The following forms are for patients of Overlake Surgery Center. For your convenience, some forms may be completed online, while others are available to download and print. Just be sure to bring any printed forms with you to your appointment.
Durable Power of Attorney and Healthcare Directives
Advance Directives/Living Will are legally recognized documents indicating a patient’s wishes for the level and type of medical care he/she wants in the event he/she cannot make that decision for himself/herself.
At Overlake Surgery Center, all patients receiving anesthesia services or conscious sedation will be asked if there are Advance Directives the center should be aware of. As an ambulatory surgery center that performs elective cases, Overlake Surgery Center does not honor Advance Directives, and if there is a situation that threatens life, all efforts will be made to resuscitate you for transfer to an acute care facility. The acute care facility will follow the Advance Directives. If you are transferred to another facility, information on the presence and location of an Advance Directive, if applicable, will be transferred with you.
Overlake Surgery Center has the responsibility to inquire at the time of the pre-op call and the admission process if there is an advance directive and if there is, a copy of it will be placed on the chart.
Overlake Surgery Center will provide informational materials concerning Advance Directives to all interested patients and their families/health care representatives and to assist patients interested in discussing and executing an Advance Directive. Please click on the link which will lead you to an Advance Directive form.
›› Download Form (41.38kb PDF, revised 10/19/2011)
Medical Records Release Form
According to the Federal HIPAA Privacy Rule, your medical records are considered private and confidential. No one can see them without your express permission. In order to release your medical records, we require that you complete this form, sign and either fax or mail it to our office.
›› Download Form (52.09kb PDF, revised 10/19/2011)