1220 East Venice Ave., Venice, FL 34285

Phone (941) 484-5000 • Fax (941) 484-4414

Monday - Friday  8:00am - 4:00pm

GCLogoResized AAAHC-accredited Untitled-1

Pre-Procedure Information

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Please click on the form above to complete your questionnaire.  Completing and submitting the form will help make your check in process on the day of your procedure a little faster and more comfortable for you.  When you click on submit, the form will be transmitted directly and confidentially to the facility to be entered into your medical record.  Thank you for your help and allowing Gulf Coast Endoscopy Center of Venice to take care of your health care needs.

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OTHER DOCUMENTS FOR YOUR REVIEW

Information for our Patients:

 

Gulf Coast Endoscopy and Surgery Center’s management and staff care about the treatment their patients receive.  If at any time we fail to meet your expectations, please feel free to ask for the administrator or supervisor on duty.

 

Administrator:

Terri Lopez, CASC

941.484.5000, ext 1009

tlopez@gulfcoastendocenter.com

 

We are required under the provisions of Florida Patient’s Bill of Rights and Responsibilities to inform those patients who inquire regarding filing of complaints with the State of Florida the following information:

 

Complaint Against Health Care Professional or Facility

 

Florida Department of Health

Consumer Services Unit

4052 Bald Cypress Way, Bin C-75

Tallahassee, FL  32399-3275

1-850-245-4339

http://www.doh.state.fl.us/mqa/enforcement/enforce_csu.html

 

Consumer Assistance Notice

 

Agency for Health Care Administration

2727 Mahan Dr

Tallahassee, FL  32308

1-888-419-3456

 

The Department of Insurance State of Florida Abuse Registry

200 East Gaines St. 1-800-96-ABUSE

Tallahassee, FL  32399

1-877-693-5236

 

Office of the Medicare Beneficiary Ombudsman:

https://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html

 

The Gulf Coast Endoscopy Center’s Patient Grievance Policy can be found in our patient packet, on our website or by calling the Center.

 

If you need the address and toll-free telephone number of the grievance department of any of our contracted HMOs, please ask one of our business office employees.

 

Quality measures and statistics that are disseminated by the State of Florida Agency for Healthcare Administration pursuant to s.408.05 F.S. are available at www.Floridahealthfinder.gov

pre-op