Admissions Information
Before You Check In
There are a number of forms you'll need to fill out before you actually have treatment or surgery. Some of the forms may seem a bit repetitive. We do this so that full information on your treatment is clearly known to all who are providing your care. Having complete and accurate records also eliminates delays or questions by your insurance company or other payers.
As our Notice of Privacy Policy spells out, we regard your medical records and information about your care as strictly confidential documents and limit the availability of information to the specific, defined conditions you consent to share. You may request to share or withhold your information at any time.
Request for Information
Requests for information should be made to Health Information Management (Medical Records) at Halifax Health Medical Center. You can call 386.254.4040 or write us at 303 N. Clyde Morris Blvd. Daytona Beach, FL 32114.
Information not provided on the signed Consent Form will be released only upon authorization in writing by you or your legal representative.
All significant forms used in providing your care are available in large print or on cassette tapes and available in Spanish and French. Translators for non-English speaking individuals and interpreters for the hearing impaired are available to facilitate communication for patients and their families or authorized guests. If you have such needs that were not handled at the time of admission, ask your caregiver to arrange this assistance for you.
Informed Consent
Before you have an operation, special examination, diagnostic procedure, or are given blood or anesthesia, you will be given a document which describes in detail the activity planned, its purpose, alternatives and any risks associated with it.
You will be asked to sign the document, indicating you have read it and have had the opportunity to ask any questions about the action described and fully understand the potential benefits and drawbacks.
If you are unable to discuss the procedure and sign the document, a legally authorized representative may act on your behalf. Forms may be signed at your physician's office prior to your admission or after your admission to the hospital.
Your documents must be signed before you are placed on any medication that may affect your ability to clearly understand all that is discussed and contained in the form.
Living Will Information
Florida Law provides that residents may execute a "Living Will" to set forth their wishes regarding levels of care to be extended in the event of a terminal illness and/or an organ donation.
It is also possible to designate a Health Care Surrogate to identify individuals who shall act on behalf of the patient in consulting with clinical personnel on appropriate care.
An advance directive may be signed by a competent adult at any time. The signature on an advance directive must be witnessed by two persons, one of whom is neither a spouse nor a blood relative of the person making the Living Will.
It is the patient's responsibility to notify health care providers that an advance directive exists and to provide a copy for inclusion into the medical record.
An advance directive may be revoked at any time by the person completing it in several ways:
- Destroying it or having it destroyed in his or her presence
- Orally expressing revocation to any staff member or physician
- By execution of a substantially different Living Will at a later date
You may express your desires in lieu of a directive. Your wishes will be recorded in your hospital record by your physician or nurse.
Detailed information on advance directives and our procedures relative to them are contained in the booklet furnished to you on admission. If you would like additional copies of this booklet, you can call 386.254.4241 to reach Patient Relations who can provide you with copies.
Your Valuables
Halifax Health Medical Center does not assume responsibility for valuables brought with you and left in your room such as purses, jewelry, eyeglasses, hearing aids, dentures and other personal items. We suggest leaving your valuables at home or entrusting them to a relative or friend until you are able to use them. As a courtesy, a hospital safe may be used for depositing your valuables in the event an emergency did not allow for making these preparations in advance.
Financial Arrangements
Halifax Health provides treatment based on the best interests of the patient and regardless of compensation or the ability to pay. Nevertheless, it is important that each patient provide adequate financial information to determine his or her insurance status, ability to pay and to participate in payment to the extent possible.
Prior to, or at the time of your admission, you or your representative may be required to make a payment depending on your insurance coverage and/or financial information. If the services are considered non-covered by your insurance, you will be asked to sign a notice of non-coverage and will be asked for payment unless other arrangements have been made.
You will need to present your insurance identification cards, photo ID and other pertinent information that will assist us in filing your insurance claim for you. Normally, insurance plans do not provide full coverage of the hospital bill. Either prior to, or immediately after your admission, your insurance coverage will be verified.
Your hospitalization coverage is a contract between you and your insurance company, and while we will cooperate to the fullest in expediting your claim, you are ultimately responsible for your account.
If your financial information indicates that you cannot pay, then you will be asked to apply for assistance through the Halifax Managed Care Assistance Program and/or the Department of Children & Family Services.
