Deliverable 7 - Healthcare Intake Packet
itsawonderfulday
PleaseUpdate.docxRunning head: HEALTHCARE INTAKE PACKET 1
HEALTHCARE INTAKE PACKET 9
Healthcare Intake Packet
Sharlene Salinas
Professor Bradshaw
Rasmussen College
HSA
August 15, 2019
Healthcare Intake Packet
New Patient Letter
Three Mountains Regional Hospital
5096, Detroit, MI 3963-1130,
US
____________, day of _______, 20____
Dear ________________________ (Patient’s Name),
RE: HEALTHCARE INTAKE PACKET INTRODUCTION
Greetings and it is an honor to have you at Three Mountains Regional Hospital. We are dedicated to excellence within our professional practice of promoting community, organizational, family, and individual health. The following healthcare intake packet includes the hospital’s code of ethics and a living will.
The code of ethics provides a structure and shape to the hospital’s environment and ethical position. A living will is a legal document with proper instructions which specifies the type of treatment or medical care that you want or not want, in the event, I am unable to make decisions for yourself.
Three Mountains Regional Hospital will handle your information under HIPAA and its regulations to protect the confidentiality of medical and personal information as permitted and required by the law.
Save time before your appointment at the Three Mountains Regional Hospital. It is recommended that you print and complete your patient intake form before your appointment. (This is not mandatory but offered as a convenience for patients)
Sincerely,
________________________
Health Services Manager
Three Mountains Regional Hospital
Code of Ethics
· Uphold policies of the Three Mountains Regional Hospital.
· Protect the intellectual, physical, and electronic property of the hospital.
· Promote a healthy, secure, and safe working environment.
· Promote the principles of accuracy and confidentiality in billing processes.
· Uphold the principles of social networking by not transmitting or placing online, individually identifiable patient information. Protect and respect the confidentiality and privacy of all individuals and information linked to the Three Mountains Regional Hospital policies and relevant legislation such as HIPAA.
· Treat both internal and external members of the community with dignity, respect, and without discrimination.
· Promote the communication of information, rights, and responsibilities to nurture informed decision making geared towards offering the highest quality of care and safety.
· Offer patient care, support work, and research education with professional competence, high ethical standards, and intellectual honesty.
· Uphold the values of the Three Mountains Regional Hospital
· Individuals are encouraged to professionally engage in social-political activities through transparency and honesty to the healthcare profession.
Three Mountains Regional Hospital
Living Will Declaration
Advance Health Care Directive of: _________________________
To my family, doctors, surgeons, medical care providers, hospitals, and all others concerned with my care:
I, ______________________, residing at _____________________, in the County of ____________, in the State of _________________, in the zip code _____________, and whose telephone number is ________________, being of rational thought and sound mind, and acting willingly without duress, herein direct that this declaration to be followed as a formal statement of my desires if I become incapacitated or incompetent to communicating my desires, preferences, and wishes. I voluntarily make this designation with regards to my living will which makes these directives and instructions to be binding to the fullest extent permitted by the law.
Directions
1. In the event, there is no reasonable expectation of recovery; I direct my attending primary care or physician to withdraw or withhold life-sustaining treatment that only prolongs my dying.
2. I direct that treatment or medical care to be in limited measures, which will only keep me comfortable by relieving pain, which might occur by withdrawing or withholding the above stated life-sustaining treatment or medical care.
3. In the event that I am in the condition described above in item 1, I direct that I specifically do not want the following forms of treatment or medical care:
a) _________________________________________
b) _________________________________________
c) _________________________________________
d) _________________________________________
e) _________________________________________
f) _________________________________________
g) _________________________________________
4. In the event that I am in the condition described above in item 1, and I also have the conditions of ________________________________, I direct that I receive the following treatment and medical care:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Declaration Statement and Signature
This living will declaration expresses my sole preferences, desires, and wishes which are under a form specified by the law of the State of _____________________, and I honorably request that this will be honored in any state I may reside in.
By signing below, I certify that I understand entirely and fully aware of the contents of this document and that I am in the state of a sound mind and body.
I make this living will declaration on ____________, day of _______, 20____.
Declarant’s Signature: __________________________
Declarant’s Address: ____________________________
Witness Statements
This living will was signed by ___________________________ (Declarant’s Name) in the presence of the following individuals, who confirm through their signature below that ____________________ (Declarant’s Name) was, at the time this document was signed, of sound mind, disposition, memory, understanding, at least 18 years, and able to understand the impact of this decision, and not under duress or improper influence.
Witness’s 1 Name: __________________________________
Witness’s 1 Signature: _______________________________
Witness’s 1 Address: _________________________________
Date: _____________________________
Witness’s 2 Name: __________________________________
Witness’s 2 Signature: _______________________________
Witness’s 2 Address: _________________________________
Date: _____________________________
Notarization
State of _________________________, County of ___________________
Subscribed and sworn before on _________________ day of _______, 20____.
Signature of Notary Public: _______________________
My commission expires: _________________________
Three Mountains Regional Hospital
Healthcare Intake Packet Acknowledgement
To warrant that you receive the best of care, kindly confirm the receipt of the following documents of the hospital's healthcare intake packet. Kindly acknowledge the receipt by signing the declaration below.
Receipt Acknowledgement Statement
By signing below, I approve that I have received the following documents:
i. Three Mountains Regional Hospital Code of Ethics
ii. Living Will
Patient’s Name: __________________________________
Patient’s Signature: __________________________________
Patient’s Address: __________________________________
____________, day of _______, 20____
Email to the CEO and Board of Directors
Subject: Purpose of the Health Intake Packet
Date: Wed, 15 Aug 2019 14:35:16
From: Sharlene Salinas <[email protected]>
To: Mary Smith <[email protected]>
Cc: Board of Directors
Greetings,
Just a reminder on the proposed patient intake packet which will include the Three Mountains Regional Hospital’s Code of Ethics and the patient’s living will.
The healthcare intake packet provides patients with the purpose of each part in the packet. Through the hospital’s values and code of ethics part, the patients will receive information about HIPAA, informed consent, and the confidentiality of their health reports.
This patient intake packet will help establish patient trust in Three Mountains Regional Hospital and its employees.
Thank you,
Sharlene Salinas
Sharlene
Nice work on the letter, as you did a nice job addressing it to the patient, but you need to develop the introduction more, as this letter sets the tone throughout the document of the importance of privacy and the intake packet. The opening letter should be a full page length document . You needed more in covering HIPPA and ethics, as you needed sections on each of these issues and why they are important to the facility. You also need to include your privacy p[ledge. You need to make sure to have APA citations to show that you used your material in the letter.
Your one page bullet point on ethics looks good. Your Living Will and patient acknowledgement forms look really good. Your email to the Board of Directors was good and had a good overview and discussion how this new intake packet should address the issues that the facility has previously experienced and how this packet will build trust between the patients and the facility and its staff.
