SXM   SYMPTOM MEDICINE

Pain Medicine, Palliative Care, Anesthesia


2030 NORTH PACIFIC AVE., SUITE F, SANTA CRUZ, CA 95060

tel: 888.796.6331 fax 888.796.633

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FOR PATIENTS

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ADMINISTRATION

         Clinic Policies & Terms

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RESOURCES

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Patients will be required to read Clinic Policies and give an electronic signature to obtain any forms or reserve an appointment. This  website is not HIPPA secure; and thus, cannot accept or exchange ANY sensitive information or private data.

PATIENT INFORMATION

Self Determination

To ensure that every patients’ wishes are met and carrier out regarding self determination, we ask all patients to complete at least one of the of the following forms-- POLST, DNR/DNI, DPOA, advance directives. Click on the form that is most appropriate for you, complete it and forward it to the clinic.  It will be placed in your medical records.  Please note, these forms can be changed or revoked at any time.


Patient Rights, Responsibilities, Privacy and Health Information

All patients have a right to privacy and know that their medical information aka protected health information (PHI) is safe.  At SxM all medical records and PIH are kept in accordance with governmental standards and regulations.  Read more about your and at any of the sites below.  Related information is also available in writing at the clinic.


Patient Forms and Information

  1.     SXM Notice of Health Information Patient Privacy Practices.pdf

  2.     SXM Notice of Health Information Patient Privacy Practices.pdf

  3.     Health Insurance Portability and Accountability www.hipaa.org    

  4.     DNR/DNI PRE-HOSPITAL www.emsa.ca.gov/pubs/pdf/DNRForm.pdf

  5.     California Medical Association Advance Directives www.cmanet.org

  6.     DPOA  http://www.cmanet.org/publicdoc.cfm/7  www.cmanet.org

  7.     US Department of Health and Human Services www.dhhs.gov

  8.     PLOST www.caPOLST.org

  9.     Medicare www.medicare.gov

  10.     California Department of Health www.cdph.ca.gov 

  11.     Advance Directive Living Wills www.cmanet.org, http://ag.ca.gov,

      www.nlm.nih.gov/medlineplus/advancedirectives.html

  1.     Patient Privacy http://www.hhs.gov/ocr/privacy/