Consents & Waivers | Linktree

Insurance and Authorization

I acknowledge that I am responsible for providing up to date insurance information to EOA to ensure authorization is obtained for my upcoming surgery.

Englewood Hospital and Anesthesia may also bill your insurance company for their services.

Any questions regarding billing from the hospital or anesthesia please contact Englewood Hospital Billing Department 201-894-3031.


Billing | Authorization 

will be signed at Preop Visit (2 wks before surgery date)

DME | PT | Discharge Waiver - FULL

Pre Surgery Waiver - FULL

Office Release Forms

will be signed at Preop Visit 2 weeks before surgery after watching the video

Hip Replacement Patient Release

Knee Replacement Patient Release 

Regardless of how you acquire the DME, it is imperative that you have it prior to your surgery. At your pre-op visit, you will be asked to sign a waiver that you will have acquired the DME before your procedure

DME 

Pre-Surgery Waiver

I acknowledge that this surgery will not be performed on me if I am currently a smoker.

I acknowledge that this surgery will not be performed on me unless I have a HgB A1C level of 6.5 or lower.


I acknowledge that I am responsible to notify the office of any changes in medication or addition of usage of antibiotics prior to the date of surgery.


Smoking | H1A1c | Rx

Patient Discharge Waiver

I acknowledge that staying in a rehabilitation facility after surgery will increase my risk of infection from exposure to others and is highly discouraged


Same Day

I acknowledge my surgery is same day surgery at the hospital. I am responsible for being picked up before 2 pm on the day of my surgery. 

23-hour stay

I acknowledge my surgery is authorized for a 23-hour stay at the hospital. I am responsible to be picked up prior to 12 pm the day after the surgery. If I am not picked up on time, I may be responsible for further bills from Englewood Hospital.


Hospital Discharge

Patient Insurance Waiver

Insurance and Authorization

I acknowledge that I am responsible for providing up to date insurance information to Englewood Orthopedic Associates to ensure authorization is obtained for my upcoming surgery. It is my duty to ensure that I have continued insurance for the upcoming year after surgery.

Englewood Orthopedic Associates will obtain authorization for the upcoming surgery.

I acknowledge that my surgery will be authorized as same-day surgery or for a 23-hour stay, and I must arrange a ride for discharge prior to 23 hours.

Billing

Englewood Orthopedic Associates will obtain authorization for the upcoming surgery. Englewood Orthopedic Associates will bill your insurance company for your surgery.

Englewood Hospital and Anesthesia will also bill your insurance company for their services. 

Any questions regarding billing from the hospital or anesthesia please contact Englewood Hospital Billing Department 201-894-3031.





Health Insurance

Hospital Surgical Consent (Sample)

General Consents | Waivers 

No PT Coverage at Home Options


After surgery, you will need to have physical therapy at home or as an outpatient. If your insurance does not provide that option, one of the following options may be available to you:

Have a private physical therapist come to your house for approximately 7 to 10 days (about 1 and a half weeks).

Enroll in our remote patient monitoring program.

Enroll in a different insurance plan.

Go to an outpatient physical therapy facility immediately after surgery starting post-op day 3.

These options will be discussed at length at your pre-surgical consultation


Physical Therapy

Consents & Waivers

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