PATIENT GUIDE

Everything You Need to Know About Your Stay

at Houston Methodist Baytown Hospital

4401 Garth Rd. | Baytown, TX 77521 | 281.420.8600 | houstonmethodist.org/baytown

Welcome

Dear Guests, Houston Methodist

Welcome to Houston Methodist Baytown Hospital. We recognize you Baytown Hospital
have a choice when it comes to your health care provider and we thank
you for choosing Houston Methodist. We believe in creating a personal Mission
and meaningful experience for our patients and guests – this is what we To provide high-quality,
call the Houston Methodist Experience. cost‑effective health care that
Caring for you means more than addressing your physical needs. It also delivers the best value to the
includes the emotional and spiritual aspects of the healing process. Our people we serve in a spiritual
dedicated team of doctors and staff are here to service you and provide environment of caring in
unparalleled safety, quality, service and innovation. We are dedicated association with internationally
to exhibiting our values at all times, while providing innovative and recognized teaching and research.
personalized care to you and your family.
Vision
During your time with us, you may have questions about the hospital, your stay
or the many services we offer our patients and guests. This patient information People will seek Houston
guide has been written and designed to help answer those questions. Methodist Baytown Hospital
as a leader in medical expertise
We understand that hospitalization can be a stressful time for patients and and innovative personalized care
their families. Rest assured, we are here to assist you. Please feel free to in Baytown.
contact our guest relations department at 281.420.8825 to let us know
how we can make your stay with us more comfortable. Values Statement: I CARE
Again, thank you for choosing Houston Methodist Baytown Hospital. Integrity: We are honest and
ethical in all we say and do.
Sincerely,
Compassion: We embrace
the whole person and respond
to emotional, ethical and
spiritual concerns as well as
physical needs.
Accountability: We hold ourselves
accountable for our actions.
Respect: We treat every individual
as a person of worth, dignity
and value.
Excellence: We strive to be the
best at what we do and a model for
others to emulate.

David P. Bernard
CEO, Houston Methodist Baytown Hospital

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About Us

Since opening its doors in 1948, Houston Methodist Baytown Hospital has
provided our community with quality medical care. Through the years, we’ve
grown with the community, enhancing and expanding our services every step
of the way. Today, Houston Methodist Baytown offers comprehensive care for
patients at every stage of life.
Our success begins with patient centered care. We are dedicated to
providing the widest possible range of services, while making significant
investments in advanced technology and focusing on the Houston Methodist
patient experience.
We are dedicated to serving others, in conjunction with innovative technology
and medical expertise. Houston Methodist Baytown’s commitment is supported
by our more than 300 top-quality doctors representing a full range
of medical specialties.

Building for our Community:

Hospital Expansion
To further serve our growing
community, Houston Methodist
Baytown is constructing and
building new and enhanced
facilities in 2019/20.
Features include:
• Expanded emergency room
• Increased inpatient bed capacity
• Additional outpatient diagnostics
and treatment areas
• Additional operating rooms
• Additional patient and
visitor parking

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Contents

4-5 Campus Map Medical Equipment 23-30 Advance Directives

6 Communications Hand Hygiene Directive to Physicians
Telephone Directory Fall Prevention Medical Power of Attorney
Language Interpretation Blood Clot Prevention Out-of-Hospital Do-Not-
Know Your Medications Resuscitate Order
Sign Language Interpretation
Biomedical Ethics
Making Calls 14-15 Infection Prevention
Directive to Physicians Form
Cell Phones Catheter-associated Urinary
Tract Infections Medical Power of Attorney Form
Wireless Internet
Surgical Site Infections 31-33 Patient Financial Responsibilities
7 Visitors
Catheter-associated Billing
Visitor Guidelines
Bloodstream Infections How to Settle Your Bill
E-greetings
Clostridium difficile Infections Affiliated Providers
Visiting After Hours
16-17 Discharge Insurance
Hotels and Accommodations
What to Expect Medicare
8-10 During Your Stay During Discharge Coordination of Benefits
Getting Admitted Before You Go Financial Assistance
Patient Rooms Patient Satisfaction Survey Policy and Program
Nursing Activity in Your Room At Home 34 Giving Back
Calling Your Nurse Follow-up Appointments Gifts of Gratitude Program
Technology and Your Care Find a Doctor Make a Philanthropic
Service Animals Scheduling Imaging Contribution
Mail and Flowers Appointments Online Become a Volunteer
DAISY Award for Outpatient Care Share Your Story
Extraordinary Nurses Patient Portal: Houston Join Our Mailing List
Your Health Care Team Methodist MyChart
38-40 Notes
Pain Management Continued Care
Hospital Pharmacy Long-Term Acute Care Hospital
Guest Relations 18-19 Patient Rights and
Spiritual Care Responsibilities
Volunteer Services
20 Patient Concerns
Food Services
Guest Relations
11 TV Guide External Resources
12-13 Your Health and Safety How You Can Ensure Safe
Identification Health Care
Security Services 21 Notice of Nondiscrimination
Valuables 22 Your Privacy and Information
Firearms Business Practices Officer
Smoking “No Information” Patients
Fire Drills Copies of Medical Records
Electronic Appliances Civil Rights

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Campus Map

Garth Campus - 4401 Garth Rd.

W. BAKER RD.

ENTRANCE

Construction
Area
Outdoor OUTPATIENT Outpatient
Sports Surgery
CENTER
Field ENTRANCE
Imaging
Outpatient
Unit

E
EN ME
TR RG
AN EN

M NT
CE CY

AI RA
E
N N
Cath

CE
Lab

GARTH RD.
ENTRANCE PLAZA 2 ENTRANCE
Conference
Center
DINING Observation
Unit 1 & 2
ELEVATOR
INFORMATION
PARKING
RESTROOM
PLAZA 1
EMERGENCY ROOM
CANCER
Outpatient
Lab
CENTER

Main Hospital LEVEL TWO Plaza 1

4401 Garth Rd. Cafeteria 4201 Garth Rd.
Dialysis
LEVEL ONE LEVEL ONE
Administration IMCU Outpatient Lab
ATM Observation
LEVEL THREE
Boardroom Pharmacy
Diabetes
Cardiac Rehab 2 East Patient Rooms 232-264
Weight Management
Cath Lab 2 West Patient Rooms 201-231
Coffee Shop 2 South Patient Rooms 269-291 Plaza 2
Conference Center 4301 Garth Rd.
LEVEL THREE
Emergency Department Chapel LEVEL ONE
Gift Shop ICU/SICU ATM
Imaging Childbirth Center Case Management
Registration Surgery Waiting LEVEL TWO
Security 3 East Patient Rooms 332-364 Medical Records
Sleep Center 3 West Patient Rooms 301-331
Cancer Center
4021 Garth Rd.
Garth Campus - Outpatient Center - 1677 W. Baker Rd.
LEVEL ONE

Pre-Admission Physical &

Testing Occupational
Laboratory Therapy
Occupational
Imaging Health Clinic Outdoor
Outpatient Sports
Surgery Medicine
Registration/
Field
Patient Access

Center for Orthopedics &

Sports Medicine

ENTRANCE
W. BAKER RD.

LEVEL TWO

Employee
IT Training Wellness & Gym
Lab
Breast Care
Center
Conference
Center
Primary Care Group

LEVEL ONE MAPS LEGEND

Center for Orthopedics & Sports Medicine
Occupational Health Clinic
Outpatient Imaging Services – MRI, CT,
X-ray and Ultrasound
Outpatient Laboratory Services
Outpatient Surgery Center
Physical and Occupational Therapy,
including an Outdoor Sports Medicine Field
LEVEL TWO
Breast Care Center – Mammography and
Bone Density
Clinical Training Center
Primary Care Clinic
PARKING

Parking is free at Houston Methodist Baytown.

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Communications

Language Interpretation Telephone Directory

Houston Methodist uses Stratus
Hospital Operator 281.420.8600
video and language services. If you
need an interpreter, please ask Billing 832.667.5900
your nurse or see page 21.
Cashier’s Office 281.420.8570
Sign Language Interpretation Chaplains/Spiritual Care 281.420.8811
If you need a sign language Doctor Referral 713.790.3333
interpreter, please ask your nurse
or see page 21. Ethics Line 800.500.0333
Food Services Help Line 281.420.4441
Making Calls Gift Shop 281.420.8976
To make free local calls from your
bed, press 9 and dial the number. Guest Relations/Patient Concerns 281.420.8825

To make a long-distance call, Houston Methodist Cancer Center 281.420.8557

press 9, then 0 and dial the Houston Methodist Global Health Care Services 713.441.2340
number. The operator will ask
you for your method of payment Houston Methodist Lung Center 281.428.4510
(collect or credit card) and will Houston Methodist USA Patient Services 877.790.DOCS (3627)
connect your call.
Imaging Services 281.420.8670
Friends and family can dial directly
to all patient rooms. The number for Lost and Found 281.420.8798
your room is listed on your phone. Medical Records 281.420.8760
Patient Access (admitting) 832.556.6546
Cell Phones
Cell phones are allowed in all Patient Information Desk 281.420.8535
areas of the hospital. Certain Patient Transport/Patient Escort 281.420.8535
departments may restrict the use
of cell phones if it interferes with Radiation Therapy 281.420.8557
patient care. Please set the ring Scheduling 832.556.6300
to vibrate to help promote a quiet,
healing environment. Ask your Security (public safety) 281.420.8798
nurse if you have questions. Social Services 281.420.8610

Wireless Internet
Houston Methodist offers free
wireless internet access via
MethodistGuestWiFi.
No password is required.

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Visitors

Houston Methodist knows the vital role loved ones play in a patient’s healing. Visiting After Hours
Visitors are welcome in most areas of the hospital 24/7. When possible, a visitor Visitors entering the hospital
may spend the night in the patient’s room. In most cases, patient rooms have between 9 p.m. and 6 a.m. are
furniture that transitions into a makeshift bed, and the patient’s nurse can provide required to sign in with security
a pillow and blanket for the visitor. Sleeping overnight in public waiting areas is near the front desk or with patient
not allowed, and patients must remain in their room after hours. admissions at the emergency
department entrance.
Visitor Guidelines
We have guidelines in place to help patients and family members work with our Hotels and Accommodations
doctors, nurses and staff to get the most from their hospital stay. Please take a There are several hotels close
few minutes to review these guidelines. to Houston Methodist Baytown
• Visitors are asked to practice good hand hygiene. Hands should be sanitized Hospital.
or washed before and after all patient contact. Hand gel is located outside Please visit visitbaytown.com/stay
each room and throughout the hospital for a complete listing.
• For your protection, if the patient’s room has “Isolation” signage, please follow
all instructions and check with the patient’s nurse if you have questions
• Ask the nurse for permission before bringing food to patients
• Ask the nurse before bringing outside food or drinks in for yourself
• Do not visit if you have a cold or any contagious diseases
• A “No Visitors” sign may be posted on the door at the patient’s request
• Smoking, including vaping, is not allowed anywhere on Houston Methodist
campuses, including medical office buildings and parking areas

Some of our units take care of critically ill patients. To care for these patients,
we may limit visiting hours in these units. Patients and visitors should check with
staff on the unit to confirm hours.
Patients have the right to choose who visits them. Their preferences for lengths
of visits will be respected. The number of visitors may be limited based on patient
request, patient care or for respect of other patients.
You may be asked to step out of the room so staff can care for the patient.
We offer a safe, healthy setting that is free from violence or threats. We do not
allow conduct from visitors that:
• Does not respect the rights of others, including but not limited to other
patients and health care providers
• Harasses or intimidates
• Interferes with a person’s legal rights of movement or expression
• Disrupts the workplace, setting of care, or our ability to provide safe,
quality care

E-Greetings
Loved ones can visit houstonmethodist.org/egreetings to send an e-greeting
to patients.

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During Your Stay

Service Animals Getting Admitted

A service animal may accompany Your doctor manages your admission and your care. Once you are in your
the partner/handler in any room, your nurse will help you get familiar with your surroundings and tell you
area of the hospital that is not what to expect during your stay, including the plan of care and the expected
specifically prohibited as long as length of stay. Your nurse will review the plan of care and specific goals with
the service animal does not pose you daily, and will include your loved ones when possible.
a direct threat and the presence
of the service animal does not Patient Rooms
require fundamental alteration in We want your stay to be as comfortable as possible. You will find the following
the hospital’s policies, practices in your room:
or procedures. The care and
supervision of the service animal • Communication board with information about your nurse and your care
is the sole responsibility of the plan for the day
partner/handler. • Television with a controller attached to your bed
• In most cases, furniture for guests to sit and stay overnight
Mail and Flowers • Space for storage
Mail will be delivered to your room.
• Emergency pull cords or buttons in the restroom, next to the toilet and
Mail received after you have been
in the shower
discharged will be forwarded to
your home address. For your comfort, you may:

Flowers purchased from the • Adjust the temperature in your room

hospital gift shop will be delivered • Adjust your bed using the buttons on the side
to your room. Flowers purchased • Ask your nurse for additional blankets or pillows
from a local florist will be delivered
by the florist. Flowers received • Ask your nurse for toiletries if needed
after you leave will be returned to Housekeeping staff will clean your room daily, and the nursing staff will
the florist. change bed linens. If your room needs more attention, please ask your nurse
to contact our housekeeping or maintenance staff.
Live flowers or plants are not
allowed in the intensive care unit,
Nursing Activity in Your Room
but silk flowers are acceptable.
Your nurse or a nursing assistant will stop by your room frequently to check
on you and ask if you need anything. At the start and end of every shift, your
DAISY Award for current nurse and the next nurse in charge of your care will come into your
Extraordinary Nurses room to discuss your condition and care goals for the next shift. You may also
The DAISY Award is an receive a visit from the charge nurse or nurse leader.
international program that rewards
and celebrates extraordinary Calling Your Nurse
nurses who consistently show You may press the call button on the controller attached to your bed, and a unit
excellence through their medical secretary will route your concerns to your nurse or patient care assistant. To
expertise and compassionate care. reach your nurse directly, call the number on the communication board
If you meet an extraordinary
nurse during your stay, please visit Technology and Your Care
houstonmethodist.org/daisy- To offer you the most specialized care, we may need doctors at different
awards or ask your charge nurse locations to share information using electronic devices – called telemedicine.
for a nomination form. If we believe telemedicine is important to your care, we will give you more
information and allow you to make the best decision for you.
Please do not take photos or videos of your caregivers without their permission.

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Your Health Care Team Wong-Baker FACES®
In addition to your doctors and nurses, many professionals may make up your Pain Rating Scale
health care team.
Registered dietitians may review your medical record and work with your
health care team to develop a nutrition care plan. Dietitians are available for
education and questions.
Physical therapists, occupational therapists and/or speech pathologists
may be consulted by your health care team to identify resources you may need
to continue your recovery after you leave the hospital.
Pharmacists are on duty 24/7 and review your medication list regularly to
ensure medication safety.
Case managers are nurses who help with discharge planning, including home
care, transfer to another health care facility, or arranging for medical equipment.
Social workers offer emotional support, counseling and guidance to help
patients and families with financial, social and emotional challenges, as well as
lifestyle adjustments, due to a change in health.
Chaplains are available to help you address your emotional and spiritual
needs. They can talk with you directly, or they can assist you in contacting a
representative of your faith.

Pain Management
Managing your pain is one of our key goals while you’re here. We want to make
sure you’re as comfortable as possible. You are the only one who can measure
your pain. Please tell your nurse or doctor when you experience any level of
pain. We are committed to responding to your pain quickly and to helping you
prevent pain when we can.
At Houston Methodist, we use the scale to the right to help patients
communicate their pain level. This scale is also located on the communication
board in your room.

Hospital Pharmacy
The Houston Methodist Pharmacy Department is committed to partnering with
you to meet all your medication needs. We can answer any questions you have
about your prescribed medications.

The hospital pharmacy will:

• Provide all medications your doctor orders during your stay
• In some situations, we may need to provide medications you bring from home
• Work with your doctor to choose other medications if an ordered
medication is not in stock
• Not dispense or provide non-FDA regulated herbal supplements

© 1983 Wong-Baker FACES Foundation

9
During Your Stay

Reading Materials Guest Relations

Patients and family members may A team of patient liaisons is available to help patients and visitors with any
check out books and magazines questions, concerns or special requests that may arise during their hospital
by calling the front desk at stay. Patient Representatives are here daily and you may contact them
281.420.8535. at 281.420.8825.

Spiritual Care
Regardless of your religion or faith, Houston Methodist’s Department of
Spiritual Care and Values Integration strives to provide you with resources to
fulfill your spiritual needs while in the hospital. Our staff chaplains, volunteer lay
ministers, Catholic Eucharistic ministers and volunteers work together to offer
24/7 spiritual support and resources, including Bibles (in English, Spanish
and additional languages), other sacred texts, prayer, bereavement support
and more.
Our chapel is open 24/7. Please see the map on page 4 for locations.
If you have an urgent need ask your care provider to request a chaplain.

Volunteer Services
Volunteers are a key part of our hospital. They contribute their time, services
and energy to help you have a more pleasant stay. You will find them throughout
the hospital. They are happy to serve you, so let them know if they can help.
Most volunteer programs are accessible Monday through Friday, 8 a.m. to
5 p.m. Some include after hours from 5 to 9 p.m. and weekends.
For more information or to find out how our volunteers can help you, visit
houstonmethodist.org/volunteer or call 281.420.7289.

Food Services
Meals must be ordered from your bedside phone by dialing extension 4441.
Room service will deliver meals directly to your room between 7 a.m. and 6:30
p.m. Should you require a meal after hours, the hospital will make arrangements
through your care provider.

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TV Guide

2 KPRC / NBC 25 ESPN

3 CNN 26 KRIV / FOX 26
4 Direct TV Preview Channel 27 CNBC
5 TNT 28 MSNBC
7 Cartoon Network 29 Bloomberg
8 PBS 30 ROOT Sports
9 Weather 38 NFL Network
10 Fox News 39 The CW 39
11 KHOU / CBS 40 Discovery Channel
12 Discovery Family 41 TBS
13 KTRK / ABC 43 Destination America
14 USA 44 TLC
15 A&E 45 Univision (Spanish)
16 Headline News 46 ID Channel
17 Azteca 51 (Spanish) 47 FX
18 Gameshow Network 48 HLN
20 KTXH / MY 20 49 Syfy
21 History Channel 50 The Weather Channel
22 Lifetime 55 AMC
23 National Geographic
24 ESPN 2

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Your Health and Safety

Hand Hygiene Patient safety is vital to everything we do at Houston Methodist. Please see
below for steps you can take to help us ensure your safety and health.
All doctors, nurses, staff and
visitors should clean their hands
every time they enter your room. Identification
If you do not see people who enter Many people will enter your hospital room. All Houston Methodist doctors and
your room cleaning their hands, employees must wear identification badges at all times. If someone visits your
please remind them to. For your room without a badge, tell your nurse. Feel free to ask everyone who enters your
safety, do not hesitate to ask if they room their name, role and purpose. You may find it helpful to write down this
have cleaned their hands. information.

You and your caregivers may clean You received a patient identification band upon admission to the hospital. It will
your hands using soap and water or be checked before every test, procedure, treatment or medication. Every staff
alcohol‑based hand sanitizers. member who provides a service to you must check your full name and date of
birth. While this may feel overwhelming, it is the greatest action we can take to
• When using soap and water, ensure your safety.
clean your hands for 15 to
20 seconds For Your Safety
• When using alcohol hand The thought of a particular exam, procedure or treatment may make you feel
sanitizer, apply it to the palm of uncomfortable. Talk to your nurse if you would like an additional person, or
your hand, and rub it into your chaperone, at your bedside during these occasions.
hands until they are dry
Good hand hygiene is the No. 1 Security services are available 24/7 for specific patient needs. Our team is
way to prevent the spread of highly trained for any emergency response, with law enforcement support when
infection, especially in a hospital. necessary. If you have questions or concerns related to lost-and-found items,
You should always clean your valuables, escorting throughout the hospital, or other security needs,
hands in the following situations: call 281.420.8798.

• After sneezing or coughing If you have valuables with you, please give them to a loved one for safekeeping,
or ask your nurse to request for hospital security to store them in a safe. You
• If you accidentally come in will be responsible for picking up your valuables when you leave the hospital.
contact with the place where Houston Methodist is not responsible for replacing personal belongings.
catheters or drains are inserted,
or if you come in contact with Do not bring firearms into the hospital. Texas State Laws 30.06 (Concealed
an incision Handgun) and 30.07 (Open Carry Handgun) are posted on signs throughout
• Before and after contact with hospital property prohibiting guns from being brought into the hospital.
medical equipment Smoking, including vaping, is not allowed anywhere on Houston Methodist
campuses, including medical office buildings and parking areas.
We sometimes conduct fire drills, and you may hear an alarm. If there is an
actual fire, hospital staff will help ensure your safety.
Electronic appliances such as computers and hair dryers are allowed in patient
rooms. Hospital staff may ask you to remove or not use them if they feel it is
unsafe or disrupts your care.
Houston Methodist will provide medical equipment during your stay. You will be
allowed to bring equipment from home only with a doctor’s order and sufficient
proof that you or your qualified representative can operate the equipment.

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Fall Prevention
In the hospital, people can be at a higher risk for falls. Illness, surgery and
medicines can weaken or affect balance and judgment. Also, medical
equipment and the unfamiliar environment can make movement more difficult.
Houston Methodist is committed to preventing patient falls. If you are at risk for
falling, we may place a sign on your door and ask you to wear an armband and/
or special socks to alert others. If you need help, call your nurse or push the call
button on the controller attached to your bed.

During your stay, we will:

• Evaluate your risk of falling upon admission and as your condition changes
• Decide what actions to take to prevent a fall, and share it with staff taking
care of you
• Show you how to use your call button and remind you when to call for help
• Respond to your calls for help in a timely manner
Know Your Medications
• Help you with getting in and out of bed and using the restroom
It is important for you to know the
• Give you safe footwear and recommended equipment, such as a walker or
medications you take regularly,
bedside toilet, which will make it safer for you to move around
including over-the-counter and
• Make sure the call button and other needed items are within reach before herbal and vitamin supplements, as
staff leaves your room well as recreational drugs. Make
sure your doctors and nurses know
We ask you and your loved ones to: allergies or reactions you have to
• Tell your nurse if you have a history of falls medications, foods or materials like
latex or adhesive.
• Ask your nurse about your risk for falling and the actions being taken to
reduce that risk You should also understand
• Use the call button before trying to get out of bed, and wait for staff to new medications your doctor
come help you prescribes while you’re in the
hospital. Make sure you know:
• Wear nonskid footwear and use equipment that has been provided for
your safety • The name of the medication and
• Make sure the call button and other needed items are within reach before generic counterparts
family or staff leaves your room • The purpose for the medication
• Tell a member of the health care team if your identification band comes off • Dosage, frequency and duration
• Possible side effects and
Blood Clot Prevention interactions with other
Blood clots can permanently affect your quality of life, and can even be deadly. medications or foods
Your care providers will determine your risk when you are admitted. Based on • Ways you and your health care
your risk, you may need compression devices, stockings, medication or team can monitor the effects of
frequent walks. the medication

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Infection Prevention

At Houston Methodist, we do everything we can to prevent Prevention of Surgical Site Infections

infections from spreading in our facilities, using best and
A surgical site infection occurs in the part of the body
proven practices. We urge all patients and visitors to join us
where surgery took place.
in preventing infections.
To prevent surgical site infection, your health care
Prevention of Catheter-Associated providers will:
Urinary Tract Infections • Wash their hands with soap and water or an
A urinary catheter is a thin tube placed in the bladder to alcohol‑based hand sanitizer before and after caring
prevent urine backup and help flow. An infection may occur for each patient
if the catheter is not cared for properly. • Wash their hands and arms up to their elbows with an
antiseptic agent just before the surgery
To prevent catheter-associated urinary tract
• May remove some of your hair immediately before your
infection, your health care providers will:
surgery using electric clippers; they should not shave
• Evaluate the need for the catheter before inserting it you with a razor
• Follow all guidelines for being sterile during catheter • Wear special hair covers, masks, gowns and gloves
insertion: hand hygiene, gloves and cleaning the site during surgery to keep the surgery area sterile
beforehand
• Give you antibiotics before your surgery starts. In most
• Perform catheter care at least once each shift, or more cases, you should get antibiotics within 60 minutes
often if necessary before surgery starts. Antibiotics should be stopped
• Check for signs of infection often within 24 hours after surgery unless your doctor gives
• Check daily to see if the catheter can be removed different instruction
• Clean the skin at the place of your surgery with a
How you can help: special soap that kills germs
• Avoid touching the catheter and tubing • Clean hands and wear clean gloves when caring for
your surgical site after surgery
• Let your nurse or doctor know immediately if:
–– You have the urge to urinate but cannot How you can help:
–– You have any abdominal or lower back pain, • Tell your doctor about other medical problems you may
or a burning sensation have, such as allergies, diabetes, high blood pressure or
–– Your leg tubing support has come loose and infections
the bag is not emptied frequently • If you smoke, quit
–– Your genital area is not being cleaned at least • Do not shave close to where you will have surgery;
once each shift speak up if someone tries to shave you with a razor
instead of clippers
Please visit cdc.gov/hai/infectiontypes.html for • Ask if you will get antibiotics before surgery
more information on preventing infections. • Make sure health care providers, family and friends
wash their hands before and after visiting you
• Do not allow family or friends to touch the surgical
wound or dressing
• Always wash your hands before and after touching your
surgical site
• Make sure you understand wound care instructions
before you leave the hospital and that your health care
provider answers all your questions

14
Prevention of Catheter-Associated Prevention of Clostridium difficile Infections
Bloodstream Infections Clostridium difficile, also known as C. diff, is a germ that
A central line is a tube placed into a patient’s large vein — can cause diarrhea. Most cases of C. diff infection occur
usually in the neck, chest, arm or groin — to give fluids, in patients taking antibiotics. C. diff spores can live outside
antibiotics or other medications. It may be left in place for the human body for a long time and may be found on
several weeks. A bloodstream infection may occur if proper surfaces such as bed linens, bed rails, bathroom fixtures
catheter care is not practiced. and medical equipment. The elderly and people taking
antibiotics that lower the level of normal bacteria in the
To prevent catheter-associated bloodstream intestine are most likely to get this infectious disease.
infection, your health care providers will:
To prevent C.diff infection, your health care
• Evaluate the need for the catheter before inserting it
providers will:
• Follow all recommendations for being sterile during
• Wash their hands with soap and water before and
insertion: hand hygiene, gloves, gown, mask, hair cover
after caring for patients. Alcohol hand sanitizers are
and use of a sterile drape
not effective against C. diff spores and should not be
• Perform hand hygiene and clean the catheter tip before used if C. diff infection is suspected or confirmed
using the line to draw blood, giving medicines or fluids,
• Tell family and visitors to wash their hands with
or changing the bandage
soap and water
• Check for signs of infection (fever and chills, or
• Carefully clean all hospital rooms and medical
redness around the insertion site) often and change
equipment
the bandage as required
• Use the following isolation precautions with other
• Check daily to see if the line can be removed, and have
patients who have C. diff:
it taken out if no longer needed
–– Patients will be told to wash their hands with
How you can help: soap and water when leaving the room for tests
• Avoid touching the line, tubing and bandage or procedures
• Let your nurse or doctor know immediately if: –– Health care providers will wear gowns and gloves
–– The bandage is loose, falls off, or becomes when in the patient room
wet or dirty –– Patients on isolation precautions are asked to
–– The skin around the catheter is red or sore stay in their rooms as much as possible. They
should not go to common areas such as the
• Ask visitors to clean their hands and not to gift shop or cafeteria
touch your catheter
–– Only give patients antibiotics when needed
• Ask questions such as:
How you can help:
–– Why and how long do I need the line?
• Make sure your health care providers and visitors are
–– What steps will be taken to lower the risk performing hand hygiene before and after touching
of infection? you and your immediate surroundings
• Make sure your room is being cleaned daily and tell
This information is from the following: your nurse if it is not
• Centers for Disease Control (CDC) • If you are on antibiotics, ask your doctor if they are
• American Hospital Association (AHA) really needed
• Society for Health Care Epidemiology of America • If a patient has C. diff, visitors are encouraged to wear
(SHEA) gowns and gloves while in the patient’s room, and to
• Infectious Diseases Society of America (IDSA) avoid bringing food or drinks into the patient’s room
• Association for Professionals in Infection Control
and Epidemiology (APIC)

15
Discharge

Find a Doctor When your condition improves or changes, you will be discharged from the
hospital to return home or transfer to another health care facility.
If you would like help finding a
primary care doctor or specialist,
please call 281.428.2273. What to Expect During Discharge
When your doctor says you are ready for discharge, many people go to
Schedule Imaging work behind the scenes to get you ready for home or your next health care
Appointments Online destination. Our staff will make every effort to discharge you early in the
day. Your nurse will lead the charge in getting the doctor to sign important
Houston Methodist offers online documents, working to get necessary medical equipment and prescriptions
scheduling for mammograms, CT ordered, and other necessary actions. You should begin gathering your
scans, MRIs, ultrasounds and belongings, arranging transportation, and preparing to leave. This process may
more. Visit houstonmethodist.org/ take several hours, and we appreciate your patience as we ensure the best
imaging to schedule your transition for the next phase of your healing and recovery.
imaging appointment.
Within 24 hours after discharge (or Monday if discharged Friday or Saturday),
you will receive a two-minute automated phone call from us, asking if you have
any questions or concerns about your health status. If you indicate you’d like to
speak with us, a care team member will contact you directly to address
your needs.

Before You Go
• Ask your nurse to call a case manager if you have questions or concerns
about your discharge plan or care after your hospital stay, including medical
equipment you may need during your recovery
• Ask your nurse to return any medications you brought from home
• Make sure you have someone available to pick you up or go with you to the
health care facility where you’ll be admitted – and talk to your nurse about
an anticipated time
• Check every space in your hospital room and restroom for personal
belongings

Patient Satisfaction Survey

After you leave the hospital, you will receive a patient satisfaction survey from
Houston Methodist via mail, phone or email. To ensure your privacy, this survey
is conducted by an independent third party. Please take the time to complete
and return the survey. We will use your feedback to improve the care and
services we provide.

At Home
Once you are home, remember to continue working to improve your
health. Keep up with medications, diet, activity, incision care and follow-up
appointments or care.

16
Follow-Up Appointments Long-Term Acute
If your doctor or nurse ordered additional tests, therapy or follow-up Care Hospital
appointments, it is important to schedule them quickly. Call your primary care Houston Methodist Continuing
doctor to notify him/her about your hospitalization and plan of care. Care Hospital proudly serves the
Greater Houston area, focusing on
Outpatient Care the needs of patients who need
extended hospital care. Located
Houston Methodist will file with your insurance company for outpatient hospital
in Katy, west of the Texas Medical
charges. Be sure to ask your doctor about special preparations for these
Center, we are committed to
procedures.
providing our patients high quality
You are encouraged to register for all patient services in advance by calling and safety, with a central focus on
281.420.6779. the patient and family.
Our unique approach combines a
Patient Portal: Houston Methodist MyChart comprehensive, interprofessional
Houston Methodist MyChart provides you convenient, online access to portions team of specialty doctors, nurses,
of your health records — from home or wherever and whenever you need. With therapists and other health care
Houston Methodist MyChart, you or your designee can: providers with the family to get the
outcomes the patient needs.
• Review your visit summary: View clinical discharge summaries with
prescription and follow-up notes houstonmethodist.org/
• Access test results sooner: See your results and doctor’s comments when continuing-care
they’re available. Main hospital: 832.522.7550
• Pay your Houston Methodist bills securely: Review your medical bills and Referral line: 832.522.5822
send secure payments online
To sign up for Houston Methodist MyChart, visit houstonmethodist.org/mychart
and select “Sign Up Now.” An activation code may be provided at admitting,
during registration, on your after-visit summary, or on your billing statement.
Houston Methodist MyChart is also available as an app for mobile devices.
Download the app from Apple App Store or Google Play.
For more information or help with your account activation, please call
832.667.5694.

Continued Care
You may require home health care, which means a nurse, therapist or other
health care professional will visit you at home to continue care.
If you need further inpatient care, you may be transferred to a facility such as:
• Inpatient rehabilitation – dedicated to physical rehabilitation
• Long-term acute care hospital – provides intensive medical and
rehabilitative care for patients with complex needs, usually for 18-25 days
• Nursing home – residential, 24/7 nursing care
• Hospice – focuses on comfort and quality of life for terminal patients
Apple and the Apple logo are trademarks of Apple Inc.,
registered in the U.S. and other countries. App Store is a
service mark of Apple Inc. Android, Google Play, and the
Google Play logo are trademarks of Google Inc.

17
Patient Rights and Responsibilities

As a patient, you have the right to respectful and • Receive information about your illness, course of
considerate care. Also, there are specific rights and treatment and chances for recovery in words you
responsibilities you have during your hospital stay. can understand
• Assign a guardian, next of kin or support person who
Patient Rights has the right to exercise, to the extent allowed by law,
You have the right to: your rights on your behalf if you are not capable of
understanding treatment, are unable to communicate
• Exercise each of the rights without regard to race, color, your wishes, are judged incompetent, or if you are
religion, national origin, sex (including gender identity), a minor
sexual orientation, age, disability, economic status,
educational background, ancestry, marital status, or the • Make decisions, along with your doctor, about your care
source of payment for care and participate, along with your support person, in your
plan of care, including the informed consent process
• Receive information about your rights and the process
for starting, reviewing and, when possible, resolving • Accept and refuse treatment to the extent allowed by
your complaints regarding quality of care. You have the law; and the right to be informed of the medical results
right to receive this information when you are admitted of accepting and refusing treatment
to the hospital in a language you understand • Be told about ongoing health care needs after leaving
• Share a concern to the appropriate hospital staff or to the hospital
the Texas Department of State Health Services, DNV • Be informed, along with your family when appropriate,
GL Healthcare, KePro or CMS. You can find more of the results of care, including unexpected outcomes
information on page 20
• Have a family member or support person and your
• Share a concern about health information privacy to
doctor told about your admission to the hospital
appropriate hospital staff or to the Secretary of the U.S.
Department of Health and Human Services • Know the name of the doctor who is managing your
care and the names and associations of anyone else
• Share a concern about any health care provider
participating in your care
licensed by the state of Texas
• Personal privacy, within legal limits. Case discussion,
• Effective communication and a fair response to your
consultation, examination and treatment are private and
requests and needs for treatment or service within
should be performed thoughtfully. You have the right
the hospital’s ability, mission, and applicable laws
to be told the reason for the presence of any individual
and guidelines
during these events
• A setting that upholds dignity and supports a positive
• Allow or refuse photography, videography, electronic
self-image
or audio recordings, or the use of any personally
• Considerate and respectful care. This includes social, recognizable information for purposes other than
spiritual and cultural values. Care for the dying patient identification, diagnosis or treatment
focuses on comfort and dignity, treating end-of-life
• Know your health information rights. This includes
symptoms such as pain, and providing information about
the right to access and request changes to your
death and grief for you and your loved ones
health information, and to get a record of your health
• Participate in, or have your support person participate information, as allowed by law
in, the consideration of ethical issues arising in your
• Access, within legal limits, or have your support person
care
access, information in your medical records
• Participate or not to participate in any human testing,
• Know how Houston Methodist is required and allowed
research or education projects for which you are eligible
by law to use and share your health information
• Receive care in a safe setting

18
 • Be free from mental, physical, sexual and verbal abuse,
neglect and exploitation
• Access protective and aid services
• Be free from restraint or seclusion of any form that is
not medically necessary or is imposed as a means of
force, discipline, revenge or convenience by staff
• Have your pain managed effectively
• Complete advance directives and have health care
providers follow them
• Know your visitation rights, including any medical
restriction or limitations
• Receive visitors you wish to see. This includes, but is
not limited to, a spouse, a domestic partner (including a
same-sex domestic partner), another family member or
friend. You have the right to deny any visitor at any time
• Know that all visitors will enjoy full and equal visitation
consistent with your wishes. The hospital will not
restrict, limit or deny visitation based on race, color,
national origin, religion, sex (including gender identity),
sexual orientation or disability

Patient Responsibilities
You have the responsibility to:
• Identify yourself and provide accurate and complete
information about your medical history
• Share unexpected changes in your current state
• Ask questions when you do not understand medical
information you have received
• Follow the directions and instructions of your health
care providers, unless you have used your right to
refuse treatment
• Recognize the effect of your lifestyle on your health
• Respect the rights of others, including, but not limited
to, other patients and health care providers
• Understand your health care benefits
• Verify the financial duties related to your care are met in
a timely manner

19
Patient Concerns

Guest Relations
Quality health care is our top priority, and we tirelessly review ways to improve
our patient care. If you have a concern about your care, please ask your nurse
to speak with a patient liaison or call us at 281.420.8825.

External Resources
You may contact any of the entities listed below to file a complaint.

CMS Region 6 Quality of Care Complaints – Customer Service

Center for Medicare & Medicaid Services, local region
1301 Young St., Suite 714
Dallas, TX 75202
214.767.6423

DNV GL Healthcare
Private organization that provides hospital accreditations, certifications
and standards development
400 Techne Center Dr., Suite 100
Milford, OH 45150
866.496.9647
How You Can Ensure dnvglhealthcare.com
Safe Health Care
You are the most important KePRO
member of your health care team. Medicare quality improvement organization

• Ask questions Rock Run Center

5700 Lombardo Center Dr., Suite 100
• Ask a friend or loved one to Seven Hills, OH 44131
take notes 844.430.9504
• Know all the medicines you take keproqio.com
and why you take them
Texas Department of State Health Services
• Keep track of all medical tests
Health Facility Compliance Group (MC 1979)
and results, and make sure you
State department focused on health and well-being of Texans
understand them
• Make sure you understand what PO Box 149347
will happen before every Austin, TX 78714-9347
procedure or test 888.973.0022
hfc.complaints@dshs.texas.gov
• Ask for the identification of
everyone who enters your room
• Ask everyone who enters your
room to clean their hands
• Express any concerns you have
about your care

20
Notice of Nondiscrimination

Houston Methodist follows federal civil rights laws and does Korean
not discriminate on the basis of race, color, national origin, 어떤 언어를 사용하시는지 알려주시면 무료로 통역을
age, disability or sex. Houston Methodist does not exclude 제공해 드립니다.
individuals or treat them differently because of race, color,
national origin, age, disability or sex. Urdu
‫ جو آپ کے لیے مفت‬،‫براہ کرم اپنی زبان بتائیں تاکہ مترجم کا انتظام کیا جاسکے‬
Houston Methodist ‫ہوگا۔‬
• Provides free aids and services to people with disabilities
to communicate effectively with us, such as: Tagalog
–– Qualified sign language interpreters Mangyari lamang na ipahiwatig ang inyong wika para
–– Written information in other formats, including large ang isang tagapagsalin ay maisaayos na walang gastos.
print, audio and accessible electronic formats
Hindi
• Provides free language services to people whose primary
language is not English, such as: कृ प्या अपनी भाषा बताइये सो अनुवादक का प्रभंध किया जा सके जो
–– Qualified interpreters आपके लिए निशुल्क होगा ।
–– Information written in other languages Farsi
If you need sign language interpretation services or other ‫لطفا بفرمایید به چه زبانی صحبت می کنید تا بدو ن هیچگونه هزینه اضافی برای‬
aids or services for individuals with disabilities, please call ‫شما مترجم فراهم کنیم‬
713.441.2340 during normal business hours. Gujarati
If you need language interpretation services, please contact કૃપા કરી તમારી ભાષામાં સૂચવો કે જે થી દુભાષિયાની ગોઠવણ કરી શકાય
Houston Methodist Global Health Care Services જે ના માટે તમને કોઇ ખર્ચ થશે નહીં.
at 713.441.2340.
Japanese
Spanish あなたのお話しされる言語をお知らせください。無料に
て通訳の手配を致します。
Por favor indique su idioma para proveerle un intérprete
gratuitamente. Laotian
Arabic ກະລຸນາບອກພາສາຂອງທ່ານເພ ່
ອວ່
າພວກເຮາຈະສາມາດຈັ
ດ
ຫານາຍແປພາສາໃຫ້ທ່ານໄດ້
ບ່ຕ້
ອງເສຍຄ່
າໃຊ້
ຈ່
າຍ”
‫يرجى اإلشارة إلى اللغة التي تتكلمها وسوف يتم توفير الترجمة‬
.‫الفورية لكم وبدون مقابل‬ German
French Bitte geben Sie Ihre Sprache an, so dass ein
Dolmetscher kostenlos für Sie arrangiert werden kann.
S’il vous plaît indiquer votre langue, afin que nous
puissions fournir un interprète pour vous. Le service est
gratuit. If you believe that Houston Methodist has failed to provide
these services or discriminated in another way on the basis
Russian of race, color, national origin, age, disability, or sex, a patient
Пожалуйста, укажите на каком языке Вы liaison is available to assist you in filing a grievance. Please call
разговариваете и мы предоставим Вам переводчика 281.420.8825.
бесплатно. You can also file a civil rights complaint with the U.S.
Department of Health and Human Services, Office for Civil
Vietnamese
Rights, electronically through the Office for Civil Rights
Xin vui lòng cho biết ngôn ngữ của quý vị để chúng tôi Complaint Portal, available at ocrportal.hhs.gov/ocr/portal/
sắp xếp một thông dịch viên hoàn toàn miễn phí cho lobby.jsf, by phone at 800.368.1019 or 800.537.7697 (TDD),
quý vị. or by mail at U.S. Department of Health and Human Services,
200 Independence Ave. SW, Room 509F, HHH Building,
Chinese Mandarin
Washington, DC 20201.
请告知您使用的语言，我们会为您提供免费翻译。
Visit hhs.gov/ocr/office/file/index.html to access
complaint forms.

21
Your Privacy and Information

Adapted from U.S. Houston Methodist is required, by law, to keep your identifiable health
Department of Health & information private. Our Notice of Privacy Practices explains your legal rights
regarding your health information, identifies how we may use and disclose your
Human Services Office
health information, including participation in a health information exchange with
for Civil Rights your other providers, and informs you of our legal duties and privacy practices.
If you believe your health For a copy of our Notice of Privacy Practices, visit houstonmethodist.org/
information privacy rights have for-patients/patient-resources/patient-right-privacy. Contact your patient
been violated, you can file a access services representative for a paper copy.
complaint with Houston Methodist,
your provider, your health insurer Business Practices Officer
or with the Secretary of the United
States Department of Health and If you have questions or need information regarding our legal duties and privacy
Human Services. There will be practices, or how to exercise any of your health information rights listed in the
no penalty or retaliation against Notice, you may call 713.383.5129. You may also contact the business practice
you for making a complaint. Visit officer for Houston Methodist Baytown Hospital:
hhs.gov/ocr/hipaa for more Houston Methodist Baytown Hospital
information. 281.420.8765
A separate law provides 4401 Garth Rd.
additional privacy protections Baytown, TX 77521
to patients in alcohol and drug
treatment programs. We will not “No Information” Patients
share information identifying an If you ask to be a “No Information” patient during registration, we will give NO
individual as a patient or provide information to anyone who asks for you by name. The hospital will not reveal
any medical information relating you are a patient. Choosing “No Information” status means:
to the patient’s substance abuse
treatment unless: the patient • You will not receive a delivery of flowers unless the person who ordered
consents in writing; a court order them gave the florist your room number
requires disclosure; medical • Family and friends will not be told you are in the hospital. They will not be
personnel need the information to able to find you in the hospital directory unless you give them your room
meet a medical emergency; or in number and telephone number
other cases where it is absolutely
If you wish to change your status to or from “No Information” during your stay, or
necessary. Visit samhsa.gov for
if you have any questions, talk to your nurse.
more information.

Copies of Medical Records

You have the right to access and receive a copy of your health information,
or medical record. Medical records requests can be made through our health
information management department. Copy fees may apply, depending on the
request, and consistent with state and federal law. Requests associated with
continuity of care are free.
For additional information regarding release of medical records, please contact:
Health Information Management/Release of Information
281.420.8760
4401 Garth Rd.
Baytown, TX 77521

22
Advance Directives

Advance directives are legal documents that allow you to Explanation: Many serious illnesses, failure of major
explain and share your wishes for medical treatment to organs and serious brain disease may be considered
your family, health care professionals and other key people irreversible early on. There is no cure, but the patient may
in your life. While considering advance directives may be be kept alive for long periods of time if the patient receives
emotionally difficult, completing these forms helps reduce life-sustaining treatments.
uncertainty and emotional burdens your family might feel
Late in the course of the same illness, the disease may
if they do not know your wishes. Advance directives do not
be considered terminal when, even with treatment, the
affect your access to care, treatment or services.
patient is expected to die. You may wish to consider which
There are three types of legal documents included in burdens of treatment you would be willing to accept. This is
advance directives: Directive to Physicians (Living Will), a personal decision that you may wish to discuss with your
Medical Power of Attorney and Out-of-Hospital Do-Not- doctor, family or other key people in your life.
Resuscitate Order. For your convenience, the Directive to
Life-sustaining treatment: treatment that, based on
Physicians and Medical Power of Attorney documents are
reasonable medical judgment, supports the life of a patient
provided on pages 25-30.
and without which the patient will die.

Directive to Physicians (Living Will) Explanation: The term includes both life-sustaining
medications and mechanical life support, such as
A Directive to Physicians, or Living Will, shares your medical
mechanical breathing machines, kidney dialysis treatment,
choices for the future in case you are not able to make
and artificial hydration and nutrition. The term does not
them known. This document goes into effect when you
include pain management medications, medical procedures
cannot make or share your decisions, and are in a terminal
needed to provide comfort care, or any other medical care
or irreversible state as decided by your doctor.
to ease pain.
Share your values and wishes with your family or agent,
Terminal condition: a fatal condition caused by injury,
and your doctor. Your health care providers or medical
disease or illness that, according to reasonable medical
institution may give you tools to help you fill out the form.
judgment, will produce death within six months, even with
Short definitions are listed below and to the right to help
available life-sustaining treatment provided in accordance
you with your advanced care planning. Place your initials
with the current standard of medical care.
on the choices that best reflect your personal wishes. Give
a copy to your doctor, hospital, and family or agent. Review Explanation: Many serious illnesses may be considered
this document every year to make sure your choices are up irreversible early in the illness, but they may not be
to date. considered terminal until the disease is advanced. When
thinking about terminal illness and treatment, you may want
You may also wish to complete a directive related to the
to consider the benefits and burdens of treatment and
donation of organs and tissues.
discuss your wishes with your doctor, family or other key
people in your life.
Definitions
Artificial nutrition and hydration: the giving of nutrients
or fluids by a tube inserted in a vein, in the tissues under the
skin, or in the stomach (gastrointestinal tract).
Irreversible condition: a condition, injury or illness that:
• May be treated, but is never cured
• Leaves a person unable to care for or make decisions
for himself/herself
• Without life-sustaining treatment, provided in
accordance with the current standard of medical care,
is fatal

23
Advance Directives

Medical Power of Attorney Out-of-Hospital Do-Not-Resuscitate Order

The Medical Power of Attorney is a legal document that An Out-of-Hospital Do-Not-Resuscitate Order directs
names someone you trust to act as your agent if you are health care members to avoid performing resuscitative
not able to speak for yourself. This is used when your actions (e.g., compressions on your chest) if your heart
doctor decides you cannot make your own treatment stops and you are outside of the hospital. This document
decisions. It is not limited to times when you are in a takes effect only when you are outside of the hospital.
terminal or irreversible state.
If you would like more information regarding the
Your agent has the authority to make most health care Out‑of‑Hospital Do-Not-Resuscitate order, please ask
decisions for you. Respecting your wishes, your agent your doctor.
can agree, disagree, and withdraw agreement to medical
treatment decisions. This includes refusing and removing
life-sustaining treatment (e.g., breathing machine). There
are a few limits to your agent’s authority. Your agent cannot
agree to the following treatments: voluntary inpatient
mental health services, convulsive treatment, psychosurgery,
or ending a pregnancy.
Your agent is ethically and legally obligated to make
decisions that are in line with your wishes for medical
treatment. You should discuss your values and wishes
with your agent, doctor and loved ones. Without knowing
your wishes, they may have a difficult time making medical
decisions for you.
In the document, you may also choose up to two other
agents to make medical decisions for you in case your
primary agent is unable and/or unwilling to.

Biomedical Ethics
Decisions in the modern health care setting are getting more and more complicated, which can seem overwhelming. An
ethics consultation, or discussion, helps patients and doctors determine which decisions or actions are most appropriate.
Ethics consultations can help provide guidance in areas of uncertainty. An ethics consultation is a service available to
all patients, families and health care professionals in the hospital at no charge. You might consider requesting an ethics
consultation when you find yourself asking, “What’s the right thing to do here?”, or when you have questions about how
to interpret an advance directive. We can also address concerns or questions regarding treatment decisions at the
end‑of-life, or refusing or removing life-sustaining treatment.
If you would like to talk with a member of Houston Methodist’s bioethics consultation services team, please ask your
nurse to page the ethics consultant on call.

24
 *000289*
1A

Directive to Physicians and Family or Surrogates

000289
I, , recognize that the best health care is based upon a partnership of
1B

trust and communication with my physician. My physician and I will make health care decisions together as long as I
am of sound mind and able to make my wishes known. If there comes a time that I am unable to make health care
decisions about myself because of illness or injury, I direct that the following treatment preferences be honored:
If, in the judgment of my physician, I am suffering with a terminal condition from which I am expected to die
within six months, even with available life-sustaining treatment provided in accordance with prevailing standards
of medical care:
I request that all treatments other than those needed to keep me comfortable be discontinued or withheld
and my physician allow me to die as gently as possible; OR
I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS
SELECTION DOES NOT APPLY TO HOSPICE CARE.)
If, in the judgment of my physician, I am suffering with an irreversible condition so that I cannot care for myself or
make decisions for myself and am expected to die without life-sustaining treatment provided in accordance with
prevailing standards of care:
I request that all treatments other than those needed to keep me comfortable be discontinued or withheld
and my physician allow me to die as gently as possible; OR
I request that I be kept alive in this irreversible condition using available life-sustaining treatment.
(THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
Additional requests: (After discussion with your physician, you may wish to consider listing particular treatments
in this space that you do or do not want in specific circumstances, such as artificial nutrition and fluids, intravenous
antibiotics, etc. Be sure to state whether you do or do not want the particular treatment.)

After signing this directive, if my representative or I elect hospice care, I understand and agree that only those treatments
needed to keep me comfortable would be provided and I would not be given available life-sustaining treatments.
If I do not have a Medical Power of Attorney, and I am unable to make my wishes known, I designate the following
person(s) to make treatment decisions with my physician compatible with my personal values:
1.
2.
(If a Medical Power of Attorney has been executed, then an agent already has been named and you should not list additional names in this document.)
If the above persons are not available, or if I have not designated a spokesperson, I understand that a spokesperson will be
chosen for me following standards specified in the laws of Texas. If, in the judgment of my physician, my death is imminent
within minutes to hours, even with the use of all available medical treatment provided within the prevailing standard of care,
I acknowledge that all treatments may be withheld or removed except those needed to maintain my comfort. I understand that
under Texas law this directive has no effect if I have been diagnosed as pregnant. This directive will remain in effect until I
revoke it. No other person may do so.
Signed Date
City, County, State, Country of Residence

This directive is not valid unless it is signed in the presence of two

competent adult witnesses [OPTION 1], or, in lieu of signing in the
presence of witnesses, the declarant may sign the directive and have
the signature acknowledged before a notary public [OPTION 2]. ADHERE
PATIENT LABEL
WITHIN THIS
®
Directive to Physicians
and Family or Surrogates AREA
8502113867

Page 1 of 3
FORM # 289 (08/2011)

25
2A

OPTION 1:

Two competent adult witnesses must sign below, acknowledging the signature of the declarant. The witness
designated as Witness 1 may not be a person designated to make a treatment decision for the patient and may
not be related to the patient by blood or marriage. This witness may not be entitled to any part of the estate and
may not have a claim against the estate of the patient. This witness may not be the attending physician or an
employee of the attending physician. If this witness is an employee of a health care facility in which the patient
is being cared for, this witness may not be involved in providing direct patient care to the patient. This witness
may not be an officer, director, partner, or business office employee of a health care facility in which the patient
is being cared for or of any parent organization of the health care facility.

Witness 1

Witness 2

OPTION 2

ACKNOWLEDGMENT
State of Texas

County of

Before me, the below signed notary public, on this day personally appeared (declarant) ,
and acknowledged to me that he/she executed said document for the purposes therein expressed.

Acknowledged before me on (date) .

(Seal) Notary Public

1
⁄ 4"

ADHERE
PATIENT LABEL
⁄ 4"
1
WITHIN THIS
Directive to Physicians
and Family or Surrogates AREA
8502113867

Page 2 of 3
FORM # 289 (08/2011)

26
 INSTRUCTIONS FOR COMPLETING DEFINITIONS
THIS DOCUMENT
3A

The Texas Legislature authorizes the use of “Artificial nutrition and hydration” means the provision of
written advance directives, including a directive nutrients or fluids by a tube inserted in a vein, under the skin in
the subcutaneous tissues, or in the stomach (gastrointestinal
3B

in accordance with the following form:

tract).
This is an important legal document known as “Irreversible condition” means a condition, injury, or illness:
an Advance Directive. It is designed to help (1) that may be treated, but is never cured or eliminated;
you communicate your wishes about medical
treatment at some time in the future when you (2) that leaves a person unable to care for or make decisions
for the person’s own self; and
are unable to make your wishes known because
of illness or injury. These wishes are usually (3) that, without life-sustaining treatment provided in
based on personal values. In particular, you may accordance with the prevailing standard of medical care,
is fatal.
want to consider what burdens or hardships of
treatment you would be willing to accept for a Explanation: Many serious illnesses such as cancer, failure
particular amount of benefit obtained if you of major organs (kidney, heart, liver, or lung), and serious
were seriously ill. brain disease such as Alzheimer’s dementia may be considered
irreversible early on. There is no cure, but the patient may be
You are encouraged to discuss your values and kept alive for prolonged periods of time if the patient receives
life-sustaining treatments. Late in the course of the same
wishes with your family or chosen illness, the disease may be considered terminal when, even
spokesperson, as well as your physician. Your with treatment, the patient is expected to die. You may wish
physician, other health care provider, or medical to consider which burdens of treatment you would be willing
institution may provide you with various to accept in an effort to achieve a particular outcome. This is
resources to assist you in completing your a very personal decision that you may wish to discuss with
advance directive. Brief definitions are listed your physician, family, or other important persons in your life.
below and may aid you in your discussions and “Life-sustaining treatment” means treatment that, based on
advance planning. Initial the treatment choices reasonable medical judgment, sustains the life of a patient and
that best reflect your personal preferences. without which the patient will die. The term includes both
Provide a copy of your directive to your life-sustaining medications and artificial life support such as
physician, usual hospital, and family or mechanical breathing machines, kidney dialysis treatment, and
artificial hydration and nutrition. The term does not include
spokesperson. Consider a periodic review of the administration of pain management medication, the
this document. By periodic review, you can best performance of a medical procedure necessary to provide
assure that the directive reflects your comfort care, or any other medical care provided to alleviate
preferences. a patient’s pain.
“Terminal condition” means an incurable condition caused
In addition to this advance directive, Texas law by injury, disease, or illness that according to reasonable
provides for two other types of directives that medical judgment will produce death within six months, even
can be important during a serious illness. These with available life-sustaining treatment provided in
are the Medical Power of Attorney and the accordance with the prevailing standard of medical care.
Out-of-Hospital Do-Not-Resuscitate Order. Explanation: Many serious illnesses may be considered
You may wish to discuss these with your irreversible early in the course of the illness, but they may not
physician, family, hospital representative, or be considered terminal until the disease is fairly advanced. In
other advisers. You may also wish to complete thinking about terminal illness and its treatment, you again
a directive related to the donation of organs and may wish to consider the relative benefits and burdens of
treatment and discuss your wishes with your physician,
tissues. family, or other important persons in your life.

ADHERE
PATIENT LABEL
WITHIN THIS
Directive to Physicians
and Family or Surrogates AREA
8502113867

Page 3 of 3
FORM # 289 (08/2011)

27
 MEDICAL POWER OF ATTORNEY
DESIGNATION OF HEALTH CARE AGENT
3A

Advance Directives Act (see §166.164, Health and Safety Code)

I, (insert your name) appoint:

3B

Name:
Address:
Phone:
as my agent to make any and all health care decisions for me, except to the extent I state otherwise in
this document. This medical power of attorney takes effect if I become unable to make my own health
care decisions and this fact is certified in writing by my physician.

LIMITATIONS ON THE DECISION-MAKING AUTHORITY OF MY AGENT ARE AS FOLLOWS:

DESIGNATION OF ALTERNATE AGENT

(You are not required to designate an alternate agent but you may do so. An alternate agent may make the
same health care decisions as the designated agent if the designated agent is unable or unwilling to act as
your agent. If the agent designated is your spouse, the designation is automatically revoked by law if your
marriage is dissolved.)
If the person designated as my agent is unable or unwilling to make health care decisions for me, I designate
the following persons to serve as my agent to make health care decisions for me as authorized by this
document, who serve in the following order:

A. First Alternate Agent

Name:
Address:
Phone:

B. Second Alternate Agent

Name:
Address:
Phone:
The original of this document is kept at:

The following individuals or institutions have signed copies:

Name:
Address:
Name: ADHERE
Address: PATIENT LABEL
WITHIN THIS
®
MEDICAL POWER
AREA
8502113869

OF ATTORNEY
Page 3 of 5
292 (08/2014)

28
 DURATION
I understand that this power of attorney exists indefinitely from the date I execute this document unless I
establish a shorter time or revoke the power of attorney. If I am unable to make health care decisions for
4A

myself when this power of attorney expires, the authority I have granted my agent continues to exist until
the time I become able to make health care decisions for myself.
(IF APPLICABLE) This power of attorney ends on the following date:
4B

PRIOR DESIGNATIONS REVOKED

I revoke any prior medical power of attorney.
4C

ACKNOWLEDGMENT OF DISCLOSURE STATEMENT

I have been provided with a disclosure statement explaining the effect of this document. I have read and
understand that information contained in the disclosure statement.
(YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY. YOU MAY SIGN IT AND HAVE
YOUR SIGNATURE ACKNOWLEDGED BEFORE A NOTARY PUBLIC OR YOU MAY SIGN IT IN
THE PRESENCE OF TWO COMPETENT ADULT WITNESSES.)
SIGNATURE ACKNOWLEDGED BEFORE NOTARY
I sign my name to this medical power of attorney on day of (month, year) at

(City and State)

(Signature)

(Print Name)
State of Texas
County of
This instrument was acknowledged before me on (date) by
(name of person acknowledging).

NOTARY PUBLIC, State of Texas

Notary’s printed name:

My commission expires:

ADHERE
PATIENT LABEL
WITHIN THIS
MEDICAL POWER
AREA
8502113869

OF ATTORNEY
Page 4 of 5
292 (08/2014)

29
 OR
5A

SIGNATURE IN PRESENCE OF TWO COMPETENT ADULT WITNESSES

I sign my name to this medical power of attorney on day of (month, year) at

5B

(City and State)

(Signature)

(Print Name)

STATEMENT OF FIRST WITNESS

I am not the person appointed as agent by this document. I am not related to the principal by blood or
marriage. I would not be entitled to any portion of the principal’s estate on the principal’s death. I am not
the attending physician of the principal or an employee of the attending physician. I have no claim against
any portion of the principal’s estate on the principal’s death. Furthermore, if I am an employee of a health
care facility in which the principal is a patient, I am not involved in providing direct patient care to the
principal and am not an officer, director, partner, or business office employee of the health care facility or
of any parent organization of the health care facility.

Signature:

Print Name: Date:

Address:

SIGNATURE OF SECOND WITNESS

Signature:

Print Name: Date:

Address:

ADHERE
PATIENT LABEL
WITHIN THIS
®
MEDICAL POWER
AREA
8502113869

OF ATTORNEY
Page 5 of 5
292 (08/2014)

30
Patient Financial Responsibilities

Billing Houston Methodist Hospital

PO Box 4315
Your hospital bill includes the cost of your room, meals, 24/7 nursing care,
Houston, TX 77201
laboratory work, tests, medications, therapy and the services of hospital 832.667.5900 or
employees. You will receive a separate bill for professional services, including 877.493.3228
doctors, radiologists, pathologists and others, incurred during your stay.
Houston Methodist
The hospital is responsible for submitting bills to your insurance company and Pathology Associates
will do everything possible to expedite your claim. Your policy is a contract PO Box 4701
between you and your insurance company. You have the final responsibility for Houston, TX 77210
payment of your hospital bill. 800.874.1705
Houston Methodist Baytown Hospital Houston Radiology Associated
832.667.5900 or 877.493.3228 2190 N. Loop West, Suite 250
4401 Garth Rd. Houston, TX 77018
Baytown, TX 77521 281.206.9050
Emergigroup Physician
How to Settle Your Bill Associates
PO Box 24125
Before you leave, we ask that you pay your co-payment, deductible and/or
Fort Worth, TX 76124-1125
co-insurance. If Patient Access Services has not cleared you, please check on
800.378.4134 or
your account by asking to speak with a financial counselor. You can also stop by
817.451.4208
the cashier’s office before you leave.
MASTOS Imaging
Patient Registration PO Box 4109
Adjacent to front desk Houston, TX 77210
Payment can be made by cash, personal check, MasterCard, Visa, American 713.426.4010
Express, Discover or traveler’s checks. San Jacinto Emergency
Physicians
Affiliated Providers PO Box 8148
Ft. Worth, TX 76124
Upon admission or services rendered at any Houston Methodist facility, 800.378.4134 or
you or your legal representative must assume some or all of the following 817.451.4208
responsibilities:
US Anesthesia Partners (USAP)
• You or your legal representative can accrue billing from the hospital, the 1500 City West Blvd., Suite 300
doctors and affiliated entities Houston, TX 70042
• If you have surgery, you can accrue billing from the anesthesiologist, 855.877.2810
surgeon and an independent surgical assistant
• The affiliates listed at right are contracted with various insurance plans and
may not be covered under your individual plan. Please check with affiliates
to determine if they are contracted

31
Patient Financial Responsibilities

Insurance
As a service to our customers, Houston Methodist will forward a claim to
your commercial insurance carrier based on the information you provide at
registration. It is important for you to provide all related information, such as
policy number, group number and the correct mailing address for your insurance
company. Claims will be filed for inpatient and outpatient hospital charges
approximately three to five days after discharge.
Visit houstonmethodist.org for an updated list of our managed care plans.
If you have questions or need further information while you are still in the
hospital, please call patient access services at 832.556.6546.
If you have questions after your discharge, call the Houston Methodist
Centralized Business Office at 832.667.5900.

Medicare
Houston Methodist is an approved Medicare provider. All services billed to
Medicare follow federal guidelines and procedures. Medicare has a
Coordination of Benefits (COB) clause.
At the time of service, you will be asked to answer questions to help determine
the primary insurance carrier paying for your visit. This is referred to as a
Medicare Secondary Payer Questionnaire and is required by federal law.
Providing accurate information allows us to bill the correct insurance company.
Hospital personnel cannot call Medicare on your behalf to correct COB. The call
has to be made by the patient.
Secondary insurance may cover Medicare deductibles and coinsurance. If you
do not have a secondary insurance, you will be asked to pay or establish a
payment plan. If you are not able to pay, we will help you figure out if you qualify
for financial assistance.

Coordination of Benefits
Coordination of Benefits (COB) is a term used by insurance companies when
you have two or more insurance policies.
This usually happens when both spouses are listed on each other’s insurance
policies, when both parents carry their children on their individual policies, or
when there is eligibility under two federal programs.
Most insurance companies have COB rules that determine who pays medical
expenses. This prevents duplicate payments. COB priority must be identified
when you are admitted to comply with insurance guidelines. Your insurance
company may request a completed COB form before paying a claim. Every
attempt will be made to notify you if this happens. The hospital cannot provide
this information to your insurance company. You must work with your insurance
company for the claim to be paid.

32
Financial Assistance Policy Financial Assistance
Houston Methodist is committed to providing charity care to persons who are Program
uninsured, underinsured, ineligible for a government program, or otherwise not To learn about Houston Methodist’s
able to pay for emergency and medically needed care based on their individual financial assistance program, you
financial situation. can speak with a financial counselor
by calling 281.420.8499.
Patients whose family income is at or below 200 percent of the Federal Poverty
Level (FPL) are eligible to receive free services, and patients whose family Our financial counselors will ask you
income is above 200 percent but not more than 400 percent of the FPL are or your family member to complete
eligible to receive services at a discounted amount. This discounted amount a financial assistance application
is not to exceed the average amount Houston Methodist would get paid by for uncompensated or discounted
private insurance and Medicare, including any patient payments in the form of hospital care.
deductibles, co-payments and co-insurance. Patient access services and patient
accounting departments will be
You will not be required to make advanced payments or payment arrangements
responsible for reviewing completed
for emergency and medically necessary services before you receive care. But if financial assistance application
you are required to pay a discounted amount, and you cannot pay it in full after forms and determining eligibility.
the services are provided, Houston Methodist will attempt to collect it. We will The eligibility criteria rely on income
send monthly invoices asking for payment. If you cannot pay the discounted levels and means testing indexed
amount in a single payment, we offer interest-free extended payment options. to the federal poverty guidelines,
Any discounted amounts remaining unpaid will be turned over to a third-party updated at the beginning of each
collection agency for further collection attempts. Third-party collection activity calendar year and available from the
will not include personal liens, legal actions or credit bureau notification. federal government.
A free copy of Houston Methodist’s financial assistance policy, the Eligible applicants are classified
financial assistance application and collection policies are available at as either financially indigent or
houstonmethodist.org/billing. You can also find these documents in medically indigent. The review may
admitting and registration areas, or you can call the centralized business office be conducted using either the
to ask for them in various languages. traditional or fast-track method.

Houston Methodist’s financial assistance team can answer questions and

provide information about the financial assistance policy. We can help you with
the application process. We are open Monday through Friday, from 7 a.m. to
7 p.m., and on Saturday from 8 a.m. to noon.
Completed financial assistance applications and all supporting documents can
be faxed or mailed to the centralized business office.
Houston Methodist Centralized Business Office
Attn: Financial Assistance Unit
832.667.5900 or 877.493.3228
Fax: 832.667.6014
701 S. Fry Rd.
Katy, TX 77450

33
Giving Back

Share Your Story Support Houston Methodist through the

Has Houston Methodist touched Gifts of Gratitude Program
your life? We encourage you to When you receive care at Houston Methodist, you become part of our family.
share your experience with us. With Houston Methodist’s commitment to your health and well-being goes beyond
your permission, your story could you to caring for your loved ones — now and for generations to come.
be included in a Houston Methodist
communication or special event. We invite you to ensure a legacy of health by giving, sharing and volunteering
through the Gifts of Gratitude program. No matter how you partner with us,
your involvement will make a significant difference in our patients’ lives.
Join Our Mailing List Visit houstonmethodist.org/gifts-of-gratitude to learn more.
Learn more about Houston
Methodist news and events by
Make a Philanthropic Contribution
subscribing to our publications.
Keep informed about the latest We invite you to make a gift in honor of a Houston Methodist doctor, nurse
leading medicine advances and or other staff member who has made a difference in your care. These
achievements throughout our honorary gifts help advance Houston Methodist’s leading medicine mission
hospital system. by supporting research, education and patient care. Make your gift online at
houstonmethodist.org/giving or by mail to Houston Methodist Hospital
To participate in the Gifts of Foundation, PO Box 4384, Houston, TX 77210-4384.
Gratitude program or to learn about
additional giving opportunities, visit
Become a Volunteer
houstonmethodist.org/giving or
call 832.667.5816. Giving of your time and sharing your experiences can make a wonderful
difference in the lives of other patients. Visit houstonmethodist.org/volunteer
for opportunities and additional information.

34
LEADING MEDICINE IN YOUR COMMUNITY

PROVIDING QUALITY CARE

CLOSE TO HOME
Serving Baytown and Houston since 1948,
Houston Methodist Baytown Hospital continues
to grow by enhancing and expanding its services
in step with the rapid growth of the community.

Houston Methodist Baytown has been

recognized as one of the area’s only not-for-profit,
church-affiliated medical centers. The hospital
continues to meet the needs of our community
and region with cutting-edge medical services
and technology.

PROVIDING A FULL SPECTRUM OF CLINICAL EXPERTISE

•• Birthing Center •• General Surgery •• Skilled Nursing Facility
•• Breast Care Center •• Imaging & Diagnostic Services* •• Sleep Center*
•• Cancer Center* •• Level II Neonatal Intensive Care Unit •• Stroke Program*
•• Cardiac Rehab •• Neurology •• Thoracic Surgery
•• Cardiology •• Obstetrics & Gynecology •• Urology
•• Cardiovascular Surgery •• Orthopedics & Sports Medicine •• Vein Clinic
•• Chest Pain Center* •• Plastic & Reconstructive Surgery •• Weight Loss Surgery*
•• Diabetes Education Program* •• Pulmonary Rehabilitation Services •• Wound Care Program
•• Emergency Medicine •• Rehabilitation Services*
*Accredited
•• Gastroenterology •• Robotic Surgery

4401 Garth Rd.  |  Baytown, TX 77521

281.420 8600
houstonmethodist.org/baytown

35
LEADING MEDICINE STARTS WITH
PRIMARY AND SPECIALTY CARE
At Houston Methodist Primary and Specialty Care Groups, your family is at the center of everything we do. From
standard checkups to advanced treatment of complex illnesses and surgeries, our board-certified doctors provide the
compassionate care you deserve. Our skilled team of physicians and physician assistants will work with you to manage
chronic illnesses such as diabetes, hypertension, cancer, joint pain, neurological disorders, digestive disorders, asthma
and more. And, with multiple locations throughout the Baytown area, we are dedicated to the well-being of our patients.

Make an appointment today. Schedule online houstonmethodist.org/find-a-doctor or call 281.428.2273.

4401 Garth Rd.  |  Baytown, TX 77521

281.428.2273 | houstonmethodist.org/find-a-doctor
SCHEDULE YOUR OUTPATIENT IMAGING
APPOINTMENT ONLINE!
• Bone Density • MRI
• CT Scan • Screening Mammogram
• Fluoroscopy • Ultrasound

Make an appointment today. houstonmethodist.org/baytown

Notes

38
39
Questions for My Doctors

My Doctors Are:

Dr. Specialty:

Dr. Specialty:

Dr. Specialty:

Dr. Specialty:

Dr. Specialty:

Examples of questions you may want to ask: When will I be discharged?; Why can’t I take the medications I take at home?

40
052019