Salem Laser and Surgery Center
1330 Commercial Street SE
Salem, Oregon 97302
INSTRUCTIONS FOR SURGERY
The Night Before:
A. Make sure to shower; wash hair and face.
B. Eat and drink as usual. Take all medication unless otherwise instructed by your doctor.
The Day of Surgery:
A. Nothing to eat or drink after midnight prior to procedure. Take all medications unless
otherwise instructed. If you are an insulin-taking diabetic, take your insulin, test your blood
sugar and write the results on a piece of paper to give to the nurse at the surgery center.
B. Wear loose clothes and SHORT SLEEVES. Slacks are suggested
for ladies. Tennis shoes or similar types of rubber-soled shoes are requested.
C. Do not wear make-up, lotions, or cologne. Remove all jewelry and leave it at home. Medical
alert tags and wedding rings are OK.
D. In order to allow sufficient time for the admission procedures
prior to your surgery, PLEASE ARRIVE AT THE SALEM LASER AND SURGERY CENTER
Becuase waiting room space is very limited, we ask that
only one person accompany you and that you arrive no earlier than the time indicated above. Thanks!
You will not be allowed to drive yourself after you have surgery. Be sure you have someone
to drive you home. If you plan to take a taxi home, you must
have responsible adult (other than the driver) accompany you.
Provide a responsible adult to transport him/her home from the facility and remain with
him/her for twenty-four (24) hours, if required by his/her
Please bring: current medical
insurance cards, and a photo ID (if this does not show your
current address, you must also bring a utility bill or other
correspondence which shows your current address).
Note: the photo ID is
necessary becuase we are now required to comply with federal indentity-theft prevention
laws. Also bring your glass case if you wear glasses.
Salem Laser and Surgery Center
Physician's Order Sheet
Admit to Salem Laser and Surgery Center
Routine admitting vital signs
Nurse Anethetist to evaluate patient if MAC
Saline lock started
H & P on chart
Xanax PO per standing order on
admission if local
Proparacaine 0.5% 1-3 gtts prn
1 drop surgery eye every 5 minutes x3 doses.
Check serum glucose level if on medication for diabetes
Routine per preference card
PHYSICIAN ORDER SHEET - GENERAL OPHTH
Date of Birth:
EXAM AT PRE-OP
REFRACT FIRST EYE:
Change to orders
SALEM LASER AND SURGERY CENTER
1330 Commercial St. SE
Salem, OR 97302
This information tool is to be considered an approximation of facility fees for the procedure identified above and does not cover fees for procedures not scheduled on this date.
Billed seperately by your physician.
Billed seperately by your anesthesia practitioner;
questions may be directed to: Anesthesia Associates Northwest, LLC
SURGERY CENTER FEES
The facility billing office will contact you prior to surgery to let you know what your estimated patient portion will be. Billing questions may be directed to the CBO at 1-855-887-4997.
Co-payments are due at the time of your procedure. Co-payments accepted by check, credit card, or exact amount of cash only.
INSURANCE BILLING & STATEMENTS
We participate with many plans and will bill your insurance carrier accordingly. We also accept Medicare assignment.
Depending on your insurance plan and their payment guidelines, you will receive a statment after your surgery. Check your statement for the "Amount Due" box. That is the balance due by you. Call 1-855-887-4997, if you have questions about your surgery billing.
Please do not hesitate to call us with any questions or comments you may have. We will assist you as best we can.