Patient Rights/Advanced Directives


The Cheyenne Skin Clinic and Center for Dermatological Surgery adopts and affirms as policy the following rights of patients who receive services from our facility. As a patient, you have the right to:


1. Informative Disclosure: You have the right to receive accurate and easily understood information about your health status, health care professionals, and health care facilities. If you speak another language, you have a physical or mental disability, or simply do not understand what you are being told, assistance will be provided to you to make your informed health decisions.


2. Choice of Providers: You have the right to choose your health care provider and know the identify and professional status of the individuals providing service to you.


3. Access to Emergency Services: If you are in severe pain, have sustained an injury, or a sudden illness that convinces you that your health is in serious jeopardy, you have the right to receive screening and stabilization emergency services whenever and wherever is necessary.


4. Participation in Treatment Decisions: You have the right to know all your treatment options and to make an informed decision regarding your care. You have the right to participated in the development, implementation and revisions regarding your healthcare. You have the right to request, accept or refuse treatment. You have the right to be informed of potential consequences of treatment refusal.


5. Know our policy concerning Advanced Directives: The Center for Dermatological Surgery does not accept Advanced Directives because we are an outpatient facility, using only local anesthesia. Per a mandate from the Wyoming Legislature and State Law, The Aging Division of the Wyoming Department of Health is to make available the most current approved version of the State’s Advanced Directives. To obtain a copy of this form, go to: Click on the Advanced Directives Form. If you need assistance with this or you do not have access to the internet, please let us know, we do have copies of these forms available to you at your request.


6. Respect, Safety and Nondiscrimination: You have the right to be treated with respect, dignity and comfort. You have the right to considerate and nondiscriminatory care from your physicians and other healthcare providers.


7. Confidentiality of Health Information: You have the right to speak in confidence to your healthcare providers and to have your healthcare information safeguarded from unauthorized disclosure in accordance with HIPPA guidelines.


8. Patient Responsibilities: You are responsible for providing, to the best of your knowledge, accurate and complete information about your health statue and past medical history and reporting unexpected changes to your healthcare provider. You are responsible for being considerate of the needs of other patients in the facility and providing healthcare insurance information and financial obligations.


9. Grievances and Appeals: You have the right to a fair, fast and objective review of any grievance you have against your doctors, nurses or other healthcare personnel. This includes grievances about waiting time, operating hours, conduct of healthcare personnel and adequacy of the facility. Grievances may be written or verbal. Please ask your nurse or healthcare personnel for a grievance form. Resolution to your grievance will be within a reasonable time frame, usually within 30 working days, and you will be informed of the progress of the resolution. Grievances should be reported to Cheyenne Skin Clinic & Center for Dermatologic Surgery, Attn: Teresa Lake, Facility Administrator, 123 Western Hills Boulevard, Cheyenne, Wyoming 82009 (307) 635-0226. However, if concerns are not satisfactorily resolved at the facility level, a complaint can be filed with the OHLS by calling (307) 777-7123 or fax a completed complaint form to (307) 777-7127. Written complaints against Wyoming healthcare facilities can be mailed to: Office of Healthcare Licensing & Surveys, 400 Qwest Building, 6101 Yellowstone Rd., Cheyenne, Wyoming, 82002. Medicare patients may also contract the offices of Medicare Beneficiary Ombudsman at


If you have any questions regarding your patient rights or responsibilities, please discuss your concerns with our staff.




The physicians and facilities listed below are limited partners in the Center for Dermatologic Surgery. An interest in this facility enables them to have a voice in the administration and medical policy of this health care institution. This involvement helps to ensure quality surgical care to their patients.


Sandra K. Surbrugg, M.D.

Julie A. Neville, M.D.


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