Download WELCOME to The Surgery Center at Lutheran

WELCOME to The Surgery Center at Lutheran
We are delighted that you have chosen to have your surgery or procedure at
our facility. Our goal is to make your visit and recovery a positive
experience.
We offer a comfortable, welcoming facility with a highly-skilled, caring,
friendly staff.
The staff teams with your doctor to give you the best care through use of
state-of-the-art medical equipment and the latest innovations in surgery
procedures and technology.
Please review the instructions contained in this packet to help you prepare
for your surgery.
BEFORE your visit to The Surgery Center at Lutheran
Our pre-op nurse will contact you to complete your confidential and mandatory
health history. This is required prior to your surgery date to avoid cancellation of
your surgery. If it is more convenient you may contact the pre-op nurse by calling
303-301-7708.
Please arrange for a responsible adult to drive you home from the Surgery
Center and to listen to your post-operative instructions.
If you are receiving any sedation and/or anesthesia someone must stay
with you for 24 hours after your surgery/procedure.
SCHEDULING CONFIRMATION
Date of Surgery: ___________________
Time of Arrival: ____________________
Special Instructions:
______________________________________________________________
______________________________________________________________
______________________________________________________________
Instructions for THE DAY OF SURGERY
Arrive promptly at the time given to you by the pre-op nurse.
Bring all the surgical paperwork you were given in the surgeon’s office.
Follow the instructions given to you about eating and drinking. This is important
for your safety.
Shower the morning of surgery — this will decrease the risk of infection.
Wear low-heeled shoes and loose, comfortable clothing. Sleeves, legs and
waistbands should be loose enough to fit over bandages.
All jewelry and body piercing must be removed prior to surgery. Please leave
valuables including jewelry at home or with a family member.
Bring your driver’s license or photo identification card and health insurance cards,
as well as any co-pay and/or deductible to be paid at registration. Leave
valuables at home or with your friends/family.
Medications
- You may take your normal heart, blood pressure, breathing or seizure
medication the morning of surgery with a sip of water.
-if you take insulin or routine medications, your doctor or anesthesiologist
will instruct you on what to take prior to surgery.
- if you are on blood thinners, aspirin or herbal medicines, notify your
surgeon when they are scheduling you for surgery
-Please be sure to tell your surgeon about any existing medical conditions
as well as prescription, herbal and over the counter medications that you are
taking.
Failure to follow these instructions can cause serious
complications.
Instructions for AFTER YOUR SURGERY
After your surgery/procedure you will receive care in the “Post Anesthesia Care
Unit” where the nurses will watch you closely until you are ready to be put in a
recliner. Once in the recliner, one family member may join you. In most cases,
depending on your procedure, you will be ready to leave the Center in 30 minutes
to 2 hours following completion of your surgery.
Before you are discharged, your nurse will review your home care instructions
with you and your family. A copy of these instructions will be sent home with
you.
Have someone stay with you for the first 24 hours after surgery.
Take it easy until your physician says you can return to your normal routine.
It is natural to experience some discomfort in the area of the operation. You may
also experience some drowsiness or dizziness depending on the type of
anesthesia you receive or on the amount of pain medication you are taking at
home.
Do not drive, operate heavy machinery or power tools, cook, drink alcoholic
beverages, smoke, make legal decisions, or take any medications not
prescribed by your physician for at least 24 hours after your surgery.
The day after surgery, a member of the Surgery Center staff will call to see how
you are feeling.
Contact your physician if you feel you are having problems after surgery.
If you cannot contact your doctor but feel your concerns warrant a doctor’s
attention, call or go to the emergency room closest to you.
The Surgery Center at Lutheran
HIPAA Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed,
and how you can get access to this information. Please review carefully.
The Health Insurance Portability &
Accountability Act of 1996 (HIPAA) is
a federal law governing the privacy
of individually identifiable health
information. We are required by
HIPAA to notify you of the availability
of our Notice of Privacy Practices.
This notice describes our privacy
practices, legal duties and your rights
concerning your Protected Health
Information (PHI) and includes
provisions outlined in the 2013
HIPAA Final Omnibus Rule.
Your Protected Health Information
We may collect, use and share your
PHI for the following reasons:
For payment: We use and share PHI
to manage your account or benefits
and to obtain reimbursement for the
health care services we provide.
For health care operations: We use
and share PHI for our health care
operations. For example, we may
use PHI to review the quality of care
and services you receive.
For treatment activities: We use
and share PHI to ensure you receive
the treatment you need.
To you: We must give you access to
your own PHI. We may send you
reminders about required follow-up
care.
To others: You may tell us in writing
that it is okay for us to give your PHI
to someone else for any reason.
Also, if you are present and tell us it
is okay, we may give your PHI to a
family member, friend or other
person. We would do this if it has to
do with your current treatment or
payment for your treatment. If you
are not present, if it is an
emergency, or you are not able to
tell us it is okay, we may give your
PHI to a family member, friend or
other person if sharing your PHI is in
your best interest.
As allowed or required by law: We
may also share your PHI, as allowed
by federal law, for many types of
activities. PHI can be shared for
health oversight activities. It can
also be shared for judicial or
administrative proceedings, with
public health authorities, for law
enforcement reasons, and with
coroners, funeral directors or medical
examiners (about decedents). PHI
can also be shared with organ
donation groups for certain reasons,
for research, and to avoid a serious
threat to health or safety. It can be
shared for special government
functions, for Workers'
Compensation, to respond to
requests from the U.S. Department
of Health and Human Services, and
to alert proper authorities if we
reasonably believe you may be a
victim of abuse, neglect, domestic
violence or other crimes. PHI can
also be used to report certain
information to the U.S. Food & Drug
Administration about medical devices
that break or malfunction.
Authorization: We will obtain
permission from you in writing
before we use or share your PHI for
any other purpose not stated in this
notice. You may withdraw your
authorization, in writing, at any time.
We will then stop using your PHI for
that purpose. If we have already
used or shared your PHI based on
your authorization, we cannot undo
any actions we took before you told
us to stop.
How We Protect Information
We are dedicated to protecting your
PHI and have set up a number of
policies and practices to make sure
your PHI is kept secure.
We keep your oral, written and
electronic PHI safe using physical,
electronic and procedural means.
These safeguards follow federal and
state laws. Some of the ways we
keep your PHI safe include securing
offices that hold PHI, passwordprotecting computers, and locking
storage areas and filing cabinets.
We require our employees to protect
PHI through written policies and
procedures. These policies limit
access to PHI to only those
employees who need the data to
perform their job. Employees are
also required to wear ID badges to
help keep people who do not belong
out of areas where sensitive data is
kept.
Your Rights: You may:
 Receive a copy of this Notice of
Privacy Practices
 Request limits on disclosure of
your PHI
 Receive access to view some or all
of your medical record
 Receive a paper or electronic copy
of your medical record within 30
days of your documented request
 Request an amendment to your
PHI
 Expect your record to be amended
within 60 days of your request
 Restrict disclosure of PHI to a
health plan when you pay in full at
the time of service
 Receive a record of how we have
used and/or shared your health
information
 Receive information on how to file
a complaint if you feel your
privacy has been violated
 Opt out of fundraising efforts
(when applicable)
We will:
 Not sell your PHI
 Notify you in the event of a breach
of your PHI
Contact for further information concerning our privacy practices: You may contact the Privacy Officer at (303) 301-7700.
Complaints: If you think we have not protected your privacy, you can file a complaint with us. You may also file a complaint
with the Office for Civil Rights in the U.S. Department of Health & Human Services. We will not take action against you for filing
a complaint.
Rev. 09/2013
The Surgery Center at Lutheran
HIPAA Notificación de Privacidad
Esta notificación describe como información médica sobre usted puede ser utilizada y
como puede usted puede tener acceso a esa información. Por favor lea cuidadosamente.
La Ley de Portabilidad y Responsabilidad
del Seguro de Salud de 1996 (HIPAA) es
una ley federal que regula la privacidad
de la información médica personal.
Estamos obligados por la ley HIPAA para
notificarle de la disponibilidad de nuestro
Aviso de Prácticas de Privacidad. Este
aviso describe nuestras prácticas de
privacidad, derechos legales y sus
derechos con respecto a su información
médica protegida (PHI), e incluye
disposiciones que se expresan en las
reglas establecidas en el 2013 de HIPAA.
Protección de su información
medica
Podemos juntar, usar y compartir su
información médica (PHI) por las
siguientes razones:
Para pagos: Usamos y compartimos su
PHI para manejar su cuenta o beneficios
y para obtener el reembolso por los
cuidados proveídos.
Para operaciones de cuidados
médicos: Usamos y compartimos su PHI
para operaciones de cuidados médicos.
Por ejemplo, para revisar la calidad de
atenciones y servicios que usted recibe.
Para actividades de tratamiento:
Usamos y compartimos su PHI para
asegurarnos que usted recibe el
tratamiento que usted necesita.
Para usted: Nosotros debemos darle a
usted su propia PHI. Así podemos
mandar recordatorios sobre atenciones
de seguimiento requeridas.
Para otros: Usted puede decirnos por
escrito que está bien para nosotros dar
su PHI a otra persona por cualquier
motivo. Además, si usted está presente y
nos dice que está bien, podemos dar su
PHI a un familiar, amigo u otra persona.
Queremos hacer esto si tiene que ver
con su tratamiento o pago por su
tratamiento actual. Si usted no está
presente, si se trata de una emergencia,
o que no son capaces de decirnos que
está bien, es posible que demos su PHI a
un familiar, amigo u otra persona si
comparte su PHI está en su mejor
interés.
Según lo permitido o requerido por
ley: También podemos compartir su PHI,
según lo permitido por la ley federal,
para muchos tipos de actividades. Su PHI
puede ser compartida para actividades
de supervisión de la salud. También
puede ser compartida por procedimientos
judiciales o administrativos, con las
autoridades de salud pública, por razones
de orden público, y con médicos
forenses, directores de funerarias o
médicos forenses (alrededor de los
difuntos). Su PHI también puede ser
compartida con los grupos de donación
de órganos, por ciertas razones, para la
investigación, y para evitar una amenaza
grave a la salud o la seguridad. Puede
compartirse para funciones especiales del
gobierno, para la indemnización de los
trabajadores, para responder a las
solicitudes del Departamento de Salud y
Servicios Humanos de los EE.UU., y para
alertar a las autoridades
correspondientes si tenemos razones
para creer que puede ser víctima de
abuso, negligencia, violencia doméstica u
otros delitos. Su PHI también puede ser
usado para reportar cierta información a
la Food & Drug Administration de EE.UU.
acerca de los dispositivos médicos que se
rompen o mal funcionamiento.
Autorización: Vamos a obtener el
permiso de usted por escrito antes de
usar o compartir su PHI para cualquier
otro propósito no especificado en este
aviso. Usted puede retirar su
autorización, por escrito, en cualquier
momento. A continuación, se deja de
usar su PHI para ese propósito. Si ya
hemos utilizado o compartido su PHI en
base a su autorización, no podemos
deshacer cualquier acción que tomamos
antes de que usted nos haya dicho que
se detuviera.
Cómo protegemos su información:
Estamos dedicados a proteger su PHI y
han establecido una serie de políticas y
prácticas para asegurar que su PHI se
mantenga segura.
seguridad siguen las leyes federales y
estatales. Algunas de las formas en las
que guardar su caja fuerte PHI incluyen
oficinas de fijación que sujetan PHI,
ordenadores para proteger con
contraseña y bloqueo de las áreas de
almacenamiento y archivadores.
Exigimos a nuestros empleados proteger
su PHI a través de políticas y
procedimientos escritos. Estas políticas
limitan el acceso a la PHI sólo a aquellos
empleados que necesitan la información
para realizar su trabajo. También se
requiere que los empleados usen tarjetas
de identificación para ayudar a mantener
a las personas que no pertenecen a las
áreas donde se guarda la información
confidencial.
Sus Derechos: Usted puede:
 Recibir una copia de esta
notificación de privacidad
 Solicitar límites a la divulgación de su
PHI
 Recibir acceso a parte o todo su
historial medico
 Recibir una copia de su historial
médico en papel o una copia
electrónico dentro de 30 días de
recibir su petición
 Solicitar una modificación a su PHI
 Esperar su modificación dentro de
60 días
 Restringir la divulgación de su PHI a
un plan de salud cuando usted paga
en su totalidad en el momento del
servicio
 Recibir un registro de cómo se ha
utilizado y / o compartido su
información de salud
 Recibir información sobre cómo
presentar una queja si usted cree que
su privacidad ha sido violada
 Optar fuera de esfuerzos de
recaudación de fondos (cuando
corresponda)
Nosotros:
 No venderemos su PHI
 Le notificaremos en caso de una
violación de su PHI
Mantenemos su PHI oral, escrita y
electrónicamente segura utilizando
medios físicos, electrónicos y de
procedimiento. Estas medidas de
Llámenos para más información sobre las prácticas de privacidad. Puede comunicarse con el Director de Privacidad al (303) 301-7700.
Quejas: Si usted cree que su privacidad no ha sido protegida, usted puede presentar una queja con nosotros. También puede presentar una queja con la
Oficina de Derechos Civiles con el Departamento de Salud y Recursos Humanos de los E.E.U.U. No tomaremos medidas en su contra por presentar una queja.
Rev. 09/2013
THE SURGERY CENTER AT LUTHERAN
PATIENT’S RIGHTS AND RESPONSIBILITIES
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Each patient treated at this Ambulatory Surgery Center, or their
representative, has the right to:
Be treated with respect, consideration, and dignity.
Respectful care given by competent personnel with consideration of their
privacy concerning their medical care.
Be given the name of their attending physician, the names of all other
physicians directly assisting in their care, and the names and functions
of other health care persons having direct contact with the patient.
Have records pertaining to their medical care treated as confidential.
Know what surgery center rules and regulations apply to their conduct as
a patient.
Expect emergency procedures to be implemented without necessary
delay.
Absence of clinically unnecessary diagnostic or therapeutic procedures.
Expedient and professional transfer to another facility when medically
necessary and to have the responsible person and the facility that the
patient is transferred to notified prior to transfer.
Treatment that is consistent with clinical impression or working diagnosis.
Good quality care and high professional standards that are continually
maintained and reviewed.
An increased likelihood of desired health outcomes.
Full information in layman’s terms concerning appropriate and timely
diagnosis, treatment, and preventive measures; if it is not medically
advisable to provide this information to the patient, the information shall
be given to the responsible person on his/her behalf.
Receive a second opinion concerning the proposed surgical procedure, if
requested.
Accessible and available health services; information on after-hour and
emergency care.
Give an informed consent to the physician prior to the start of a
procedure.
Be advised of participation in a medical care research program or donor
program; the patient shall give consent prior to participation in such a
program;
A patient may also refuse to continue in a program that has previously
given informed consent to participate in.
Receive appropriate and timely follow-up information of abnormal
findings and tests.
Receive appropriate and timely referrals and consultation.
Receive information regarding “continuity of care”
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Refuse drugs or procedures and have a physician explain the medical
consequences of the drugs or procedures.
Appropriate specialty consultative services made available by prior
arrangement.
Medical and nursing services without discrimination based upon age,
race, color, religion, gender, sexual orientation, national origin,
handicap, disability, or source of payment.
Have access to an interpreter whenever possible.
Be provided with, upon request, access to information contained in their
medical record.
Accurate information regarding the competence and capabilities of the
organization, its employees, and medical staff.
Receive information regarding methods of expressing suggestions or
grievances to the organization.
Appropriate information regarding the absence of malpractice insurance
coverage.
Change primary or specialty physicians or dentists if other qualified
physicians or dentists are available.
Health services provided are consistent with current professional
knowledge.
Appropriate assessment and management of pain.
Participate in their own healthcare decisions except if this is
contraindicated due to medical reasons.
Receive a Patient Privacy Notice which provides an explanation of how
their protected health information is utilized and to those that may need
to receive it. (Notification if a breach of unsecured health information occurs.)
Pastoral and/ or spiritual support
Each patient treated at this facility has the responsibility to:
Provide full cooperation with regards to instructions given by his/her
surgeon, anesthesiologist, and operative care (pre and post).
Provide the surgery center staff with all medical information which may
have a direct effect on the provider at the surgery center.
Provide the surgery center with all information regarding third-party
insurance coverage.
Know their insurance requirements, such as pre-authorization,
deductibles and co-payments
Fulfill financial responsibility, for all services received, as determined by
the patient’s insurance carrier.
Act in respectful and considerate manner toward healthcare providers,
other patients and visitors.
* See back cover for important phone numbers
Grievance Process
You and your representative have the right to:
 Voice a complaint to your healthcare providers and administrators
without a fear of reprisal.
 Contact the Management Representative at 303-301-7700 to file a
formal grievance. Or, you may contact the State of Colorado to issue
a grievance. Their website is:
http://www.dora.state.co.us/medical/complaints.htm
or call 303-894-7690.
 Contact the Colorado Department of Health and Human services @
303-692-2800 0r 1-800-886-7689×2800
 Contact the Medicare Hotline @ 1-800-633-4227 or
http://www.medicare.gov/claims-and-appeals/medicare-rights/gethelp/ombudsman.html
 Contact the Accreditation Association of Ambulatory Health Care
www.aaahc.org
 Receive a timely response with the results of your complaint (if issued
to the Surgery Center directly). Unresolved complaints are directed to
the facilities director within 3 days and are responded to in writing.
Advance Directives
You and your representative have the right to know that:
 Patients treated at The Surgery Center at Lutheran are expected to
be in reasonably good health and of low surgical/procedure risk;
making resuscitation appropriate for conditions of preserving life, until
transfer to hospital occurs.
 Your advance directives will not prevent treatment of a life threatening
condition should one occur while you are receiving care at The
Surgery Center at Lutheran. In the event of a life threatening
condition, you will be treated, stabilized and transferred via EMS to
the closest appropriate acute care facility.
Important Numbers & Websites:
The Facility Administrator: 303-301-7702
State of Colorado: 303-894-7690
http://www.dora.state.co.us/medical/complaints.htm
Colorado Department of Health and Human services:
303-692-2800 or 1-800-886-7689 x2800
Medicare Hotline: 1-800-633-4227
http://www.medicare.gov/claims-and-appeals/medicare- rights/gethelp/ombudsman.html
PATIENTS RIGHTS
AND
RESPONSIBILITIES
3455 LUTHERAN PARKWAY
SUITE 150
WHEAT RIDGE, CO 80033
303-301-7700
www.lutheranasc.com
OWNERSHIP DISCLOSURE
The physician who has referred you to The Surgery Center at
Lutheran may have a limited investment in this facility and
therefore may have a “significant beneficial interest” in
referring you to us. You are free to choose another facility
in which to receive the services that have been ordered by
your physician.
James Barron, MD
B. Andrew Castro, MD
William Ciccone, MD
David Conyers, MD
Cornerstone Wheat Ridge ASC, LLC
Gayle Crawford, MD
Tom Eickmann, MD
Thomas Fry, MD
Jennifer Grube, MD
Michael Johnson, MD
Robert Kawasaki, MD
Erik Kreutzer, MD
Nicholas Olsen, DO
Matthew Paden, DPM
William Saber, MD
Brett Sachs, DPM
Daniel Saunders, MD
Gregory Still, DPM
Michael Tralla, MD
Christopher Wilson, MD
Tracy Wolf, MD
Fredric Zimmerman, DO
The Surgery Center at Lutheran is a joint venture with
Lutheran Medical Center / SCL Health
DERECHOS Y
RESPONSABILIDADES
DE LOS PACIENTES
3455 LUTHERAN PARKWAY
SUITE 150
WHEAT RIDGE, CO 80033
303-301-7700
Números de teléfono importantes:
El Centro de Cirugía Luterano Administrador - 303-301-7702
Departamento de Salud y Servicios Humanos
303-692-2800 or 1-800-886-7689 x2800
Línea directa de Medicare: 1-800-633-4227
Website: www.cms.hhs.gov/center/ombudsman.asp
Sitio Web: www.lutheranasc.com
EL CENTRO DE CIRUGÍA LUTERANO
DERECHOS DEL PACIENTE Y RESPONSABILIDADES
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Cada paciente tratado en este Centro de Cirugía Ambulatoria tiene el derecho
de:
 Ser tratados con respeto, consideración y dignidad.
 Atención respetuosa por personal competente a la consideración de su
privacidad sobre su atención médica.
 Saber el nombre de su médico tratante, los nombres de todos los demás
médicos directamente en la ayudar de su cuidado, y las funciones de cada
quien.
 Tienen los registros relativos a la atención médica en forma confidencial.
 Saber qué normas y reglamentos son aplicables a su conducta como
un paciente.
 Que los procedimientos de emergencia deberán aplicarse sin demora necesaria.
 Falta de procedimientos clínicamente innecesaria diagnósticos o terapéuticos.
 Transferencia rápida y profesional a otro establecimiento cuando sea
médicamente necesario y que la persona responsable y la planta que el
paciente sea trasladado sea notificado antes de la transferencia.
 Tratamiento que es compatible con impresión clínica o diagnóstico en trabajo.
 Que se mantengan continuamente y revisado la atención de buena calidad y el
alto nivel professional.
 Un aumento de la probabilidad de resultados deseados.
 Toda la información en términos más generales sobre diagnóstico, tratamiento y
medidas preventivas; si no es médicamente adecuada y oportuna
aconsejable para proporcionar esta información a la paciente, la información
a la persona responsable en su nombre.
 Recibir una segunda opinión sobre la propuesta de procedimiento quirúrgico, si
lo solicita.
 Accesibles y los servicios de salud; información sobre la hora y la atención de
urgencia.
 Dar un consentimiento informado por parte del médico tratante antes del inicio
de un procedimiento.
 Se informó de la participación en un programa de investigación sobre atención
médica o programa de donantes; el paciente deberá dar su consentimiento
antes de la participación en este tipo de
Programa;
 Un paciente puede también negarse a continuar en un programa que ya ha
dado su consentimiento informado para participar.
 Una adecuada y oportuna información de seguimiento de resultados anormales
y pruebas.
 Recibir las remisiones y consulta adecuada y oportuna.
 Recibir información sobre la "continuidad de la atención"
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Niegan medicamentos o procedimientos y un médico explicar las
consecuencias médicas de los medicamentos o procedimientos.
Servicios de consultoría especializada adecuada asu disposición segun
previo acuerdo.
Servicios Médicos y de enfermería sin discriminación basada en edad, raza,
color, religión , género, orientación sexual, origen nacional, discapacidad,
discapacidad, o la fuente de pago.
Tener acceso a un intérprete siempre que sea posible.
Estar provistos en su caso, previa solicitud, el acceso a la información
contenida en su expediente médico.
Información precisa en relación con la competencia y la capacidad de la
organización, sus empleados, y el personal médico.
Recibir información sobre métodos para expresar sugerencias o quejas a la
organización.
Información adecuada en relación con la ausencia de la negligencia de su
cobertura.
Cambio principal o especialidad los médicos o dentistas si otros médicos o
dentistas están disponibles.
Servicios de salud prestados sean consistentes con los conocimientos
profesionales.
Una adecuada evaluación y manejo del dolor.
Participar en sus propias decisiones de atención de la salud excepto si este
está contraindicado debido a razones médicas.
Recibir un paciente Aviso de privacidad que proporciona una explicación de
cómo su información de salud protegida es utilizado y a los que necesitan
recibir .
Apoyo espiritural pastoral y/o
Cada paciente tratado en este centro tiene la responsabilidad de:
Proporcionar plena cooperación en lo que respecta a las instrucciones dadas
por su cirujano, anestesiólogo, y cuidados postoperatorios (pre y post).
Proporcionar al centro de cirugía personal con toda la información médica que
puede tener un efecto directo sobre el proveedor de servicios en el centro de
cirugía ambulatoria.
El centro de cirugía ambulatoria con toda la información relativa a terceros
cobertura de seguro.
Conocer sus necesidades de seguros, como una pre-autorización, deducibles
y co-pagos
Cumplir con responsabilidad financiera, para todos los servicios recibidos,
según lo determinado por el paciente portador de seguro.
Actuar de forma respetuosa y considerada hacia los proveedores de servicios
de salud, otros pacientes y visitantes.
* Ver portada para números de teléfono importantes
DECLARACIÓN DE PARTICIPACIÓN
El médico que le ha recomendado al Centro de Cirugía
Luterano puede tener una inversión limitada en este tipo de instalaciones y
Por lo tanto, pueden tener una importante participación en los beneficios" en
Refiriéndose a nosotros. Usted es libre de elegir otro servicio
Para recibir los servicios que se han ordenado por
El médico.
Los médicos que forman parte los propietarios:
James Barron, MD
B. Andrew Castro, MD
William Ciccone, MD
David Conyers, MD
Cornerstone Wheat Ridge ASC, LLC
Gayle Crawford, MD
Tom Eickmann, MD
Thomas Fry, MD
Jennifer Grube, MD
William Hineser, DPM
Michael Johnson, MD
Robert Kawasaki, MD
Erik Kreutzer, MD
Nicholas Olsen, HACER
Mateo Paden, DPM
William Sable, MD
Brett Sachs, DPM
Daniel Saunders, MD
Gregory Still, DPM
Michael Tralla, MD
Christopher Wilson, MD
Tracy Wolf, MD
Fredric Zimmerman, DO
The Patient
Self-Determination Act
3455 Lutheran Parkway
Suite 150
Wheat Ridge, CO 80033
303-301-7700
www.lutheranasc.com
T
he Patient Self-determination Act is a federal law that
requires hospitals to “provide written information” to
adult inpatients concerning “an individual’s right
under state law to make decisions concerning medical
care, including the right to accept or refuse medical or
surgical treatment and the right to formulate advance
directives.” To help patients make these choices, Colorado
law provides for advance directives. This brochure outlines
what advance directives are and what Colorado statutes
require.
The Durable Power of Attorney for Health Care
A form in which a person gives someone else the right to make
decisions about their health care. This person is called an “agent.”
An agent cannot be a physician or other health care provider, unless
the health care provider is related by blood or marriage to the person
signing the document. This document must also be notarized or
signed by two witnesses. These witnesses must follow the same
criteria as the Living Will.
The Pre-Hospital “Do Not Resuscitate Request”
Advance Directives
Advance directives are papers that state a patient’s choices for
treatment. This includes decisions like refusing treatment, being
placed on life support, and stopping treatment at a point the patient
chooses. It also includes requesting specific life sustaining
treatments.
There are several kinds of advance directives. The three that are
most common are the living will; durable power of attorney for
healthcare and the pre-hospital do not resuscitate order.
The Living Will
A form that states that life sustaining procedures should be withheld
or withdrawn. This only goes into effect when the patient can no
longer make decisions. Medical procedures which are necessary
to provide comfort or pain relief are not considered life-sustaining
procedures. For the Living Will to be effective, two physicians must
personally examine the patient and determine that the patient has a
terminal illness. The physicians must agree that death will occur
with or without intervention. The living will must be notarized or
signed by two witnesses. These witnesses must be two adults that
are not involved with the patient’s care or financially responsible for
the patient.
A form that lets the patient prohibit medical procedures outside the
hospital. The form must be signed by a doctor and given to
emergency personnel if they are called.
The Surgery Center at Lutheran will not discriminate against those
patients who have or have not completed an Advance Directive.
The Patient Self-Determination Act requires that all adult patients be
provided with written information concerning the right to formulate an
Advance Directive. All patients will be questioned as to the existence
of an advance directive and provided with information if they so
desire.
For all Advance Directives to be effective, copies must be placed on
the chart upon admission. If, for any reason the hospital or the
physician cannot carry out the wishes of the Advance Directive, the
patient will be transferred to another physician or hospital that is
willing to follow the instructions.
For further information please visit the website at:
www.caringinfo.org/stateaddownload or 1-800-658-8898
or
www.healthfacilites.info
The Surgery Center at Lutheran respects your right to participate
in decisions regarding your health care. Our policy is that
we will use all measures possible to sustain life.
Ley de auto-determinación
del paciente
3455 Lutheran Parkway
Suite 150
Wheat Ridge, CO 80033
303-301-7700
La ley de auto-determinación es ley federal que requiere que los
hospitales "proporcionen información escrita" para adultos
hospitalizados sobre el "derecho de la persona bajo la ley del
estado para tomar decisiones relativas a la atención médica,
incluyendo el derecho a aceptar o rechazar tratamientos médicos y
quirúrgicos y el derecho a formular las directrices anticipadas."
Para ayudar a los pacientes a tomar estas decisions la, ley de
Colorado ofrece las directrices anticipadas. Este folleto describe lo
que son las voluntades anticipadas y lo que los estatutos exigen en
Colorado.
El poder notarial duradero para la atención de la Salud
Un formulario en la que una persona le da a otra persona el derecho de
tomar decisiones sobre su atención médica. Esta persona se denomina
como un "agente". Un agente no puede ser un médico u otro proveedor
de atención médica, a menos que el médico se relaciona por sangre o
matrimonio a la persona que firma el documento. Este documento debe
ser firmado ante un notario o por dos testigos. Estos testigos deben
seguir los mismos criterios que en la voluntad de vivir.
Los primeros auxilios "Peticion de No Resucitar "
Las Directivas avanzadas
Las directrices anticipadas son documentos que indicant las opciones de
tratamiento. Esto incluye la adopción de decisiones como denegación de
tratamiento, apoyo a la vida, y la interrupción del tratamiento en el punto
en el cual el paciente elige. También incluye solicitar mantener
tratamientos específicos para mantenerse en vida.
Hay varios tipos de directrices anticipadas. Los tres más comunes son la
voluntad de vivir; poder notarial duradero para la atención de la salud y la
orden de no resucitar.
La voluntad de vivir
Un formulario cual indica si deben ser suspendidos o retireados los
procedimientos de sostenimiento de vida artificial. Esto sólo entra en
vigor cuando el paciente ya no puede tomar decisiones. Los
procedimientos médicos que son necesarios para proporcionar
comodidad o alivio del dolor no se consideran procedimientos de
conservación de la vida. Para que sea eficaz la voluntad devivir dos
médicos deben interrogar personalmente al paciente y determinar que el
paciente tiene una enfermedad terminal. Los médicos deben estar de
acuerdo que la muerte se producirá con o sin intervención. La voluntad
de vida debe ser notariada o firmada por dos testigos. Estos testigos
deben ser dos adultos que no están relacionadas con el cuidado del
paciente o financieramente responsable del paciente.
Un formulario que permite al paciente prohibir los procedimientos
médicos fuera del hospital. El formulario debe estar firmado por un
médico y entregado al personal de emergencia en caso que sean
llamados. Centro de Cirugía Luterano, no discrimina a aquellos
pacientes que hayan o no hayan completado una directiva avanzada.
La Ley de auto determinación del paciente requiere que todos los
pacientes adultos reciban información escrita sobre el derecho a
formular un directiva avanzada. Todos los pacientes deberán ser
cuestionado en cuanto a la existencia de una directiva avanzada, o
proporcionarles con la información si así lo desean.
Par que todas las directivas avanzadas sean eficaces, las copias deben
ser colocadas en el archive al ser ingresado. Si, por cualquier razón, el
hospital o el médico no puede cumplir los deseos de la Directiva, el
paciente va a ser trasladado a otro médico u hospital que está dispuesto
a seguir las instrucciones.
Para obtener más información, visite el sitio web en:
www.caringinfo.org/stateaddownload o llame al 1-800-658-8898
o www.healthfacilites.info
El Centro de Cirugía Luterano respeta su derecho a participar en las
decisiones sobre su atención de la salud, nuestra política es que
vamos a utilizar todas las medidas posibles para mantener la vida.
The Surgery Center at Lutheran
Conditions of Service / Consent for Treatment
1. The Surgery Center maintains personnel and facilities to assist your physician(s) in his or her performance
of various surgical operations and other special diagnostic or therapeutic procedures and/or treatment.
These procedures may all involve risks of unsuccessful results, complications, injury, or even death, from
both known and unforeseen causes, and no warranty or guarantee is made as to result or cure.
You have the right to be informed of such risks as well as the nature of the operation, procedure and/or
treatment; the expected benefits or effects of the same; and the available alternative methods and their
risks and benefits. Except in cases of emergency, operations, procedures and/or treatments are not
performed until you have had the opportunity to receive this information and have given your consent. You
have the right to consent or to refuse any proposed operation, procedure and/or treatment any time prior to
its performance.
2. The operation, procedure and/or treatment will be performed by my physician (or in the event of an
emergency causing his or her inability to complete the procedure, a qualified substitute physician or
surgeon), together with associates and assistants, including anesthesiologists, pathologists, and
radiologists from the medical staff to whom the physician or surgeon may assign designated
responsibilities. The person in attendance for the purpose of performing specialized medical services such
as anesthesia, radiology, or pathology are not agents, servants, or employees of the Center or your
physician or surgeon, but are independent contractors and, therefore, your agents, servants, or employees.
3. The pathologist is hereby authorized to use his or her discretion in disposing of any member, organ, or
other tissue removed from your person during the operations or procedures set forth above.
4. Advance Directives: I understand that even though the physicians and staff of the Surgery Center respect
my rights to participate in decisions regarding my health care, the policy of the Surgery Center is that all
patients undergoing surgical procedures will be considered eligible for life-sustaining emergency
treatments.
5. In the event of an emergency or urgent situation: I consent to the transfer and/or admission to a nearby
acute-care facility for continuity of care. In the case of an emergency transfer to another facility or hospital,
I consent to the use of blood and/or blood by-products at the receiving facility. (Initial on the appropriate
line)
_______Yes, I agree to a blood transfusion if needed in an emergency.
_______ No, I refuse a blood transfusion even in an emergency.

In the Case of an Emergency:
Notify my next of kin: Name:
______________________________
Phone:
_________________
6. Accidental Exposure: In the event of an accidental exposure of my blood or bodily fluids to a physician,
contractor, or employee of the facility, I consent to testing for HIV and Hepatitis.
7. Health Plan Obligation: This Center maintains a list of health plans with which it contracts. A list of such
plans is available upon request from the Administrative Office of this Center. The Center has no contract,
expressed or implied, with any health plan that does not appear on the list. The undersigned agrees that
she/he is individually obligated to pay the full charges of all services rendered to him/her if he/she belongs
to a plan that does not contract with the Center. If my insurance is Medicare, I certify that the information
given by me in applying for payment under Title XVIII of the Social Security Administration Act is correct.
8. Investors: Your physician may be an investor in The Surgery Center at Lutheran. The receptionist, upon
request, can provide more details regarding the ownership of the Center.
Conditions of Service/Consent for Treatment
1
Patient Label
The Surgery Center at Lutheran
9. Permission to Discuss Financial Information: I authorize (name of another adult other than myself)
_____________________________, to discuss my account information with the Surgery Center at
Lutheran. I understand that conversations will be limited to account balance, claim/personal payment,
insurance benefits and insurance coverage. Medical information will not be discussed without further
documented authorization.
10. Ride Arrangements: I have made arrangements to have a responsible adult drive me home and care for
me for the next 24 hours.
11. During your stay with us: While you are at the Center we are committed to running on time. If you have
been waiting for more than 15 minutes after your initial check-in, please alert the receptionist, who will
check into the delay. The Center shall not be liable for the loss or damage to any money, jewelry,
documents, dentures, glasses, hearing aides, clothing, etc. or other personal articles. Regarding the use of
Cell Phones, they are prohibited in the surgical areas. The Surgery Center requests that usage be limited
to the waiting area.
12. Permission: During your time at the Center and during your convalescence, the doctors and nurses are
concerned about your care and may need to talk with your significant others to provide for the very best
surgical outcome. Whom can we talk to:

_________________________________
_______ Yes, my doctor or nurse can talk to my family/friends
_______ Yes, my doctor or nurses may leave messages on my home phone, if I can
not be reached
13. Payment: This Center expects each patient to pay his or her deductible and co-pays on or before the day
of surgery. Once the insurance company has adjudicated the claim, patients will be responsible for all
remaining balances. The Surgery Center at Lutheran will allow patients up to three months to pay off the
remaining balance. It is the responsibility of the patient to contact the Business Office Manager, to request
a 3-month payment plan.
14. Authorization: The undersigned certifies that he/she has read the foregoing, received a copy thereof, and
as the patient, or the patient’s legal representative, or is duly authorized by the patient as the patient’s
general agent to execute the above and accept its terms. The signature constitutes your acknowledgement
that (1) you have read and agree to the foregoing; (2) that the operation, procedure and/or treatment has
been adequately explained to you by the physician; (3) that you authorize and consent to the performance
of the operation, procedure and/or treatment at this facility; (4) that you have read the Patient’s Rights and
Responsibilities.
When signing this form you are consenting to the performance of all routine
medical/surgical care and treatment (e.g., physical examination, tests, x-rays, therapy, etc.) which may be
performed while a patient at The Surgery Center at Lutheran, as well as emergency treatment or services
that may be required under the general and special instructions of the patient’s physician or surgeon.

________
______________ _______________
Signature (patient/parent/guardian)
_______________________________________________
Witness Signature (if signed by other than patient)
Date
Time
________________________________
Relationship to patient
I have received information in language I understand and have been given an opportunity to ask questions
about: Please initial the items that apply.
___Advance Directives ____I have provided a copy of my Advance Directives to the Surgery Center
___My Rights and Responsibilities as a patient
___My physician’s part ownership in the Surgery Center
Conditions
of Service/Consent
for Treatment
2
___HIPAA/Notice
of privacy
practices
Patient Label
The Surgery Center at Lutheran
Conditions of Service / Consent for Treatment
1. El Centro de Cirugía mantiene personal e instalaciones para ayudar a su médico (s) en su desempeño de varias
operaciones quirúrgicas y otros procedimientos diagnósticos o terapéuticos especiales y / o tratamiento. Estos
procedimientos pueden involucrar todos los riesgos de resultados fallidos, complicaciones, lesiones e incluso la
muerte, por tanto conocidos como causas imprevistas, y ninguna garantía en cuanto al resultado o la cura.
Usted tiene el derecho de ser informado de dichos riesgos, así como la naturaleza de la operación, el procedimiento
y / o tratamiento, los beneficios o los efectos de la misma, y los métodos alternativos disponibles y sus riesgos y
beneficios. Excepto en casos de emergencia, operaciones, procedimientos y / o tratamientos no se realizan hasta
que haya tenido la oportunidad de recibir esta información y ha dado su consentimiento. Usted tiene el derecho de
aceptar o rechazar cualquier propuesta de operación, el procedimiento y / o tratamiento en cualquier momento
anterior a su rendimiento.
2. La operación, procedimiento y / o tratamiento se llevará a cabo por mi médico (o en el caso de una emergencia que
causa su incapacidad para completar el procedimiento, un médico sustituto calificado o cirujano), junto con asociados
y asistentes, incluyendo anestesiólogos, patólogos y radiólogos del personal médico para que el médico o cirujano
pueden asignar responsabilidades designado. La persona en la asistencia con el propósito de llevar a cabo los
servicios médicos especializados, tales como anestesia, radiología o patología no son agentes, funcionarios o
empleados del Centro o su médico o cirujano, pero son contratistas independientes y, por lo tanto, sus agentes,
empleados, o empleados.
3. El patólogo queda autorizado para usar su discreción en la eliminación de cualquier miembro, órgano o de otro tejido
removido de su persona durante las operaciones o procedimientos establecidos anteriormente.
4. Directivas Anticipadas: Entiendo que a pesar de que los médicos y el personal del Centro de Cirugía respetan mis
derechos a participar en las decisiones sobre mi cuidado de salud, la política del Centro de Cirugía es que todos los
pacientes sometidos a procedimientos quirúrgicos se considerarán elegibles para tratamientos DE emergencia para
mantener la vida.
5. En el evento de una emergencia o situación urgente: Doy mi consentimiento para ser transferido y/o ser admitido
a una institución cercana para la continuación de tratamiento. En caso de una transferencia de emergencia a otra
institución u hospital, doy mi consentimiento para el uso de sangre o subproducto de sangre en la facultad que me
reciba.(Ponga sus iniciales en la línea apropiada)
_______Si, estoy de acuerdo en recibir una transfusión de sangre en caso de emergencia.
_______ No, no quiero recibir una transfusión de sangre aunque sea emergencia.

En caso de una emergencia:
Notifique mi pariente más cercano: Nombre: ______________________________ Teléfono:
_________________
6. Exposición accidental: En el evento de que haya una exposición accidental de mi sangre o fluidos a un doctor,
contratista o empleado de la institución, doy mi consentimiento a una prueba del VIH y Hepatitis.
7. Obligación del Plan de Salud: Este Centro mantiene una lista de los planes de salud con el que contrata. Una lista
de este tipo de planes está disponible a su petición en la Oficina Administrativa de este Centro. El Centro no tiene
contrato, expresa o implícita, con ningún plan de salud que no aparece en la lista. El suscrito acepta que él / ella tiene
la obligación individual de pagar los cargos completos de todos los servicios prestados a él / ella si él / ella pertenece
a un plan que no tiene contrato con el Centro. Si mi seguro es Medicare, certifico que la información dada por mí en
la solicitud de pago bajo el Título XVIII de la Ley de la Administración de Seguro Social es correcta.
8. Inversores: Su médico puede ser un inversor en el Centro Luterano de Cirugía. La recepcionista, a su petición,
puede proporcionar más detalles con respecto a la titularidad del centro.
9. Permiso para discutir información financiera: Yo autorizo a (nombre de otro adulto que no sea yo)
_____________________________, para discutir mi información sobre mi cuenta con el Centro Luterano de
Cirugías. Yo entiendo que las conversaciones serán limitadas al balance de mi cuenta, reclamo/pago personal,
beneficios y coberturas del seguro medico. Información sobre mi salud no será discutida sin autorización por escrito.
Conditions of Service/Consent for Treatment
1
Patient Label
The Surgery Center at Lutheran
10. Arreglo de viaje: He hecho planes para que un adulto responsable venga por mí, me lleve a casa y cuide por mí las
siguientes 24 horas.
11. Durante su estancia con nosotros: Mientras que usted está en el Centro, estamos comprometidos a siempre estar
a tiempo. Si usted ha estado esperando por más de 15 minutos después de su llegada, por favor avise a la
recepcionista, que comprobará la demora. El Centro no se hace responsable por la pérdida o daño de cualquier
dinero, joyas, documentos, dentaduras, gafas, audífonos, ropa, etc. u otros artículos personales. En cuanto al uso de
los teléfonos celulares, están prohibidos en las áreas quirúrgicas. El Centro de Cirugía solicita que el uso se limita a
la zona de espera.
12. Permiso: Durante su tiempo en el Centro y durante su convalecencia, los médicos y enfermeras se preocupan por su
cuidado y puede que tengan que hablar con sus familiares para proporcionar el mejor resultado quirúrgico. Con
quienes podemos hablar: _________________________________

_______ Sí, mi doctor o enfermera pueden hablar con mis familiares/amistades.
_______ Sí, mi doctor o enfermera pueden dejar recados en mi teléfono de casa en caso de no estar
disponible.
13. Pago: Este Centro espera que cada paciente pague su deducible y co-pagos en o antes del día de la cirugía. Una
vez que la compañía de seguros ha adjudicado el reclamo, los pacientes serán responsables de todos los saldos
restantes. El Centro Luterano de Cirugía permitirá a los pacientes tres meses para pagar el saldo restante. Es la
responsabilidad del paciente mantenerse en contacto con el Gerente de la Oficina de Empresas, para solicitar un
plan de pago de 3 meses.
14. Autorización: El firmante abajo certifica que él / ella ha leído lo anterior, recibió una copia del mismo, y que el
paciente o el representante legal del paciente, o está debidamente autorizado por el paciente como agente general
del paciente para ejecutar lo anterior y aceptar sus términos. La firma constituye el reconocimiento de que (1) usted
ha leído y está de acuerdo con lo anterior, (2) que la operación, procedimiento y / o tratamiento se ha explicado
adecuadamente a usted por el médico, (3) que autoriza y consiente el rendimiento de la operación, el procedimiento
y / o tratamiento en nuestro centro, (4) que ha leído los Derechos y Responsabilidades del Paciente. Al firmar este
formulario, usted da su consentimiento para la realización de todos los cuidados de rutina médica / quirúrgica y el
tratamiento (por ejemplo, la exploración física, las pruebas, radiografías, terapia, etc.) que puede realizarse mientras
el paciente está en el Centro Luterano de Cirugía, así como el tratamiento de emergencia o servicios que pueden ser
necesarios en virtud de las instrucciones generales y especiales del médico o cirujano del paciente.

________
Firma (paciente, padre, tutor)
_______________________________________________
Firma de testigo (si fue firmado por alguien mas)
______________ _______________
Fecha
Hora
________________________________
Relación al paciente
He recibido la información en un idioma que yo entiendo y me han dado la oportunidad de hacer
preguntas. Por favor ponga sus iniciales en lo que aplique a usted.
___Directivas Avanzadas ____He recibido una copia de mis directivas avanzadas del centro quirúrgico.
___Mis derechos y responsabilidades como paciente.
___ Parte responsabilidad de mi médico en el Centro de Cirugía
___HIPAA/Notificación de prácticas privadas
Conditions of Service/Consent for Treatment
2
Patient Label
Frequently Asked Questions
General Questions
Where can I find directions to The Surgery Center at
Lutheran?
Follow this link to our Maps and Directions page where you will find driving
directions and parking information.
What are the hours of operation for the Surgery Center?
Our clinical hours of operation are 6:15 am to 5 pm. Business hours are 8
am to 5 pm.
Does the Surgery Center have a parking lot?
Yes, we provide free parking to our visitors. The parking lot is located
directly south of the building.
Do you have a cafeteria at the Surgery Center?
We do not have a cafeteria at our facility. We provide coffee and there is a
soda machine and a vending machine with snacks in the waiting area for
families. There are many restaurants in the area as well as a cafeteria at
the hospital on campus.
What does NPO mean?
NPO stands for "nothing by mouth." This includes water, gum (gum
increases natural saliva production), hard candy, chewing tobacco, food
and drink.
What should I wear the day of my procedure?
You will be provided a surgical gown to wear during your procedure. Please
wear loose, simple, comfortable clothing and comfortable walking shoes.
Leave all jewelry at home. Please keep in mind what procedure is being
performed and bring clothes that are appropriate for your return home. For
example, for shoulder surgeries, loose button-up shirts are best. For leg
surgeries, loose shorts or pants are recommended. Whichever site you are
having worked on, wear something that will accommodate a bandage, cast
or other type of dressing. If you are having a pain injection, wear elastic
loose fitting pants and avoid wearing jeans or pants with metal around the
waist area, such as zippers, grommets or buttons. Please remember to
leave all valuables at home.
Why do I have to arrive so early before my surgery?
There are many things we need to do to prepare for your surgery. A
registered nurse or nurses will take your vital signs, wash and remove hair
from your surgical area, review your medical history and medications, and
start your IV. We will take time to discuss your surgery with you, answer
any questions you may have and review instructions for your return home.
You will also visit with your surgeon and anesthesiologist prior to your
surgery. If your surgeon has requested your anesthesiologist to provide
you with a pain management block as part of your anesthetic, this will be
performed before your surgery.
Will I have my surgery at the time I am scheduled?
Your scheduled surgery time is an estimated time. Surgeries may take a
shorter or longer amount of time than planned; therefore, we cannot
provide you with an exact scheduled time. We will make every effort to
meet your expected surgery time and will keep you and your family
informed of any delays.
Pre-Procedure
Why can't I have anything to eat or drink several hours
before surgery?
There are several reasons for this rule. First, if there are contents
remaining in your stomach at the time of surgery, you are more likely to get
nauseated and possibly vomit after surgery. Second, during sedation or
anesthesia, when anything is present in your stomach, including water,
excess saliva, food or drink, these contents can be regurgitated and
inhaled into your lungs. This may cause complications, including severe
pneumonia.
Why should I fill prescriptions my physician has given me
before I have my surgery?
After your procedure, you may be tired and groggy and may not be up to a
trip to the pharmacy. Filling your prescriptions beforehand will be easier on
you and you will have pain medications on hand when you need them.
Please bring them with you when you have surgery.
Do I need crutches?
If you are having any surgery on your lower extremities, ask your physician
if you will need crutches. If possible, please bring the crutches with you.
What should I bring?
Bring a case for your glasses, contacts and dentures. Bring reading
glasses if needed. Bring your folder if you were given one at the doctor’s
office. Bring crutches, ice machine, brace, boot or sling if needed. Bring
your inhaler, CPAP, and insulin if discussed. Bring a photo ID, your
insurance card and a form of payment if you have been notified of a copay, deductible and/or co-insurance amount due on the day of your
procedure. All jewelry and piercings need to be removed. It is best to
leave all valuables at home or with your family.
Will my family be able to stay with me while I am being
prepared for my surgery?
Yes, you may have a friend or family member with you during the
preparation for surgery. We prefer you limit visitors to one friend or family
member as the rooms are small. If possible, make arrangements for
someone to care for your children the day of the surgery. We do our best
to provide a calm, quiet area for our patients while they recover at our
surgery center.
Post-Procedure
Will I be able to see my family after my surgery?
There is a period of time that you will be in the recovery room. One friend
or family member may join you in the post-operative recovery room
depending on your nursing needs.
How will I feel after my procedure? You may feel groggy and tired. You may feel cold or have some chills.
Warm blankets are available. Noises may seem louder than usual. Your
vision may be blurred and you may have a dry mouth. You may feel some
discomfort. If needed, your recovery room nurse can give you pain and
nausea medications that your anesthesiologist and surgeon have ordered
for you. What can I do to minimize pain after surgery?
If you are having a surgical procedure, it is normal to experience pain
afterwards. If you have been given a prescription for pain medications, get
them filled as soon as possible, preferably before surgery and bring them
with you to the surgery center. Stay on top of your pain by taking the pain
medication when you first become aware of pain sensations. Remember to
always eat before taking pain medications to avoid nausea. Detailed
discharge instructions will be provided based on your specific surgery.
When will I be allowed to go home?
Everyone reacts differently to surgery and anesthesia, so recovery time
depends upon the individual. When you are awake, doing well and feel
ready to go home, your nurse will review your post-operative instructions
with your responsible party, then allow you to go home. If you receive
anesthesia or sedation, you will need to have a responsible adult with you
for the first 24 hours to help you with your care. Your safety is our primary
concern.
Do I need someone to drive me home and stay with me
after my procedure?
Yes, you will need to have a responsible adult take you home after any
procedure requiring sedation or anesthesia. This is for your safety. You will
need someone available to assist you at home. Patients cannot drive for
24 hours after having sedation or anesthesia.
When can I resume my usual activities? Go back to work?
Drive a car?
With regard to driving a car, going back to work or resuming exercises, etc.,
ask your surgeon, who will explain any limitation(s) you may have.
What signs should I watch for when I go home?
Notify your physician immediately if you experience any excessive
bleeding, signs of infection (redness, swelling, heat, increased pain, red
streaks, drainage from the wound, fever of 100.6 degrees or higher),
difficulty breathing, excessive pain, excessive nausea and vomiting,
inability to urinate, shortness of breath or if you have any new pain in either
calf area. For any other concerns or problems, contact your physician or,
during business hours, the Surgery Center at 303-301-7700. In case of an
emergency call 911.
Contacting The Surgery Center at Lutheran
Who do I contact for questions regarding payment or
insurance coverage for an upcoming procedure?
Please contact the Surgery Center Business Office at 303-301-7700.
Who do I contact for questions regarding my bill?
Please contact Specialty Billing Solutions at 720-359-2110. Please identify
the Surgery Center at Lutheran as your surgical facility to ensure that you
are connected to the correct representative.
Who do I contact for questions regarding preoperative
clinical questions?
Please call 303-301-7708 and ask to speak to a pre-operative assessment
nurse. If your call goes to voice mail, please leave a message; we check
our voice mail box frequently throughout the day.
Who do I contact for questions regarding lab or pathology
results?
Please contact your physician's office.
Who do I contact for questions regarding medical records?
Please contact the Business Office at 303-301-7700. A release
authorization will be required.
Who do I contact if I have a grievance?
Please call the Center at 303-301-7700 and ask to speak to a Management
Representative to file a formal grievance.
Information About Billing Procedures
Using information obtained from your surgeon’s office, our business office staff will call
your insurance company prior to surgery to verify your medical benefits for our facility
charge. We will secure any information regarding co-payments, coinsurance, and/or
deductible amounts that will be your responsibility. Payment of your share of charges is
expected in full prior to or on the day of your procedure.
Your insurance company will receive a bill for the services provided by The Surgery
Center at Lutheran. This covers your preoperative evaluation, most supplies and
medications, equipment, personnel, and use of the operating and recovery rooms.
If you have no insurance or if your insurance does not cover the procedure to be
performed, please make arrangements to pay the Surgery Center facility fee before or
on the day of the surgery. For your convenience, we accept cash, personal checks and
Visa/MasterCard.
In addition to the facility fee charges, you will/may receive separate bills for the
following services: Your Physician or Surgeon, Anesthesia (if you received general
anesthesia or it was necessary for a nurse anesthetist or an anesthesiologist to be
available for your procedure), Laboratory tests, if they were required by your physician,
and/ or Pathology, if tissues or specimens were removed during surgery. Any questions
regarding these services should be directed to the billing offices of the appropriate
provider.
Our business office staff will be happy to answer any questions you may have regarding
insurance coverage or billing procedures if you call 303.301.7700.
Thank you for choosing The Surgery Center at Lutheran for your healthcare
services. We appreciate the opportunity to serve you.
Information About Your Bill
Our billing services are provided by PINNACLE III’S Specialty Billing
Solutions, a centralized billing office located in Denver, Colorado. They are
responsible for filing claims with your insurance carrier as well as collecting
any balances attributed to your responsibility by your insurance carrier.
PINNACLE III’S Specialty Billing Solutions employees may contact you
regarding your insurance coverage related to The Surgery Center at Lutheran
in an effort to get your account paid appropriately. If your insurance provides
100% coverage and there are no other balances due, you may not receive a
statement or bill.
The bill for any balances due will be sent to you by PINNACLE III’S Specialty
Billing Solutions. Payment of any balance due is expected within 3
months. If you are unable to pay your balance in full, please contact
Specialty Billing Solutions to establish payment arrangements.
If you have questions regarding a bill or statement received, please contact
Specialty Billing Solutions at the number listed below. They will have the
information necessary to answer your questions and will be happy to assist
you.
For billing questions:
Please send payments to:
Specialty Billing Solutions
PINNACLE III
(720) 359-2101
(877) 852-7552 toll free
Lutheran Campus ASC, LLC.
P.O. Box 674245
Dallas, TX 75267-4245
Surgery For Children
The Surgery Center at Lutheran was designed to accommodate the special
needs of our pediatric patients. The Center has a highly qualified nursing staff
and the anesthesia team has extensive training and experience with children. We
welcome you to tour the Center and ask any questions you may have prior to
your child’s procedure. Bring a favorite toy or comfort item along to put your child
at ease.
WHERE to find The Surgery Center at Lutheran
The Surgery Center at Lutheran is located in the
Medical Pavilions Building.
3455 Lutheran Parkway, Suite 150, First Floor.
The Center is easily reached off of 32nd Avenue on Lutheran Parkway located between Wadsworth and Kipling Streets.
Enter off of 32
nd
onto Lutheran Parkway which is marked by a large sign, Exempla Lutheran Medical Center. Entrance #7