Bring this packet to all appointments.

Registration Guide

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We're ready to welcome you

Now that you’ve made the decision to reclaim your life, Laser Spine Institute is ready to give you the quality medical care you deserve.

Since 2005, we’ve had the privilege of providing our special blend of compassionate care to more than 75,000 patients. And with each passing year, we’ve strengthened our commitment to those who seek our care by refining the way we deliver it.

From our thoughtfully appointed state-of-the-art facilities to our highly skilled team of surgeons, Laser Spine Institute is dedicated to making the time you spend with us engaging and efficient. It’s why we provide those we serve with their very own Care Management Team, infusing respect and dignity as we guide you on your personalized path to relief.

Carrying the burden of chronic neck or back pain is something no one should have to go through alone. That’s why we’re so grateful you’ve trusted us to help you regain your life.

Your personalized path to relief

At Laser Spine Institute, you’re never alone on your journey to relief. Here’s how our dedicated team of professionals will help you take back your life from chronic neck or back pain.

Speaking with your Spine Care Consultant

Our caring team of consultants will help you understand the treatment options available to you so you find the relief you deserve.

Discuss your path

Discussion with your dedicated Care Team

This team will conduct your medical assessment before you arrive, make recommendations regarding which tests may be necessary, collect your medical records, provide details on travel and schedule your surgical procedure.

Initial medical screening

Meet with your surgeon

Meeting your highly skilled physicians and surgeons

You’ll undergo a full medical evaluation in our state-of-the-art facility to ensure it’s safe for you to have surgery in our outpatient setting. Once cleared, you’ll meet with a dedicated, board-certified+ surgeon, who is trained in our minimally invasive spine procedures, to address your specific spine condition and customize your anesthesia and surgical plan. Our goal is simple — to give you relief from your painful condition.

Staying in touch

To ensure you are healing as planned, your Care Team will check in with you throughout your recovery to monitor your path to relief.

SURGERY

+For more information, visit LaserSpineInstitute.com/surgeons. 2

Before you arrive

As you prepare for your visit to Laser Spine Institute, know you’ll be greeted with the warmest of welcomes, comforting amenities and a state-of-the-art facility that’s second to none.

Our Care TeamTo ensure your experience is as productive as possible, Laser Spine Institute will provide you with a dedicated Care Team to guide you on your personalized path to relief. Their goal is to:

• Conduct your medical assessment

• Schedule your surgical procedure

• Assist with travel information

• Make recommendations regarding which tests may be necessary

• Collect your medical records

What to bring to our facility:

Your most recent MRI or images

Copies of your medical records

Insurance card and driver’s license or

government issued ID

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Our seven state-of-the-art facilities

Tampa

Scottsdale

Philadelphia

Oklahoma City

Cleveland

St. Louis

Cincinnati

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Comforting amenitiesRelax, refresh and refuel in our pleasant lounges where convenient food and beverage options are available to all our guests during their stay.

A place to connectStay in touch with loved ones by connecting to our Wi-Fi during your time with us.

Tampa facility featured on this page

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Upon your arrival Preoperative appointments

EvaluationUpon arrival at Laser Spine Institute, our team of medical professionals will perform a full physical examination to determine if you can safely undergo surgery in our outpatient facility. During this exam, we’ll review your medical history, go over any medications you are taking and discuss prior surgeries. Your exam may include blood work, electrocardiogram (EKG) and additional testing.

Testing and imagingBefore your minimally invasive surgical procedure, we may require you to have another MRI or more X-rays at our facility or with a local provider. Our medical team will then review your images. In some cases, you may be asked to undergo an additional diagnostic test that will locate the area your pain is coming from so you can enjoy maximum relief.

MRI discussionYou’ll meet with one of our physicians to go over your medical history, document your symptoms and confirm your specific condition. If you are a confirmed candidate for surgery, a surgical order will be issued.

CoordinationOur Care Team will now review your upcoming appointments. This is the time to ask any questions you may have about our payment agreement, billing process and the filing of insurance claims. Plan to make a full payment to Laser Spine Institute based on the agreed amount at the end of this meeting.

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SurgeryEstimated time: one to four hours, depending on your procedure

Our surgical team specializes in making your minimally invasive procedure as seamless as possible. As they take you into the operating room, they’ll comfortably position you on the operating table. Your Anesthesia Team will consult with your surgeon to customize your anesthetic and monitor your vital signs throughout your surgery.

Surgery day

Preparing for surgeryEstimated time: 90 minutes

On the morning of your surgery, you and your Care Partner will arrive at Laser Spine Institute, receive a warm welcome and be shown where to sign in. You and your Care Partner will then be guided to our preoperative area to meet with your anesthesiologist, surgeon and registered nurse. This team will go over your surgical order and ask you to sign consent forms. We will then escort your Care Partner to our lounge to relax as you get set to take back your life from chronic pain. Our medical staff will administer an IV and prepare you for surgery.

Rest and recoveryEstimated time: one to two hours

After surgery, you’ll be taken to our recovery area where our nurses will monitor your vital signs and provide medications to alleviate any discomfort. Once you feel alert and are able to use the restroom, your Care Partner will be invited to join you as you change into your clothes and begin the discharge process. The two of you will then receive postoperative instructions, including a discussion with your surgeon about your surgical procedure and your future appointments at Laser Spine Institute.

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Recovery

After-surgery assessmentHow are you healing? That’s what we’ll find out during your appointment 24 to 48 hours after surgery. Here’s what you can expect us to do during this visit:

• Check your surgical dressing

• Provide more specific recovery instructions per your surgical order

• Answer your questions

After-surgery remindersRemember, the road to relief is a partnership. We help guide you, and you take the steps to get there. You'll receive detailed postoperative instructions while you're at our facility for your procedure. To make sure you stay the course, we’ve created this list of simple reminders:

• Slow down and take it easy.

• Take your medications as directed.

• Stay hydrated by drinking plenty of water.

• Limit activity (bending, lifting, twisting) that applies added weight to the spine.

• Wear your brace for the time recommended by your surgeon for your surgery type.

• Bend from your hips if you’ve had a lumbar procedure. DO NOT bend from your spine.

• DO NOT reach overhead if you’ve had a cervical procedure. Ask for assistance.

• Schedule an appointment with your local Laser Spine Institute clinic or your primary care provider to have your incision checked two weeks after your surgery.

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Postoperative contact information

Have medical concerns relating to your surgical procedure? We’re here 24 hours a day, seven days a week to provide answers. We’ll call you after surgery to check on your progress and see how we can help.

SPINE LINE Tampa – 1-877-712-6573

Scottsdale – 1-888-712-6543

Philadelphia – 1-877-712-6558

Oklahoma City – 1-888-712-6563

Cleveland – 1-877-712-6572

St. Louis – 1-877-712-6571

Cincinnati – 1-888-712-6564

“I remember walking through the front door and I was greeted with, 'Hi! You must be Dwylett. We've been waiting for you’.”

— Dwylett M. Actual Patient

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Imaging and scans

Q: What’s your policy for MRI or CT scans?A: Patients may have their diagnostic imaging, including MRI films and CT scans, done prior to their visit. If choosing this option, the following items are required before seeking evaluation and/or treatment at Laser Spine Institute:**

• CD with DICOM images of your MRI and/or hard copies (typically 14 inches by 17 inches) of your MRI/CT films.

• A reference/slice chart with your MRI films. Ask your facility to include this.

• Films/CD with a date of six months or less from the date of your scheduled surgery.

• MRI or CT scans that are hand delivered by you or your Care Partner on the day of your first appointment at Laser Spine Institute.

• A copy of the radiologist report. This can be obtained from the radiologist/physician who ordered the film. Even if this report was previously sent to Laser Spine Institute, another copy must be brought in with the film.

Patients not complying with the above requirements may be subject to postponement of the appointments and/or surgery. Any costs incurred by noncompliance with this policy will be the responsibility of the patient.

Preparing for your visit

Q: Why do I need to have a Care Partner?A: Laser Spine Institute requires all patients to be accompanied by someone who is at least 18 years of age, competent to attend all preoperative and surgical appointments and who is able to assist you for at least the first 24 to 48 hours after your surgery. We do this to ensure you receive the best care possible.

Q: Why am I required to stay so close to the surgery center?A: We require all patients stay within a 15-mile radius of our state-of-the-art facilities to meet their medical needs in a timely manner. We partner with area hotels to make this as simple as possible.

Q: How much time should I request off from work?A: We recommend you take at least two weeks off work after your surgery depending on your job description and individual recovery. Some patients may need six to 12 weeks.

Insurance and billing

Q: How does your billing process work?A: Laser Spine Institute will bill your insurance for our usual and customary fees. We cannot, however, determine the amount that your insurance carrier pays as each carrier differs.

Commonly asked questions

**This policy does not apply to patients scheduled for an MRI or CT scan upon arrival.

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Commonly asked questions

Q: Will my surgery be covered by insurance?A: Laser Spine Institute works with a variety of insurance companies to provide a cost-effective way to help our patients find relief. We verify your benefits prior to your visit, including any coinsurance, deductibles, out-of-pocket maximums and policy limitations or precertifications as provided by your insurance policy. Some of our services will require precertification. Because each individual insurance policy has varying levels of coverage, we may not know the exact amount of your financial responsibility until after your claim has been filed and we receive the explanation of benefits from your insurance carrier.

Q: I was quoted a fee for surgery. What does it cover?A: The fee we collect from you depends on your specific insurance policy. It is applied toward the cost of surgery. You may also receive a statement or invoice for services if you have not met your deductible, coinsurance or copay.

Q: Who will file my insurance?A: Laser Spine Institute will file your claims on your behalf with most insurance carriers. If we are not in network with your insurance provider, you may receive correspondence from them directly. If this happens, call 877-710-6610 immediately so we can work with your insurance carrier to expedite the processing of your claims.

Q: I received a payment from my insurance carrier. What should I do?A: If we are not in contract with your insurance carrier, the payment intended for us might be sent directly to you instead. If this happens, please forward the payment you received and any attached correspondence to Laser Spine Institute per your agreement. Doing so will ensure accurate accounting and handling of your claims.

Payment options

Q: What types of payments does Laser Spine Institute accept?A: We accept the following forms of payment:

• Credit cards

• Bank cards

• Money orders

(Payable to Laser Spine Institute)

• Cashier’s check

(Payable to Laser Spine Institute)

• Wire transfers (Please contact your Patient Concierge for instructions)

Laser Spine Institute CANNOT accept:

• Personal checks (Personal checks from credit cards or home equity lines of credit are not acceptable forms of payment.)

• Business checks

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Commonly asked questions

Q: Can I pay in advance for services I’ll receive?A: Any patient willing to pay services upfront should sign a Charge Authorization Form. You may obtain this by contacting your Patient Concierge.

Q: How will my patient deposit be applied?A: All patients will be responsible for a non-refundable deposit when scheduling surgical or diagnostic appointments at Laser Spine Institute. This deposit is not an additional fee and will be credited toward the cost of your surgery. If your visit is canceled for medical or surgical reasons prior to your arrival, your deposit will be refunded. In the event your procedure is canceled after diagnostic or evaluation services have been rendered, your deposit will be retained and applied to your patient responsibility. If your patient responsibility is more than your deposit, you will be responsible for this balance.If your plan is in network and your patient responsibility is less than your deposit, you will be refunded by a cashier’s check after all claims have processed through your insurance carrier. If your appointments are canceled without rescheduling and prior to any diagnostic or evaluation services being rendered, your deposit will be retained but applied to any future appointments should you choose to reschedule.

Financing options

Q: Is there a way to make my surgery more affordable?A: To help our patients manage costs, Laser Spine Institute is pleased to partner with CareCredit to offer low-interest financing options and affordable terms. We also offer supplemental options to assist our patients with financing the surgical procedures they need. For more information, please contact your Spine Care Consultant.

Requesting medical information

Q: How do I request my medical records?A: To obtain a copy of your medical records, call 1-866-362-7574, ext. 140, and ask for a Medical Release Form or Physician Release Form (if one of your regular physicians referred you to Laser Spine Institute). This will allow us to make a courtesy call to your physician with your permission and then send him or her information about your surgery.

Q: How can I get a return-to-work form?A: You must request it from your Care Team as they will not be sent to you automatically. Once we receive your request, we will complete it within three business days. If you need a return-to-work note sooner than that, please request it during your postoperative visit.

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Commonly asked questions

Q: Will Laser Spine Institute help me fill out my FMLA paperwork?A: Yes. We will gladly complete your medical leave certification for FMLA and/or short-term disability. A $20 fee will be charged for the completion of FMLA paperwork. Please bring these forms with you to your first evaluation day. We’ll complete them three to five days after your postoperative appointment, following your surgery. FMLA/disability medical leave will be certified for a maximum of 12 weeks postoperatively. Laser Spine Institute physicians do not certify for long-term disability/Social Security. For more details on FMLA and disability please see page 20.

Rest and recovery

Q: Will I feel any residual pain after surgery?A: You may. That’s because it’s not uncommon to feel residual pain, such as swelling and inflammation, after surgery. This discomfort is the result of the nerves healing and should become progressively less over time.*

Q: Should I avoid lifting after surgery?A: We recommend lifting no more than 10 to 15 pounds for at least four weeks and that you return to normal activities gradually to allow maximum healing.*

Q: When can I resume my normal routine?A: You can gradually return to, then increase, your regular activity level two weeks after surgery based on how you feel, continuing this gradual progress for four to six weeks after your procedure. If you’ve had a fusion procedure, it may be six weeks or more. Please avoid any prolonged postures and vary your activities and positions.*

Q: When can I swim or enjoy the water again?A: It’s best to wait until your incision is completely healed before getting into the pool, bathtub or other body of water.* You may begin a pool exercise program two weeks after surgery and increase to an active swimming program after four weeks.

Q: When can I start driving again?A: Most patients can drive 24 to 48 hours after surgery, however, all patients must not drive while taking pain medications or muscle relaxers. Patients undergoing a minimally invasive stabilization procedure (or fusion) may not drive for up to two weeks after surgery.

Q: Is it safe for me to travel after surgery?A: Yes, but to ensure your comfort, we recommend these tips: If traveling by car, stop every hour to stretch and walk. If returning home by plane, you should stand or walk around the cabin after the fasten seat belt light has been turned off.

*Each patient is different. Results may vary.14

“The people were great. And the outcome was even better. My back's as good as new.”*

— Jerry J. Actual Patient

*Each patient is different. Results may vary.14 15

Care Partner information

• Driving• Walking• Getting in and out of the car• Eating, drinking

• Getting in and out of bed• Getting to and from the restroom• Taking medications• Changing clothing and/or bandages

Care Partner requirements

The person who you choose to come with you on your day of surgery plays a vital role in your healing process. That’s why your Care Partner must be:

• At least 18 years old• Able to drive• Prepared to communicate in English with our medical team• Able to assist you on surgery day• Willing to care for you in the first 24 to 48 hours after surgery

Because you may also need assistance with daily activities, Care Partners should be prepared to help you with:

What to expect on surgery day

• The entire surgery process should take between six and eight hours.

• Your Care Partner will accompany you through the preoperative process but not surgery.

• During the preoperative appointment, you will review consent forms and instructions for after surgery. This could take 90 minutes to two hours.

• While you are in surgery, your Care Partner can relax in our patient lounge.

• If your Care Partner leaves the surgery center at any time, he or she must let a Hospitality Associate know and provide a contact number.

• We’ll provide your Care Partner with updates on your progress throughout the day.

• Depending on the procedure, your surgery should take one to four hours.

• After surgery, you should be in the recovery room for one to two hours.

• Once you are alert and able to walk, your Care Partner will join you in recovery and receive instructions on how to care for you in the first 24 to 48 hours after surgery. This discussion should last one to two hours.

• For their safety, children under the age of 13 must be accompanied by an adult at all times. They are welcome in our lounges and main areas but are not allowed in clinical and surgical areas.

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To-do list:

Complete and return your registration forms, including photocopies of your insurance card and photo ID.

Gather your conservative treatment records from the past year. These records include progress notes for treatment of your neck and back pain from a primary care doctor, physical therapist, pain management doctor, chiropractor or other treating doctor.

Refer to the medication lists and instructions provided in this packet and stop all prohibited medications prior to arrival.

Expect a member of our team to contact you one to three days prior to your visit to notify you of your evaluation appointment time.

If necessary, request FMLA or short-term disability forms from your employer and bring them to the facility to be completed.

Checklist for your visit

Make arrangements for your stay:

Identify a Care Partner over 18 years of age, in good physical and mental health, who can accompany you on your visit. He or she will need to meet the requirements on the Care Partner information sheet.

Traveling to see us? We require that you stay within 15 miles of the facility on your surgery day. Ask for your Facility Guide to find our hotel partners nearby and their Laser Spine Institute booking rates.

Bring with you to the facility:

Original copy of your Registration Guide and your completed forms.

Photo ID such as driver’s license, passport or military ID.

Insurance card.

Any postoperative reports from previous spine surgeries and all conservative treatment records you’ve gathered for treatment of your neck and back pain within the last year.

MRI report and/or CT scan and images that are less than six months old.

Any testing records less than 30 days old (bloodwork, EKG).

Any FMLA or short-term disability paperwork you need completed.

Several loose-fitting outfits and a two-week supply of all medications, including pain medications. Laser Spine Institute may not write prescriptions that have been ordered by your prescribing doctor(s).

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If you are taking an over-the-counter medication not listed here and you are unsure of its actions, please consult your pharmacist or physician, or call Laser Spine Institute at 1-866-362-7574, from Monday through Friday, 8 a.m. to 7 p.m. Eastern Standard Time.

The following medications MUST BE STOPPED 5 DAYS prior to your surgery.

• Advil• Aggrenox• Aleve• Alka-Seltzer• Amigesic• Anacin products• Anaflex• Anaprox• Ansaid• Apo-ASEN• Arco Pain Tablet• Argeric• Arthropan• Arthrotec• Ascriptin• Aspergum• Aspirin (all products

containing aspirin)• Aspir-Low• Aspirtab• Bayer• Bayer time release• Buffex• Bufferin• Bufferin Arthritis• Buffinol• Butalbital Compound• Butazolidin• Cama Arthritis• Carisoprodol

Compound• Cataflam• Clinoril

• Combunox• Cope • Daypro• Diclofenac• Diflunisal• Disalcid• Doan’s• Dolobid• Easprin• Ecotrin 81• Empirin• Endodan• Entrophen• Equagesic• Es Anacin• Etodolac• Excedrin Migraine• Feldene• Fenoprofen• Fiorinal• Flector Patch• Floctafenine• Flurbiprofen• Glucosamine• Goody’s• Halfprin• Helidac• Ibuprofen• Indocin• Indomethacin• Instantine• Kaopectate• Kava

• Ketoprofen • Ketorolac • Lodine • Lovaza• Magan• Magnaprin• Marthritic• Meclofenamate • Meclomen • Medipren • Mefenamic acid • Midol • Mobic • Mobiflex • Momentum• Mono-Gesic• Motrin • Nabumetone • Nalfon• Naprelan • Naprosyn• Naproxen• Norgesic Forte• Nuprin • Ocuvite• Oruvail• Orudis • Oxaprozin• Pamperin-IB • Pepto-Bismol• Percodan• Phenylbutazone • Piroxicam

• Piroxicam• PMS-ASA• Ponstel • Prevacid NapraPAC• Relafen • Robaxisal• Roxiprin• Salflex• Salsalate• Sine-Aid IB• Sodium salicylate• Soma Compound• St. Joseph Aspirin• Sulindac• Suprofen• Suprol• Surgam• Synalgos-DC• Tandearil• Talwin Compound• Tenoxicam• Tiaprofenic acid• Tolectin• Tolmetin• Toradol• Tricosal• Trilisate• Vanquish• Vicoprofen• Voltaren• Zorprin

We recommend you stop taking the following supplements at least five days prior to your scheduled surgery: St. John’s wort, garlic, ginger, ginkgo biloba, ephedra (ma huang) and vitamin E.

Medication hold list

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Continue these prescribed blood-thinning medications unless Laser Spine Institute has been provided with written approval/permission from your doctor that you can stop the medication. If you are on any of these prescribed medications and have not spoken with your Care Team, please contact your Spine Care Consultant.

• Aggrenox (aspirin/dipyridamole)

• Arixtra (fondaparinux)

• Aspirin (when prescribed by your physician)

• Brilinta (ticagrelor)

• Coumadin (warfarin)

• Eliquis (apixaban)

• Fragmin (dalteparin)

• Innohep (tinzaparin)

• Lovenox (enoxaparin)

• Plavix (clopidogrel)

• Pletal (cilostazol)

• Pradaxa (dabigatran etexilate)

• Xarelto (rivaroxaban)

WARNING:THESE MEDICATIONS CAN ONLY BE STOPPED WITH APPROVAL OF YOUR PRESCRIBING PHYSICIAN.

Medication alert list

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If you are diabetic: Consult with the doctor who treats your diabetes about your insulin dosage or other diabetic medication. You may experience an elevation in your blood sugar before, during and/or after surgery due to the stress of surgery and the steroid medications used during the surgery. Please have a plan to address this with your local doctor who treats your diabetes so you are ready to handle elevations in your blood sugar while you are at Laser Spine Institute. This could include additional checking of your blood sugar and additional insulin as needed. Our providers will check and treat your blood sugar before, during and after surgery. For your safety, we ask that you follow your regular doctor’s instructions after you are released from Laser Spine Institute. Please closely monitor your dietary intake to prevent blood sugar fluctuations.

Laser Spine Institute will inform you of the exact date of your surgery. Medication instructions will be given after we are able to obtain written permission from your prescribing physician.

Family and Medical Leave Act (FMLA) and short-term disability

Laser Spine Institute will gladly complete medical leave certification for FMLA and/or short-term disability. If you need medical documentation from us, please observe the following guidelines:

• A $20 fee will be charged for completion of FMLA paperwork.

• It is necessary for patients to provide Laser Spine Institute with the specific forms to complete. Please complete any employee/patient sections only; do not write in provider sections. An authorization form to disclose/release medical information will be necessary and may be included in your FMLA/Disability Claim Packet. If not, they are available when you arrive at Laser Spine Institute. It is important that you provide Laser Spine Institute with the name, phone number and fax number of the human resources/disability representative to whom we should send the completed forms.

• Please bring forms on the first evaluation day at Laser Spine Institute. They will be completed approximately three to five business days after the postoperative appointment. If you do not have your forms on arrival, they will be completed approximately three to five business days after they are sent to us. If you are scheduled for more than one procedure, the forms will be completed following the postoperative appointment for the last procedure.

• We generally recommend patients take at least two weeks off work postoperatively for proper recovery, though some patients may need six to 12 weeks, depending on job description and individual recovery.

• FMLA/disability medical leave will be certified for a maximum of 12 weeks postoperatively.

• Once forms are completed, we will fax or mail them to the third party designated on the release of information (ROI) form. A copy will be mailed to you. Without a completed ROI form all completed FMLA/disability forms will be returned to you, and you will then be responsible to ensure that your employer/insurance company receives your forms in order for you to receive benefits/coverage.

• Releases to return to work are handled by your Care Team when you are approaching readiness to return to work. You will need to request them, as they are not automatically sent. They will be completed within three business days after we receive a request.

• If you need written verification from Laser Spine Institute prior to treatment to show that you are tentatively scheduled for surgery, please contact your Spine Care Consultant or Scheduling Concierge.

• If you need a return-to-work note for your employer by the time you are leaving Laser Spine Institute, please request from the Clinic Practitioner during your postoperative visit.

• Laser Spine Institute physicians do not certify for long-term disability/Social Security.

Statement on advance directives/living wills

In an ambulatory care setting, where we expect to provide care to patients who are not acutely ill, admission to Laser Spine Institute surgery center indicates our belief that our patients will tolerate the procedure in the ambulatory setting without difficulty. If a patient should suffer cardiac or respiratory arrest or any life-threatening condition, the patient will be transferred to a more acute level of care — most likely the closest hospital emergency room.

If a patient who is to receive a procedure at Laser Spine Institute presents the staff with an advance directive/living will, the patient must be advised that Laser Spine Institute will not honor any advance directive/living will that does not allow resuscitation. It is the policy of Laser Spine Institute surgery center to transfer any patient requiring resuscitation to the hospital. The hospital can determine when to implement the advance directive/living will once the patient or others notify the hospital of the advance directive/living will.

Patients who disagree with this policy must address the issue with the attending physician prior to signing the form acknowledging an understanding of the policy regarding advance directives/living wills.

By regulation, Laser Spine Institute notifies all patients that it will not honor a previously signed advance directive/living will.

Disclosure of ownership

Notice to patientsYour surgeon or anesthesia provider may be an owner in Laser Spine Institute, LLC. This information is available for your review at each of our surgery centers.

Patient resources

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5034-041218-NM© 2018 Laser Spine Institute, LLC