This afternoon I signed and / or initialed and then faxed to Woodland Terrace the majority of the new documents which Rosa Rivera sent me yesterday. I included a cover letter, and then also emailed it to her:
Dear Ms. Rivera,
At approximately 3:00PM EDT I signed and / or initialed and returned the following sixteen (16) pages via fax to 386-740-8308:
- WOODLAND TERRACE CLOTHING POLICY (1 page)
- WOODLAND TERRACE AUDIO, VIDEO, AND PHOTOGRAPHIC RELEASE AUTHORIZATION FORM (1 page)
- SELF ADMINISTRATION OF MEDICATIONS (1 page)
- INFORMED CONSENT FOR PNEUMOCOCCAL VACCINE (declined) (1 page)
- CONSULTANT PERMISSION (1 page)
- WOODLAND TERRACE NOTICE OF PRIVACY PRACTICES (5 pages)
- Please note on page three (3) item seven (7): I have specifically indicated that only myself, David Vincent Gagne, and my sister, [name redacted], are authorized to be disclosed information relating to my mother’s health and / or care
- Please note on page three (3) item ten (10): My mother is not an organ or tissue donor and in the unlikely event of her death while at your facility, we (she and I) specifically refuse that her remains be used for organ or tissue donation.
- WOODLAND TERRACE PRIVACY ACT NOTIFICATION (1 page)
- WOODLAND TERRACE SMOKING RULES & REGULATIONS (1 page)
- Please note that Kathleen Gagne is not a smoker.
- WOODLAND TERRACE Bed Hold Policy (1 page)
- Personal Items Responsibility Acknowledgement (1 page)
- RESIDENTS BILL OF RIGHTS GRIEVANCE PROCEDURES (1 page)
- Licensing and Regulatory (1 page)
Please note that I am currently not returning the following ten (10) pages until I have had further time to review them with an attorney:
- OBRA DIRECTED ACKNOWLEDGEMENT CERTIFICATE (1 page)
- WOODLAND TERRACE Authorization to Disclose Health Information (1 page)
- WOODLAND TERRACE ACKNOWLEDGEMENT OF RESTRAINT POLICY (1 page)
- WOODLAND TERRACE EXTENDED CARE CENTER PATIENT ADMISSION AGREEMENT (7 pages)
I will return these to you, signed and / or initialed as requested, as soon as possible. In the event that I or my attorney has any questions, I will contact you as soon as possible to clarify.
Please email me at [redacted] and / or call me at [redacted] to confirm receipt of this fax, which is comprised of eighteen (18) pages, including a two-page, signed cover letter.