ENDOSCOPY SURGERY CENTER. AT1HE USF HEALTIl CAROL & FRANK MORSANl CENTER FOR ADVANCED HEAL1HCARE HEALTH

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UNIVERSITY 0 1'S 0 U T r 0 R D A _ ENDOSCOPY & - SURGERY CENTER AT1HE USF HEALTIl CAROL & FRANK MORSANl CENTER FOR ADVANCED HEAL1HCARE HEALTH

Before Your Procedure Food - Do Not Eat Or Drink Anything (including mints, gum, candy, or water) after AM/PM Pre-Operative Visit Depending upon your surgical procedure, you may be required to have a pre-operative visit with the surgery center and the anesthesiologist. Medications If you are taking a blood thinner medication, notify your physician at least two weeks before your surgery, as you cannot takes these types of medications prior to surgery. If you are taking any medications, please notify your physician for instructions regarding these medications prior to surgery. You must get instructions from your physician regarding any prescription medications you will be taking the morning of the procedure. If you use an inhaler, please bring it with you. Bathing Bathe or shower the night before and the morning of your procedure with anti-bacterial soap. This will minimize the chance of infection. You may brush your teeth, but do not swa!low any water. Smoking & Drinking Refrain from these activities at least 24 hours before and following your procedure. Pregnancy If you are pregnant, or suspect you may be pregnant, please notify your physician. Anesthesia and certain medications for the procedure may be harmful during pregnancy. Change in Health Status Prior to Surgery If there is any change in your health between the last visit with your physician and the day of your scheduled surgery, please notify your physician immediately. Minor health changes, such as a cough, cold or fever, can impact your surgery. Preparing For Your Procedure What should I wear the day of my procedure? Wear loose-fitting, comfortable clothing. Some patients wear or bring a gown or shirt that buttons in the front for easy access. During surgery you will wear a gown provided by the surgery center. Wear flat, comfortable shoes that can easily be slipped on after your procedure. What about jewelry and cosmetics? No jewelry of any type may be worn during surgical procedures, as it increases the risk for infection. You may also be required to remove make-up or nail polish, depending on the type of procedure being performed. What paperwork do I need to bring with me the day of surgery? Bring completed insurance forms, your insurance cards and all relevant medical information requested. Please check with your insurance company for pre-admission requirements, such as second opinions, preadmission certification, co-pay amount, and deductibles. This will help to expedite the admission process the day of your procedure. What about transportation? Arrange for an adult to accompany you to the facility as you will not be able to drive yourself home after your procedure. You should make arrangements for someone to stay with you for at least 24 to 48 hours after your surgery. How will I feel after surgery? You may feel slightly dizzy or sleepy after your procedure. This is normal. Please be sure to notify your doctor right away if you have a fever or excessive pain and inflammation.

After Your Procedure Follow your doctor's advice regarding your diet, exercise, prescription restrictions after your procedure. medications, work, and driving You must have someone drive you to The Center and back home after your procedure. A staff member will contact you to check on your recovery progress after your procedure. Make sure someone is available to care for you 24 hours after your procedure. Insurance and Billing Please contact the Endoscopy & Surgery Center prior to your scheduled procedure for pre-admission instructions and final arrangements. PLEASE NOTE: ALL FINANCIAL ARRANGEMENTS MUST BE MADE PRIOR TO SURGERY. Financial specialists can be reached at: (813) 396.2386 and (813) 396.2389. If necessary, we will work with you to make alternate financial arrangements, but these MUST be made prior to admission. Uninsured and cash paying patients will be required to pay for services prior to the procedure date. We do accept most credit cards. The Center will bill your insurance company as a courtesy; however, any balance due is your responsibility and will be requested from you if we have not received payment from your insurance company after 60 days. Your Surgery Center Fee Includes: Medical and surgical care Cost of routine equipment and supplies Cost of drugs and anesthesia administered Operating room time Recovery room services Anesthesia, radiology, surgeon, and physician consultant fees are not included in The Center's fee. Your insurance carrier may request an estimate of your surgical costs prior to surgery. It is your responsibility to find out your insurance carrier's requirements. About the USF Health Endoscopy & Surgery Center Our state-of-the-art facility, built in 2008, houses eight, fully-equipped and integrated operating rooms, five endoscopy suites and a 31-bed pre and post-operative recovery room, the largest in the Tampa Bay area. A large comfortable waiting area is available for your family and friends to stay onsite during your surgery. USF Health's staff is professionally trained and very experienced. We strive to offer the highest quality of care for our patients. The Morning of Your Procedure Please arrive a few minutes prior to the time given by the nurse on the day your procedure is scheduled. You may check in at the reception area located in the lobby on the second floor. Once you have completed your paperwork, a nurse will assist you in preparing for your surgical procedure. Please be sure to let us know if you have any special needs the day of surgery. We will do our best to accommodate you and make your visit as comfortable as possible. Your Procedure Is Scheduled For: Date: Please arrive at The Center AMjPM Time: the day of your procedure A}AjPM at:

The Carol & Frank Morsani Center for Advanced Healthcare is the embodiment of the USF Health Vision that USF can make the community's life better through combining the best in medicine, nursing, public health, physical therapy and pharmacy. This is the first ambularory health center in the country built from the ground up around quality, service and technology where the patient is the center of the health care system. The USF Health Endoscopy & Surgery Center is located on the second floor of the Carol & Frank Morsani Center for Advanced Healthcare, on the University of South Florida campus. Carol & Frank Morsani Center for Advanced Healthcare USF Health Endoscopy & Surgery Center 13330 USF Laurel Drive Tampa FL 33612 Phone: (813) 396-2350 Fax: (813) 396-2351 Visit www.myhealthcare.usf.edu We're transforming healthcare and YOjj are at TheCenter, -~ -... '--. HEALTH

Centers for Medicare & Medicaid Services: 1. Quality of Care Concerns: What Can Your Quality Improvement Organization (QIO) Address? Examples of quality of care concerns that your QIO can address are: Medication Errors Unnecessary or inappropriate surgery Unnecessary or inappropriate treatment Change in condition not treated Discharged from the hospital too soon Incomplete discharge instructions and/or arrangements 2. Help with other health care concerns A concern about an issue other than the quality of care you received needs to be addressed by an agency other than a QIO. The agency that can help you depends on the nature of your concern. Florida Medical Quality Assurance 1-800-844-0795 or local Tampa number 813-354-911l. A concern about a doctor, such as unprofessional conduct, incompetent practice, or licensing questions-state Medical Board A concern about conditions at a facility, rooms too hot, too cold, poor housekeeping-state Department of Health A concern about Medicare fraud - call the HHS Office of the Inspector general Hotline at 1-800-447-S477 A concern about billing, such as questions about charges and what Medicare does or does not cover - call1-soo-medicare (1-S00-633-4227). TTYusers should call1-s77-4s6-204s l-soo-medicare (1-S00-633-4227) to: Get more help with your Medicare questions Order quality and other information on Medicare health plans Listen to recorded questions and answers on topics such as Medicare health plan choices Order Medicare publications. (Some available in large print Spanish, audio-tape, and Braille) 3. Medicare has health and safety standards to protect you. You can file a complaint against a Medicare or Medicaid provider (including hospitals, home health agencies, hospices, or nursing homes) for improper care or treatment. Examples of complaints: Claims of abuse to a person; A mistake in giving out prescribed medication; Poor quality of care in a hospital, nursing home, dialysis facility, ambulatory surgery center, home health agency, hospice, intermediate care facility for the mentally retarded, and others; Unsafe conditions, like water damage or electrical or fire safety concerns; or laboratory results that were wrong and lead to improper care. How do I file a complaint? Verbally or in writing. Your personal information will only be shared with organizations who are working to protect you and investigate the complaint. Your may file a complaint without using your name. Contact your State's health department by looking in the blue pages of the telephone book or you may visit the web site at

www.medicare.gov. Under "Search tools", select "Find Helpful Phone Numbers and Websites." They will need the following information ready when you call: Your name, address, and telephone number (name optional); Name of health care provider; Location of the health care provider, including room or floor, if applicable; Details of our concern, including date and time; Name (s) of the other people involved and/or affected; Whether you have reported this complaint to anyone else, including the provider. If reported to provider, what was the response and what would you like to see happen to resolve your complaint; For more information: Visit www.medicare.gov on the web or call1-800-medicare (1-800-633-4227). TTY users should call 1-877-486-2048. State of Florida Health Department: http//ahca.myflorida.comicontactlindex.shtml, telephone 1-888-419-3456. How the Medicare Beneficiary Ombudsman Works For You An "Ombudsman" is a person who reviews issues and helps to resolve them. Congress requires that Medicare have a Beneficiary Ombudsman who helps people with Medicare. The Medicare Beneficiary Ombudsman shares information with the Secretary of Health and Human Services, Congress, and other organizations about what works well, and what doesn't work well, to continuously improve the quality of the services and care you get through Medicare by reporting problems and making recommendations. How does the Medicare Beneficiary Ombudsman help you? The Ombudsman makes sure information is available for you about your Medicare benefits, whether you have the information you need to make good health care decisions, your rights and protections under the Medicare Program, and how you can get issues resolved. How does the Medicare Beneficiary Ombudsman help you through other organizations? The Ombudsman works with organizations like State Health Insurance Assistance Programs (SHIPs) and Quality Improvement Organizations (see back for more information) to ensure they resolve your issues promptly. This allows these organizations to provide information, counseling and assistance to help you with your Medicare questions, including your benefits, coverage, premiums, deductibles, and coinsurance. grievances (complaints). appeals. (You can appeal if you think a service or item you got should have been covered or paid for and Medicare denies your request, you question the amount that was paid, or your plan stops paying for coverage you are already receiving.) problems joining or leaving a Medicare Advantage Plan (like an HMO or PPO) or any other Medicare Health Plan or Medicare Prescription Drug Plan. Richard Green - Executive Director USF Health Endoscopy and Surgery Center Adele Emery - Director USF Health Endoscopy and Surgery Center Kathy McGoorty - Operations Manager Christine McClary-Wright - RN Supervisor Ronda Westberry - RN Supervisor Arnez Wotring - RN Supervisor 813-974-8486 813-396-2458 813-396-2513 813-396-2433 813-396-2439 813-396-2430