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Below are several forms that may be helpful to you as a patient at Olean General Hospital. The forms are provided in PDF format, and you will need the free Adobe Acrobat Reader to view them. If you have any questions about these forms, we invite you to call our Patient Representative at (716) 375-6162.
Personal Medical Decisions
Advance Directive - An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, for example). If you are admitted to Olean General Hospital, our staff will talk to you about advance directives.The directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives tell your doctor that you don't want certain kinds of treatment.
Health Care Proxy Information (Downloadable) The Health Care Proxy form gives the person you choose as your agent the authority to make all health care decisions for you, including the decision to remove or provide life-sustaining treatment, unless you say otherwise in this form. "Health care" means any treatment, service or procedure to diagnose or treat your physical or mental condition.
MOLST: Medical Orders for Life Sustaining Treatment (Downloadable) - Honoring patient preferences is a critical element in providing quality end-of-life care. The New York State Department of Health has approved a physician order form, the Medical Orders for Life Sustaining Treatment (MOLST) that allows you to indicate your wishes for pain management, nurtrition, and hydration. It can be used statewide by health care providers and facilities as the legal equivalent of an inpatient Do Not Resuscitate (DNR) form.
Organ and Tissue Donations
More than 10,000 New Yorkers are on waiting lists as the need for organ donations far exceeds the supply. One person who donates organs (hearts, lungs, liver, kidneys, pancreas and intestines) can save up to eight lives, while a tissue donor (corneas, bone, skin, heart valves, tendons, veins, etc.) can improve 12 or more lives by restoring eyesight, helping fight infections in burn patients and preventing the loss of mobility and disability.
By enrolling in the Donate Life Registry, you are giving legal consent for the recovery of your organs, tissues and eyes for the purposes of transplantation and research at the time of your death.
Click Here for more Information: http://www.health.ny.gov/professionals/patients/donation/organ/
HEALTHeLINK™ is an unprecedented collaboration among physician, hospital, and insurance organizations to share clinical information in efficient and meaningful ways to improve the delivery of care, enhance clinical outcomes, and control healthcare costs throughout the region. HEALTHeLINK™ is a not-for-profit organization.
HEALTHeLINK™ supports and is working toward the vision of creating community-based virtual medical records and other clinical applications. Achieving that vision means:
- Medical professionals will have access to information they need to treat you quickly and safely
- Duplicate tests and procedures will be avoided
- Your medical information can speak for you in an emergency
- Quality, safety, and efficiency will help control healthcare costs
Inpatient Information Packet [40k]
Contains information presented to inpatients upon admission. It outlines benefits available during your hospital stay, including nutrition, internet access, pastoral care, and ethics.
Patient Complaints - The Joint Commission conducts accreditation surveys of organizations to determine their compliance with nationally established Joint Commission standards. These standards deal with organization quality, safety-of-care issues, and the safety of the environment in which care is provided. Anyone believing that they have issues concerning safety and quality of care in this organization on a continuous basis are encouraged to contact the organization by calling Olean General Hospital’s Confidential Complaint Line 716-375-6162.
The New York State Department of Health can also be contacted at 433 River Street, 6th Floor, Troy, NY 14180 or via telephone at 1-800-804-5447.
If the concern in question cannot be resolved at this level, then the Joint commission may be contacted at the Division of Accreditation Operations, Office of Quality Monitoring, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL60181. Fax: (630) 792-5636 or Email: firstname.lastname@example.org.
Patient Rights - NYS Department of Health
Every patient at Olean General Hospital is entitled to certain rights and responsibilities upon admission. New York State publishes a booklet that outlines these rights for you in one convenient place.
Access our online registration form.
[ click here ]