{"id":608,"date":"2023-06-29T08:59:11","date_gmt":"2023-06-29T15:59:11","guid":{"rendered":"https:\/\/samhealth.org\/?page_id=608"},"modified":"2025-02-07T11:42:14","modified_gmt":"2025-02-07T19:42:14","slug":"forms-and-documents","status":"publish","type":"page","link":"https:\/\/samhealth.org\/patient-visitors\/visiting-samaritan-locations\/forms-and-documents\/","title":{"rendered":"Forms and Documents"},"content":{"rendered":"\n<section id=\"block_5bceaaed52bf39c25d7eb92c403384f7\" class=\"shs-block block-section grid-container has-blue-light-background-color\" >\n\t\t<div class=\"entry-content\">\n\n<h1 class=\"wp-block-heading\" id=\"h-forms-amp-documents\">Forms &amp; Documents<\/h1>\n\n<\/div>\n\t<\/section>\n\n\n\n<section id=\"block_6f6febec729c57cfb61299c6fa104878\" class=\"shs-block block-section grid-container has-white-background-color\" >\n\t\t<div class=\"entry-content\">\n\n<h2 class=\"wp-block-heading\">For Your Convenience<\/h2>\n\n\n\n<p>Prior to your hospital, clinic or telehealth visit, you may be asked to review or fill out forms. For your convenience, these forms are available below in English or Spanish to read or download:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Conditions of Admission:\u00a0 <a href=\"https:\/\/samaritanhealthservices.navexone.com\/content\/dotNet\/documents\/?app=pt&amp;source=unspecified&amp;docid=13989\" target=\"_blank\" rel=\"noopener\">English<\/a>\u00a0\u00a0or  <a href=\"https:\/\/samaritanhealthservices.navexone.com\/content\/dotNet\/documents\/?app=pt&amp;source=unspecified&amp;docid=13990\" target=\"_blank\" rel=\"noreferrer noopener\">Spanish<\/a>.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Conditions of Service: \u00a0<a href=\"https:\/\/samaritanhealthservices.navexone.com\/content\/dotNet\/documents\/?app=pt&amp;source=unspecified&amp;docid=13991\" target=\"_blank\" rel=\"noreferrer noopener\">English<\/a>\u00a0\u00a0or  <a href=\"https:\/\/samaritanhealthservices.navexone.com\/content\/dotNet\/documents\/?app=pt&amp;source=unspecified&amp;docid=13992\" target=\"_blank\" rel=\"noreferrer noopener\">Spanish<\/a>.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Genetic Information and Research Informed Consent and Right to Decline: \u00a0<a href=\"https:\/\/samaritanhealthservices.navexone.com\/content\/docview\/?app=pt&amp;source=unspecified&amp;docid=15185&amp;public=true\" target=\"_blank\" rel=\"noreferrer noopener\">English<\/a>\u00a0\u00a0or  <a href=\"https:\/\/samaritanhealthservices.navexone.com\/content\/dotNet\/documents\/?app=pt&amp;source=unspecified&amp;docid=15186&amp;public=true\" target=\"_blank\" rel=\"noreferrer noopener\">Spanish<\/a>.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Important Message From Medicare:  <a href=\"https:\/\/samaritanhealthservices.navexone.com\/content\/dotNet\/documents\/?app=pt&amp;source=unspecified&amp;docid=15141\" target=\"_blank\" rel=\"noreferrer noopener\">English<\/a>  or  <a href=\"https:\/\/samaritanhealthservices.navexone.com\/content\/dotNet\/documents\/?app=pt&amp;source=unspecified&amp;docid=13685\" target=\"_blank\" rel=\"noreferrer noopener\">Spanish<\/a>.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Medicare Outpatient Observation Notice:\u00a0 <a href=\"https:\/\/samaritanhealthservices.navexone.com\/content\/dotNet\/documents\/?app=pt&amp;source=unspecified&amp;docid=15180\" target=\"_blank\" rel=\"noreferrer noopener\">English<\/a>  or  <a href=\"https:\/\/samaritanhealthservices.navexone.com\/content\/dotNet\/documents\/?app=pt&amp;source=unspecified&amp;docid=15181\" target=\"_blank\" rel=\"noreferrer noopener\">Spanish<\/a>.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Notice of Privacy Practices: \u00a0<a href=\"https:\/\/samhealth.org\/shs-notice-of-privacy-practices?type=pdf\" target=\"_blank\" rel=\"noreferrer noopener\">English<\/a>\u00a0 or  \u00a0<a href=\"https:\/\/samhealth.org\/shs-notice-of-privacy-practices-spanish?type=pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Spanish<\/a>.<\/li>\n<\/ul>\n\n<\/div>\n\t<\/section>\n\n\n\n<section id=\"block_bc22026eaaa697f38235607a89168edc\" class=\"shs-block block-slim-section grid-container has-gold-background-color\">\n\n\t<div class=\"entry-content\">\n\n<h2 class=\"wp-block-heading\">MyChart Video Visit Instructions<\/h2>\n\n\n\n<p>Have you scheduled a video appointment with your Samaritan health care provider? Check our instructions to learn how to prepare for your appointment using your computer or smartphone.\u00a0<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/samhealth.org\/mychart-video-visit-instructions?type=pdf\" target=\"_blank\" rel=\"noreferrer noopener\">See Instructions<\/a><\/div>\n<\/div>\n\n<\/div>\n\n\t<\/section>\n","protected":false},"excerpt":{"rendered":"<p>Find forms and documents in multiple languages on this page.<\/p>\n","protected":false},"author":18,"featured_media":0,"parent":572,"menu_order":6,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_searchwp_excluded":"","_shs_workflow_notes":"**Removed dot overlay. Changed main content theme to white to provide contrast from title block.","_shs_exclude_from_navigation":false,"_shs_promote_article_on_blogs":"","footnotes":""},"class_list":["post-608","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages\/608","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/users\/18"}],"replies":[{"embeddable":true,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/comments?post=608"}],"version-history":[{"count":0,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages\/608\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages\/572"}],"wp:attachment":[{"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/media?parent=608"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}