Running head: DELIVERABLE 7 - HEALTHCARE INTAKE PACKET 1 DELIVERABLE 7 - HEALTHCARE INTAKE PACKET 5 Healthcare Intake Packet Keri King Deliverable 7 Deliverable 7 - Healthcare Intake Packet Patient Letter Health Services Manager, Three Mountain Regional Hospital. Dear New Patient, The Intake Packet is an important document which marks the start of every successful medical procedure. This is a necessary document which will be used to process all doctor’s appointment in Three Mountain Hospital. The Intake Packet has different components which are crucial to upholding professional standards and best practice in healthcare. These components include; i) organizational ethics and values which will be used to guide healthcare practice and behavior of healthcare professionals, ii) a privacy policy which enhances the protection of patient information, and iii) statement of compliance with HIPAA regulations. Ethics is a crucial component of the Intake Packet which focuses on promoting best practice in healthcare. It also emphasizes on building the relationship between the patient and the physician so as to improve cooperation and their involvement in decision-making during care delivery. The Intake Packet adheres to the HIPAA privacy and confidentiality statement by ensuring patient information can only be used and shared with the consent of the patients. Three Mountains Hospital takes the safety of its patients seriously and will ensure that health information will only be used for medical purposes as stipulated by government laws and policies. Yours Sincerely, Health Services Manager Code of Ethics The code of ethics tends to outline the mission and values within an organisation, the ways staffs and other employees should approach company problems. The ethical principles that are based on the company’s core values and standards that the organisation is held are: · From billing for services; employees of Three Mountains Regional Hospital must remain free from offers as well as solicitations so that they can benefit at personal level by performing work where outside parties do benefit. · Communication; the employees should not at all use social media, marketing platforms or other communications forms to disclose patient’s and hospital’s confidential information. · Physicians activities; At the Three Mountains, they don’t recommend submitting bill or charge for a given service where the referring physician or immediate member of the family has financial relationship with the health system. Due to complex nature of these laws, legal department approval should be obtained before establishment of financial relationship with the physician is established. · Privacy: Giving information of the patients inappropriately may subject one to criminal prosecution. The invasion of patients’ privacy should be avoided. If patient’s information is released inappropriately is very harmful. · Conflict of interest; this exists wh.

1. Running head: DELIVERABLE 7 - HEALTHCARE INTAKE
PACKET
1
DELIVERABLE 7 - HEALTHCARE INTAKE PACKET
5
Healthcare Intake Packet
Keri King
Deliverable 7
Deliverable 7 - Healthcare Intake Packet
Patient Letter
Health Services Manager,
Three Mountain Regional Hospital.
Dear New Patient,
The Intake Packet is an important document which marks the
start of every successful medical procedure. This is a necessary
document which will be used to process all doctor’s
appointment in Three Mountain Hospital. The Intake Packet has
different components which are crucial to upholding
professional standards and best practice in healthcare. These
components include; i) organizational ethics and values which
will be used to guide healthcare practice and behavior of
healthcare professionals, ii) a privacy policy which enhances
the protection of patient information, and iii) statement of
compliance with HIPAA regulations.
Ethics is a crucial component of the Intake Packet which

2. focuses on promoting best practice in healthcare. It also
emphasizes on building the relationship between the patient and
the physician so as to improve cooperation and their
involvement in decision-making during care delivery. The
Intake Packet adheres to the HIPAA privacy and confidentiality
statement by ensuring patient information can only be used and
shared with the consent of the patients. Three Mountains
Hospital takes the safety of its patients seriously and will
ensure that health information will only be used for medical
purposes as stipulated by government laws and policies.
Yours Sincerely,
Health Services Manager
Code of Ethics
The code of ethics tends to outline the mission and values
within an organisation, the ways staffs and other employees
should approach company problems. The ethical principles that
are based on the company’s core values and standards that the
organisation is held are:
· From billing for services; employees of Three Mountains
Regional Hospital must remain free from offers as well as
solicitations so that they can benefit at personal level by
performing work where outside parties do benefit.
· Communication; the employees should not at all use social
media, marketing platforms or other communications forms to
disclose patient’s and hospital’s confidential information.
· Physicians activities; At the Three Mountains, they don’t
recommend submitting bill or charge for a given service where
the referring physician or immediate member of the family has
financial relationship with the health system. Due to complex
nature of these laws, legal department approval should be
obtained before establishment of financial relationship with the

3. physician is established.
· Privacy: Giving information of the patients inappropriately
may subject one to criminal prosecution. The invasion of
patients’ privacy should be avoided. If patient’s information is
released inappropriately is very harmful.
· Conflict of interest; this exists when one has the opportunity
of benefiting personally, beyond paycheck receipt, from the
action one takes as part of the duties you perform in your job. It
is advisable that workers don’t use their positions so that they
benefit personally at the expense of the organisation they are
working for.
· Political activities; At the Three Mountains Hospital, the
business entities here are mainly tax-exempt. One may not be in
a position of donating funds, products, services as well as any
form of resources of these tax-exempt entities towards any
course of politics, party or candidates. By making voluntary
personal contributions towards any lawful course of politics,
party or candidates is accepted. However, these contributions
should be never be presented to have come from this hospital.
· Patient Relations; We will not knowingly submit a bill or
charge for certain services in which the referring physician (or
an immediate family member) has a financial relationship with
the health system. Because of the complexity of these laws,
approval from the Legal Department, must be obtained prior to
establishing a financial relationship with any physician.
Physicians should not treat themselves or members of their own
families. Employees will not discriminate. They will at no time
refuse to work with someone due to that person’s race, religion,
culture, gender, or sexual orientation. Promote use of their
client-patient’s values and belief systems as the foundation for
their decision-making. When sharing the patients’ health
information to a referring doctor making sure to keep in line

4. with ethics guidance on confidentiality.
Sample of Living Will
I, [NAME], a resident of [CITY], [STATE], in [COUNTRY],
with an address at [ADDRESS], being of sound mind, memory,
disposition, understanding, and at least eighteen years of age,
do willfully and freely, by this Living Will, direct my family,
physician(s), attorney, and any other individuals who may in the
future become responsible for my health and well-being and any
decisions related thereto, whether partly or fully, to take the
following actions in each of the circumstances described in this
Living Will below.
1. In the event that I develop a condition deemed to be
“terminal” and my attending physician and one other physician
have both determined/agreed that there is no chance for
recovery from this terminal condition, I request/direct the
following:
a. Indicate either “Do not prolong my life using artificial life
support” or “Use whatever life-prolonging procedures are
available to prolong my life.”
b. Indicate either “Do not administer food or water artificially”
or “Administer food and water artificially” or “Administer food
and water artificially only to the extent necessary to provide
comfort or alleviate pain, provided such administration does not
have the added effect of prolonging my life artificially.”
c. Indicate either “Administer necessary care in order to provide
comfort and alleviate pain” or “Do not administer any care
intended to provide comfort or alleviate pain” or “Administer
necessary care in order to provide comfort and alleviate pain to
the extent that such care does not also have the effect of
prolonging my life artificially.”

5. 2. In the event that I fall into a coma and my attending
physician and one other physician have both determined/agreed
that there is no chance for recovery from this condition, I
request/direct the following:
a. Indicate either “Do not prolong my life using artificial life
support” or “Use whatever life-prolonging procedures are
available to prolong my life.”
b. Indicate either “Do not administer food or water artificially”
or “Administer food and water artificially” or “Administer food
and water artificially only to the extent necessary to provide
comfort or alleviate pain, provided such administration does not
have the added effect of prolonging my life artificially.”
c. Indicate either “Administer necessary care in order to provide
comfort and alleviate pain” or “Do not administer any care
intended to provide comfort or alleviate pain” or “Administer
necessary care in order to provide comfort and alleviate pain to
the extent that such care does not also have the effect of
prolonging my life artificially.”
3. In the event that I am in a persistent vegetative state and my
attending physician and one other physician have both
determined/agreed that there is no chance for recovery from this
condition, I request/direct the following:
a. Indicate either “Do not prolong my life using artificial life
support” or “Use whatever life-prolonging procedures are
available to prolong my life.”
b. Indicate either “Do not administer food or water artificially”
or “Administer food and water artificially” or “Administer food
and water artificially only to the extent necessary to provide
comfort or alleviate pain, provided such administration does not

6. have the added effect of prolonging my life artificially.”
c. Indicate either “Administer necessary care in order to provide
comfort and alleviate pain” or “Do not administer any care
intended to provide comfort or alleviate pain” or “Administer
necessary care in order to provide comfort and alleviate pain to
the extent that such care does not also have the effect of
prolonging my life artificially.”
By my signature below, in front of the witnesses identified
below, I hereby execute and subscribe to the declarations made
in this Living Will both freely and voluntarily, and
wholeheartedly request that my family, physician(s), attorney,
and any other individuals who may in the future become
responsible for my health and well-being and any decisions
related thereto, whether partly or fully, all abide by my wishes
as stated herein.
_________________________________ ______________
[NAME] DATE
This Living Will was signed by [NAME] in the presence of the
following individuals, who by their signatures below, confirm
that [NAME] was, at the time this document was signed, at least
eighteen years of age, of sound mind, memory, disposition,
understanding, and able to understand the weight of this health
care decision, and not under any improper influence. The
undersigned witnesses have subscribed this document in
[NAME]’s presence and in each other’s presence at [NAME]’s
request.
[WITNESS NAME]
[ADDRESS]_________________________________
______________DATE

7. [WITNESS NAME]
[ADDRESS]_________________________________
______________DATE
Purpose of a Will
Advanced medical directives are legal mechanisms to assure
that patients' wishes, with respect, to several medical
procedures are carried out in their final days or when they are
incapacitated. The documents reflect patients' rights of consent
and medical choice under conditions whereby patients can no
longer choose for themselves what medical interventions they
wish to undergo. A living will extends the principle of consent,
whereby patients must agree to any medical intervention before
doctors can proceed. It allows the patient to guide health care
for the future when she may be too ill to make decisions
concerning care. It can be revoked by the patient at any time.
For many, the living will preserve’s personal control and eases
the decision-making burden of a family.
Acknowledgement Form
I hereby acknowledge the receipt of the following documents
from your company, Three Mountains Regional Hospital.
Please sign and date below
References
NoAuthorFound, (2019). Code of Professional Conduct (2009).
Retrieved from http://ethics.iit.edu/ecodes/node/4270