Phone: (425) 451-7335

Information on Advance Directives and Information on Living Wills


Statement of Limitation
ASC-Wide Conscious Objection:

Due to the fact that Eastside Endoscopy Center is an Ambulatory Surgery Center for the purpose of elective endoscopy in a safe and uncomplicated manner, patients are expected to have an excellent outcome.  If a patient should have a complication, the center staff will always attempt to resuscitate the patient and transfer that patient to the hospital in the event of deterioration (RCW 70.122.060)

Eastside Endoscopy Center

Rights of Patients

The patient has the right to exercise his or her rights without being subjected to discrimination, retribution, or denial of care.

The following list of patient rights is not intended to be all inclusive. Patients receiving care at our center have a right to: 

  • Be treated with respect, consideration, and dignity.
  • Exercise these rights and treated without regard to gender, race, disability, cultural, economic, educational or religious background and without fear of discrimination, denial of care or reprisal.
  • Be treated in a safe environment that is free of all forms of abuse, neglect or harassment.
  • Quality care & services delivered pursuant to high professional standards.
  • Access communication aids (i.e., interpreters, sign language, etc.) where possible.
  • Be provided appropriate privacy and confidentiality concerning their medical care – the patient has the right to be advised as to the reason for the presence of any individual directly involved or observing their care
  • Confidentiality, privacy, security, complaint resolution, spiritual care, and communication.  If communication restrictions are necessary for patient care and safety, the facility must document and explain the restrictions to the patient and family
  • Voice grievances regarding treatment or care that is (or fails to be) furnished and receive timely compliant resolution (complaints will be initially addressed within three days).
  • Have their questions, concerns, or complaints addressed in good faith.
  • Be fully informed about a treatment or procedure and the expected outcome before it is performed.
  • Provisions for after-hour and emergency care.
  • Change their provider if other qualified providers are available.
  • Refuse to participate in experimental research.
  • Access necessary surgical and/or procedural interventions that are medically indicated.
  • Obtain any information they need to give informed consent before any treatment or procedure.
  • Be provided, to the degree known, complete and timely information concerning their diagnosis, evaluation, treatment and prognosis.  When it is medically inadvisable to give such information to a patient, the information is provided to a person designated by the patient or to a legally authorized person.
  • Participate in their care by making choices and decisions regarding their medical care to the extent permitted by law – this includes the right to refuse treatment
  • Formulate advance directives and appoint a surrogate to make health care decisions on their behalf to the extent permitted by law.  The provision of the patient’s care shall not be conditioned on the existence of an advance directive. (please see the center’s policy on advanced directives below)
  • Have their disclosures and records treated confidentially, and given the opportunity to approve or refuse their release, except when release is required by law.
  • Receive, on request, and at a reasonable fee, a copy of their medical record
  • Know the services available at the organization and the accreditation, if applicable.
  • Know the facility fees for services.
  • Request an itemized statement of all services provided to them through the facility, along with the right to be informed of the payment methodology utilized.
  • At their own expense, to consult with another physician or specialist if other qualified physicians are requested and available.
  • Be informed of patient conduct, participation, and responsibilities rules.
  • Know the identity, professional status, institutional affiliation and credentials of health care professionals providing their care, and be assured these individuals have been appropriately credentialed according to the policies of the center.
  • Be provided with appropriate information regarding the absence of malpractice insurance coverage.
  • Be informed about procedures for expressing suggestions, complaints, and grievances, including those required by state and federal regulations.
  • Have access to protective services
  • Timely complaint resolution
  • Be informed and agree to their care and informed of unanticipated outcomes
  • Patients have the right to be involved in all aspects of their care including, refusing care and treatment and resolving problems with care decisions
  • Patient has a right to family input in care decisions, in compliance with existing legal directives of the patient or existing court issued legal orders
  • Accurate representation of accreditation

Patient Responsibilities

The care a patient receives depends partially on the patient.  Therefore, in addition to these rights, a patient has certain responsibilities that are presented to the patient in the spirit of mutual trust and respect.  Patient Responsibilities require the patient to:

  • Follow Directions – The patient is responsible for following any directions given pre-procedure & any written instructions given at discharge.
  • Ask Questions – the patient is encouraged to ask all questions of the physician & staff in order that they have full knowledge of the procedure & after care.
  • — Follow the treatment plan prescribed by his/her provider, follow the policies & procedures of the facility, and participate in their care.
  • — Keep appointments and notify surgery center or physician when unable to do so.
  • — Be respectful of all the health care providers and staff, as well as other patients.
  • Provide a responsible adult to transport him/her home from the facility and remain with him/her for 24 hours, if required by his/her provider.
  • Accept responsibility for his/her actions should he/she refuse treatment or not follow his/her physician’s orders
  • Provide complete & accurate information & accept personal financial responsibility for any charges not covered by his/her insurance.
  • Provide complete and accurate information to the best of his/her ability about his/her health, any medications, including over-the-counter products and dietary supplements and any allergies or sensitivities.
  • Inform his/her provider about any living will, medical power of attorney, or other directive that could affect his/her care.

Patient Guardian

The patient’s guardian, next of kin, or legally authorized responsible person has the right to exercise the rights delineated on the patient’s behalf, to the extent permitted by law, if the patient:

  • has been adjudicated incompetent in accordance with the law.    For such patients, the person appointed under State law to act on the patient’s behalf may exercise any and all of the rights afforded to any ASC patient.  In addition, a competent patient may wish to delegate his/her right to make informed decisions to another person.
  • has designated a legal representative to act on their behalf.
  • is a minor.

Physician Participation

This is to inform you that your physician might have a financial interest or ownership in this center. The following are physicians who have a direct or indirect ownership interest of 5 percent or more:

Raj Butani, MD    (NPI 1285695221)

Kalle Kang, MD    (NPI 1780626630)

Sang Kim, MD      (NPI 1225070170)

Edwin Lai, MD    (NPI 1891824777)

Venkatachala Mohan, MD  (NPI 1194704106)

Georgia Rees Lui, MD    (NPI 1972540227)

Roanne Selinger, MD     (NPI 1003895012)

Shie Pon Tzung, MD      (NPI 1023096252)

Robert Wohlman, MD   (NPI 1265412019)


Advance Directives

In accordance with Washington State law (RCW 70.122.060), this center must inform you that we have an ASC-wide conscious objection to honoring Advance Directives. If a patient has a complication we will always attempt to resuscitate and transfer the patient to the hospital. A healthcare power of attorney will be honored.

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 Washington 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 (425) 451-7335.

Patient Rights Notification

Each patient at the center will be notified of their rights in the following manner:

  • A written notice provided prior to their procedure in a language and manner the patient understands.
  • A verbal notice provided prior to their procedure in a language and manner the patient understands.
  • A posted notice visible by patients and families waiting for treatment.

Patient Grievances

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 expectations.

A complaint or grievance should be registered by contacting the center and/or a patient advocate at the Washington State Department of Health or Medicare (numbers provided in this flyer). The surgery center will respond in writing with notice of how the grievance has been addressed.


Contacts:       Eastside Endoscopy Center

Nurse Administrator

1135 116th Ave NE Suite 570

Bellevue, WA98004

(425)  451-7335



5250 Old Orchard Road, Suite 200

Skokie, Illinois 60077

(847) 853-6060

Washington State Department of Health

DOH HSQA Complaint Intake

PO Box 47857

Olympia, WA 98504-7857

Toll Free:  800-633-6828



Medicare Beneficiary Ombudsman







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