PHYSICIANS SURGICAL CARE CENTER - One Medical Passport

PHYSICIANS SURGICAL CARE CENTER

an affiliate of SCA

As you know, your health care provider has determined that you require further medical treatment and has recommended that you receive such treatment at Physician Surgical Care Center. Your physician may have less than or equal to 1% ownership in the surgery center. An interest in this facility enables the physician to have a voice in the administrative and medical policies of the facility.

The Center also wishes to make you aware of the fact that there are other facilities available in our medical community where the same procedure(s) can be performed. The names, addresses, and telephone numbers of three reasonable alternative sources for such medical treatment are set forth below. Of course, the facility that performs the medical procedure for which you have been recommended is a matter of personal choice for you.

The following physicians have a financial interest in the Center:

Dr. Brian Barnard Dr. Jeffrey Baylor Dr. Joseph Billings Dr. Mary L. Brown Dr. John Chase Dr. Jeffrey Deren Dr. Steven Choung Dr. Adam Fenichel Dr. Kurt Gasner Dr. Henry Ho

Dr. Michael Jablonski Dr. Suresh Kannan Dr. Izak Kielmovitch Dr. Richard Konsens Dr. Kenneth Krumins Dr. Jeffrey Lehman Dr. Wadih Macksoud Dr. Craig Mintzer Dr. Hugh Morris Dr. Gregory Munson

Dr. John Papa Dr. Aftab Patni Dr. Roberto Posada Dr. Janet Robison Dr. Michael Rubeis Dr. Brian Spector Dr. Kiran Tipirneni Dr .Hao N. Tran

ALTERNATIVE SOURCES: Winter Park Memorial Hospital -200 N. Lakemont Ave- Winter Park-407-646-7000 Orlando Center for Outpatient Surgery-1405 S. Orange Ave-Orlando-407-426-8331

Florida Hospital South-601 E. Rollins St-Orlando-407-896-6611

2056 Aloma Ave-Suite 200-Winter Park-Florida-32792 407-647-5100

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