-12, and 17-18.* Bring this entire patient packet with you on the day of your appointment.  \nPlease complete page 9 ONLY if your procedure is related to an Accident/Injury.  \nPage  \nWelcome Notice 3  \nEscort & Personal Possessions Policy 4  \nPatient Registration* 5  \nPre-Procedure Questionnaire and Medication List* 6  \nUniform Assignment and Release of Information Statement* 7  \nNotice of Participation in Health Insurance Plans* 8  \nASC Accident/Injury Questionnaire 9  \nPatient Self-Determination Act/Advance Directives 10  \nPatient's Bill of Rights/Has a Responsibility to* 11, 12  \nOwnership Disclosure 13  \nNotice of Privacy Practices 14, 15, 16  \nFinancial Policy* 17  \nPatient Acknowledgement of Advance Notices* 18  \nFrequently Asked Questions (FAQs) 19, 20  \nDirections to Brooklyn Surgery Center 21  \nProcedure Information Sheets Gastroenterology 22  \nProcedure Information Sheets Reproductive 23  \nEndocrinology, Infertility, and GYN  \nProcedure Information Sheets Orthopedics 24  \nProcedure Information Sheets Pain Management 25  \nWelcome Notice  \nWelcome to Brooklyn Surgery Center (BSC) .  \nOur mission is to provide high-quality ambulatory medical/surgical/ care and related services to our community, considerate of the specific needs of individual patients. The Center’s mission is to serve all persons in need of medical/surgical care and related services, regardless of age, color, race, creed, national origin, religion, gender, marital status, disability, payer source, or any other personal characteristic or qualification, including the ability to pay.  \nBSC serves as a valuable health care resource, offering high-quality clinical care across several medical disciplines, including Gastroenterology, Female and Male Reproductive Endocrinology and Fertility, Gyn, Orthopedics, Pain Management, Podiatry, General Surgery, Urology, and Colorectal Surgery.  \nThe Center is licensed by New York State as an Article 28 free standing Ambulatory Surgery Center, is accredited by the Center for Medicare and Medicaid Services (CMS) and the Accreditation Association for Ambulatory Health Care (AAAHC) .  \nOur community-based physicians, surgeons and staff endeavor to achieve excellence inpatient. Brooklyn Surgery Centers physicians and staff take pride in serving the healthcare needs of our diverse and widespread community. Our patients and their families have embraced the Center as an integral part of their community.  \nBSC is committed to maintaining and exceeding national quality standards and is recognized asan innovative leader in the future of ambulatory surgery services for our community.  \nFurther information on BSC can be found on our website:  \n[www.brooklynsurgerycenter.com](www.brooklynsurgerycenter.com)  \nPATIENT ESCORT POLICY  \nAs a matter of patient safety, the Brooklyn Surgery Center enforces the New York State Ambulatory Surgical Center requirement","cbCaimwmJRmLyFdq","https://ap.wps.com/l/cbCaimwmJRmLyFdq","pdf",749211,25,"English","# Welcome Notice\n## Escort & Personal Possessions Policy\n## Patient Registration\n## Pre-Procedure Questionnaire and Medication List\n## Uniform Assignment and Release of Information Statement\n## Notice of Participation in Health Insurance Plans\n## ASC Accident/Injury Questionnaire\n## Patient Self-Determination Act/Advance Directives\n## Patient's Bill of Rights\n## Ownership Disclosure\n## Notice of Privacy Practices\n## Financial Policy\n## Patient Acknowledgement of Advance Notices\n## Frequently Asked Questions (FAQs)\n## Directions to Brooklyn Surgery Center\n## Procedure Information Sheets","[{\"question\":\"Why is a verified escort required for the procedure?\",\"answer\":\"Brooklyn Surgery Center enforces the New York State Ambulatory Surgical Center requirement that every patient having a procedure must have an escort verified to accompany them home after the procedure.\"},{\"question\":\"What should patients do before their appointment and what must they bring?\",\"answer\":\"Read the packet at least 5 days prior to the scheduled appointment, complete the assigned pages, and bring the entire patient packet on the day of the appointment along with ID and insurance cards.\"},{\"question\":\"What are the rules for personal possessions and valuables?\",\"answer\":\"The center provides a bag for possessions and assigns a private locker for surgery patients. Patients should not wear jewelry, should not bring laptops, and should not bring valuables of any kind; the center assumes no responsibility for lost or misplaced items.\"}]","Patient Instruction Packet - Patient Safety & Pre-Procedure Checklist | PDF",1789634331,9]