Ownership Notice to Patients

Because of concerns that there may be a conflict of interest when a physician refers a patient to a health care facility in which the physician has an ownership interest, Florida passed a law (the “Patient Self-Referral Act of 1992,” FL Statute Section 455.654). Under this law, I must disclose my ownership in this facility and tell you about alternative places where you may go to obtain these services. This disclosure is intended to help you make a fully informed decision about your health care. You have a right to obtain healthcare items or services at a location or from the provider or supplier of your choice, including the facility in which I am owner. I assure you that you will not be treated differently if you do not choose the facility listed below in which I have an ownership interest.

Drs. C. Cayce Rumsey, Robert W. Burk, Hollie J. Hickman, and Erez G. Sternberg

have an ownership interest in: Ponte Vedra Ambulatory Surgery Center

Alternative facilities in which we do not have ownership: Baptist Beaches Outpatient Surgery Center

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