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Published by Hospital Discharge, 2020-02-07 18:27:50

KaweahDeltaGuide 2019

KaweahDeltaGuide_2019

WELCOME

Welcome to Kaweah Delta Medical Center. On behalf of
the entire medical center team, thank you for choosing us
to support your healthcare needs.
We view our work as a calling to serve our community and
as an opportunity to deliver personal, professional, and
compassionate experiences, every person, every time.
Kaweah Delta is widely-recognized as a healthcare leader
in the Central Valley, and we are commi ed to demon-
strating that to every patient who walks through our
doors.
Visits to the hospital can be stressful for patients and their
families, so we ve created this guide to answer many of
your questions and to make your stay with us as comfortable and positive as possible.
We are here to provide you with safe, high quality and patient-centered services and
medical care. If you have any questions or concerns, please ask your nurse or contact
the Office of Patient Experience at (559) 624-5151.
Again, thank you for choosing Kaweah Delta and allowing us to serve you.

Gary Herbst
CEO
Kaweah Delta Health Care District

2 | www.kaweahdelta.org

ABOUT US

Kaweah Delta is proud to provide comprehensive health care in Tulare County. We are a
581 bed hospital sta ed with over 5,000 dedicated medical professionals and em-
ployees. We are commi ed to meeting the community s health needs through state-of-
the-art medicine, high-quality preventative services and specialized health centers and
clinics. Our impeccable health and safety standards have earned us a number of national
awards and recognitions, which are a testament to the tireless work of our medical team
and hospital sta , who bring the highest levels of care to our community. We have been
meeting the health needs of Tulare County for nearly 55 years and strive to deliver
experiences that are consistently personal, professional, and compassionate.

IMPORTANT NUMBERS

MAIN NUMBER: (559) 624-2000
CASE MANAGEMENT: (559) 624-2235
CHAPLAIN CARE: (559) 624-2263
FINANCIAL SERVICES: (559) 624-4200
MEDICAL RECORDS: (559) 624-2218
PATIENT EXPERIENCE: (559) 624-5151
RISK MANAGEMENT: (559) 624-2340
WEBSITE: kaweahdelta.org

Content in this patient guide has been provided for educational purposes only by Kaweah Delta Health Care District.
Kaweah Delta Health Care District has reserved the right to use royalty-free images and illustrations provided by Kaweah Delta Health Care District,
AdobeStock, and Big Stock Photo.

www.kaweahdelta.org | 3

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Key Medical Group
in partnership with

Kaweah Delta
Health Care District
is part of the integrated
delivery network known as
Sequoia Integrated Health.
Partners, caring for You.

Who is Key Medical Group?
Key Medical Group is an Independent
Physician Association (IPA) of primary care
doctors and specialists who work together
to provide excellent healthcare to our
members. Key Medical Group is owned by
local primary care providers and specialists
within Tulare & Kings County.
Key Manages your participating Commercial
and Medicare Advantage Plan. That means
we are the local Tulare and Kings County
team here to help coordinate your care.
Give us a call at (559) 802-1991. We are
here to assist you.

How many Primary Our Clinical Care Team What can our staff
Care Providers are consists of: assist with?
in our network? • Medical Directors • Care Coordination
140 • Registered Nurse Case • Referrals/Authorizations
• Medical Needs
How many Specialists Managers • Medication Needs
are in our network? • Social Workers • Social Needs
400+ • Health Coaches • High Cost Medications
• Inpatient Case • Diabetes Management
Physicians are located • COPD Management
Managers • Heart Failure Management
in: • Department Assistants • Transitions of care from
• Clinical Pharmacists
Corcoran Lindsay • Pharmacy Technicians hospital to home
Dinuba Porterville
Exeter Tulare
Hanford Visalia
Lemoore

Helpful Resources

Key Medical Group, Inc.
Phone: 559-802-1991,559-735-3892
Fax: 559-334-0112
www.keymedical.org
Medicare Advantage Carriers Accepted: Humana
Commercial Carriers Accepted: Blue Cross,
Blue Shield, Health Net, and UnitedHealthcare

DURING YOUR STAY

YOUR SAFETY AND SECURITY
To protect your personal well-being while providing you with the best medical care
possible, Kaweah Delta has implemented key safety procedures and practices to reduce
the possibility of safety errors. There are some common risks that are inherent in all
hospitals. Please review these simple tips to avoid or minimize those risks:
ID BRACELET
Once you are admi ed, you will be given an identification band with your name and
medical record number on it. For your safety, do not remove the band until you are
discharged from the hospital.
RECOGNIZE YOUR MEDICATION
Our nurses follow a careful procedure to ensure that the right medications are given
to the right patient. Our nurses will explain the purpose and common side e ects of
new medications. If the medications you receive do not look familiar, alert your nurse.
Chances are, despite its appearance, the medication is correct. But it is always advisable
to be an informed patient.
CHANGE IN CONDITION
We take your concerns seriously regarding the way you are feeling. If you or a family
member thinks there has been a change in your condition, please tell a member of the
healthcare team (care partner, nurse, physician, etc.) immediately. ou can feel confident
that any concern you express will be addressed.
TOBACCO FREE ENVIRONMENT
For everyone s health, safety and comfort, we are a tobacco-free environment through-
out all indoor and outdoor areas to include all surrounding streets, sidewalks and
parking structures. The use of all tobacco-related products and devices, such as e-ciga-
re es and chewing tobacco, are also prohibited on campus grounds. Tobacco-cessation
patient education materials are available from your nurse. Additional resources and
information are available by calling 1 (800)-NO-BUTTS.

6 | www.kaweahdelta.org

DURING YOUR STAY

FALL PREVENTION
Good communication among patients, visitors
and nursing sta is key to preventing falls.
Visitors can help prevent falls by staying alert to
the needs and capabilities of the person they are
visiting and notifying a nurse with any concerns.
Patients should use the call light to request
assistance ge ng out of bed, and they should
wear nonskid footwear (if a shoe, then it needs
a back or back strap; flip flops or slippers are
dangerous) when mobile. Patients at high risk of
falling need to have a care partner or nurse with them during all bathroom activities.

CLEANLINESS
Kaweah Delta expects that every care provider, including doctors, nurses and other
sta , wash their hands before and a er performing any “hands on” procedures with pa-
tients. Overwhelming evidence shows that washing hands is the single most important
precaution that anyone (including your doctor or nurse) can take to e ectively prevent
the spread of infection. If you notice that any members of your healthcare team have
forgo en to wash their hands, remind them it is for everyone s benefit.

PERSONAL BELONGINGS
We encourage patients to send home their belongings as items that they keep are their
responsibility. Found items will be sent to our Lost Found and will be held for 30
days. Any unclaimed items will be donated to charity or discarded. Lost Found can be
reached at (559) 624-2044.

QUIET ENVIRONMENT
We understand the importance that rest has in the
mental and physical well-being of our patients. At
Kaweah Delta, we promote H.U.S.H. (Help Us Support
Healing) in which care providers, patients and visitors
partner to minimize noise. Two simple ways to help are
by 1) using indoor voices and 2) limiting visitors to two
people at a time.

www.kaweahdelta.org | 7

PAIN MANAGEMENT

WHAT IS PAIN MANAGEMENT?
Pain management is the care and medicine that are used to help lessen your pain, so
that you can take care of yourself. The goal of pain management is not to get rid of pain;
this is o en not possible or safe. The goal is to help make it easier to take a deep breath,
turn in bed, walk around, and maintain a social life. The medicines may be di erent
based on what is causing your pain, the type of pain, and what has worked for you
before.

our doctors and nurses can help you understand your type of pain, how much pain you
may have, and how long it may last.

Medicines for pain may include pills, creams, pumps, films, or shots:
• Opioids (morphine, hydromorphone, hydrocodone, etc.)

• Non-Opioids: Acetaminophen (Tylenol), NSAIDs (ibuprofen-Motrin, naproxen- Aleve,
celecoxib-Celebrex, etc.), Nerve pain medications (gabapentin and pregabalin)

Your nurse, doctors, and pharmacists can tell you more about your medicines. Each of these
medicines will ha e di erent side e ects and ris s.

WHAT ELSE MAY HELP MY PAIN?
There are easy things that you, your family, or nurses can do to help you have less pain.
Ge ng extra rest, warm blankets, cool or heat pack, extra pillows, taking a short walk, or
moving in bed can help. ou can also use puzzles, coloring books, laptops, and tablets to
help distract you from the pain.

Things you can do to help your pain are deep breaths or trying to be calm and relax
taking slow deep breaths can help you relax and lessen your pain, or closing your eyes
and imagining a place that is calm for you. Think about the sights and sounds you enjoy.

Physical and/or Occupational Therapy may also improve your pain.

HOW SHOULD I TELL MY CARE TEAM ABOUT MY PAIN?
ou will be asked many questions about your pain:

• How bad is your pain on a scale of 0-10?

• Please tell me about your pain, does it feel: sharp, shooting, dull, achy, burning, etc.?

• Is your pain be er, worse, or the same as before?

The more you can tell your care team about your pain, the be er they will be able to help you.

HOW WILL MY PAIN BE AFTER I LEAVE THE HOSPITAL?
Remember that you may have more pain when you go home. As you go back to your
normal life, it is important to take your medicine as you were taught. Keep doing the
things listed above; such as resting, and deep breathing to calm the pain. Talk to your
doctors and nurses and read your hospital instructions for any reasons why you may
need to see your doctor or come into the emergency department.

8 | www.kaweahdelta.org

PAIN MANAGEMENT

WHAT SHOULD I DO WITH EXTRA MEDICINE AT HOME?
Keep medicines in a safe place and out of reach of others (children, friends, family, and
visitors)
Do not leave medicine or pill bo les on countertops, tables, nightstands, or in open
view.
Lock travel cases when traveling with prescription medicine.
DO NOT flush medicine down the toilet unless it is a patch [i.e. Duragesic (fentanyl) or
Butrans (buprenorphine)]
Throw out extra medicine in the trash:
1. Remove or cross out your name and the drug name on the label.
2. Mix medicine with water or soda and then add something like ki y li er, dirt, spices,
or co ee grounds.
3. Close and seal medicine bo les with strong tape.
4. Place sealed bo les in a box or a bag you can t see through.
5. Throw out in trash bin just before garbage pickup time.
Places in the community that will take back your medicine:
*Please contact each place before taking your medicine there to make sure they will
accept controlled substances
1. Drop box locations

Walgreens- On Walnut Ave Court St. (559) 635-7810
2. Medicine collection events

Drug Enforcement Administration (DEA) “Got Drugs” event happens one Saturday in
April and October of each year
Call Visalia Police Department (559) 734-8116 OR City of Visalia at (559) 713-4531
for more information
Don t live in Visalia? Find your local take-back or mail-back program at:
3. DEA Office of Diversion Toll-free number: 1-800-882-9539
Online: www.deadiversion.usdoj.gov/drug_disposal/takeback/
4. National Safety Council Toll-free number: 1-800-621-7615
Online: www.NSC.org/disposalresources

www.kaweahdelta.org | 9



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KNOW YOUR HOSPITAL STAFF

All Kaweah Delta employees doctors, nurses, medical residents and sta wear their
photo identification in a prominently displayed manner. Although we secure the prem-
ises, we ask that you first alert a nurse by call light and then question anyone unknown
to you who walks into your hospital or examination room without a photo identification
badge. Kaweah Delta Medical Center is an academic medical center and a teaching hos-
pital, so a team of doctors will take care of you, and you may see many doctors.
Throughout your medical care, you will come into contact with many people. All employ-
ees, including physicians, are expected to introduce themselves, let you know what role
they have in your health care, what they are planning to do, when they are going to do
it, what e ect it will have on you and what to expect next. If you have any questions,
please do not hesitate to ask.
Physicians our team of doctors is led by an a ending physician, who is in charge of
your care. The doctors, including the a ending physician, may rotate on and o your
care. In other words, the residents and your a ending physician may change during your
stay and may result in your treatment by many doctors. New physicians will introduce
themselves as they join the team. Each doctor on your team contributes to your care;
and, as a patient, you are contributing to the education and training of future physicians.
Residents are doctors who have recently graduated medical school. They work under
the guidance of an a ending physician. As a patient, you are contributing to the educa-
tion and training of future physicians.

12 | www.kaweahdelta.org

KNOW YOUR HOSPITAL STAFF

Registered Nurses provide a critical link between
the patient and the healthcare team. In addition
to contributing to your care, nurses communi-
cate your needs to your doctors and other team
members and inform you about your medications,
in-hospital treatment and post-hospital home care.
Registered nurses also oversee other healthcare
workers, such as care partners, to ensure that your
comfort and hygiene needs are met.

Charge Nurses take a leadership role in the day-to-day operations of a nursing unit.
They can serve as a resource for you if you are in need of additional assistance.

Nurse Managers / Nursing Directors are leaders that are responsible for the clinical
outcomes and service that is delivered on their unit. They provide direction, oversight
and support of clinicians.

Pharmacists are important members of your
healthcare team, meticulously preparing
medication, and monitoring drug therapy for
e ectiveness, potential side e ects, allergies
and possible food and drug interactions.

Chaplains (559) 624-2263 are a part of your
healthcare team and are available to meet
with you to support your spiritual care needs
during your stay. Chaplains can listen to your
concerns, share in your faith struggles, assist
you and your family members in seeking
inner peace and strength, and bring you scriptures or holy writings from your specific
faith tradition. They can also help you access/receive religious sacraments, assist you
in contacting religious leaders from your faith tradition, and/or help with other spiritual
needs. If you would like a visit from the chaplain on your unit, tell your nurse, or call the
Department of Spiritual Care.

Case Managers (559) 624-2235 work with you, your family and your healthcare team
to coordinate your hospital stay. They are also available to assist with the planning and
coordination of your transition from the hospital to home or to other care facilities.

Discharge Advocates work in collaboration with case managers to help you transfer to
a continuing care facility or home. Their goal is for you to have a successful transition
out of the hospital and to support you in your journey to improved health.

Social Workers can assist you and your family members
with any personal, emotional and/or family problems and
difficulties due to your illness or injury. Individual, family
and group support for sudden illness, separation from
home and job, bereavement, substance abuse, domestic
violence and other issues can be arranged, as well as
referrals to community resources.

Dietitians work closely with your healthcare team and
ensure that you are receiving the appropriate balance of
nutritional meals throughout your stay.

www.kaweahdelta.org | 13

YOUR COMFORT

SECURITY

If you have questions or concerns about
safety while visiting patients, day or night,
please contact Security.

VALET PARKING
Valet services is located at our Mineral
King Entrance and is free for patients and
visitors

Hours: 9 a.m.-6 p.m. Monday-Friday;
11 a.m.-7 p.m. Saturday-Sunday

To retrieve a valet-parked vehicle a er
hours, please call Security at

RESPITE HOUSE

People whose loved ones are hospitalized
and have no place to stay may qualify for
lodging to keep them nearby thanks to a
community partnership forged by Visalia
Rotary Clubs and Kaweah Delta Health
Care District. Contact a social worker to
assess availability.

CHAPLAIN SERVICES

We provide interfaith services from trained chaplains. Spiritual care caters to people of
all faiths, including non-religious counseling for people without a faith tradition.

ou do not have to abstain from your spiritual journey during your stay at Kaweah Delta.

FINANCIAL SERVICES

We are commi ed to fulfilling our mission
of providing high quality, customer-oriented,
and financially strong healthcare services to
meet the needs of those we serve. If you
have questions regarding coverage, financial
assistance or how to pay your bill, call us.

MEDICAL RECORDS

A patient, or his/her legal representative, may inspect and/or obtain a copy of their med-
ical records, or have copies of medical records sent to another facility. For information
on medical records, call us.

14 | www.kaweahdelta.org

YOUR COMFORT

INTERPRETERS

Language di erences should never be a barrier to quality health care. We are sta ed
with interpreters for over 150 di erent languages who represent patients at no cost.

WIRELESS ACCESS
Kaweah Delta o ers wireless internet. To access the internet, search for “guest” net-
work. No password is required.

VISITING HOURS
Hours: 8 a.m.-9 p.m.

Children under 13 years of age are not permi ed on the patient care units. ou may
request an exception by contacting security.

RETAIL PHARMACY

Kaweah Delta provides prescription delivery to
patients and provides the community a retail phar-
macy steps from the hospital where people can
conveniently get prescriptions filled.

Hours: Monday-Friday 9 a.m.-7 p.m.; Saturday: 9
a.m.-1 p.m.; Sunday: closed

CASUAL DINING
Cafeteria
Location: 1st floor of Mineral King Wing

The Siren Grill
Location: The Siren Grill is parked on the west side of the Acequia entrance at the south
end of the parking lot.

Hours: 5:30 a.m.-7 p.m. daily

SHOPPING AT KAWEAH DELTA
Courtyard Gi Shop
Location: Next to Mineral King Lobby

Hours: Mon., Tues., Friday 10 a.m.-7 p.m.;
Wed. and Thursday 10 a.m.-4 p.m.; Sat.
Sun 10 a.m.-4 p.m.

Nursery Nook
Location: 3rd floor of Acequia Wing

Hours: 9 a.m.-4:30 p.m. Monday-Friday

www.kaweahdelta.org | 15

ADVANCE CARE PLANNING

We want to be certain that each patient s values and preferences guide the medical care
received. The process of discussing values in the context of your medical care and iden-
tifying goals for care, called advance care planning, is an important part of communica-
tion between physicians and patients. Engage your physician in advance care planning.
Furthermore, patients can complete an advance directive that records these values and
indicates who they would want to speak for them if they cannot. Ask your physician,
nurse or social worker for an advance directive to complete if you do not already have
one.
OTHER IMPORTANT POINTS
• Make sure that you know who is in charge of your care. This is particularly important

when many people are involved in your treatment, or when you have many health
problems.
• Make sure your healthcare professionals know who you are. All physicians, nurses or
other sta members should check your identification bracelet before examination and
treatment.
• Speak up if you have questions or concerns. ou have the right to know about your
care and to ask questions of any member of your care team.
• If you have a test taken, do not assume that no news is good news. Always ask your
doctor for the results.
• When surgery is involved, be informed. Make sure that you, your doctor and your
surgeon all agree on what exactly needs to be done.
• Get an advocate. Ask a family member or trusted friend to serve as your advocate to
protect your best interests, especially when you may be distracted by the stress of
illness.
If something about your care or environment seems unsafe or you identify something
that can be improved, contact the Office of Patient Experience at (559) 624-5151.

16 | www.kaweahdelta.org

RIGHTS & RESPONSIBILITIES

YOU HAVE THE RIGHT TO:
Considerate and respec ul care, and to be made comfortable. ou have the right to

respect for your cultural, psychosocial, spiritual, and personal values, beliefs and prefer-
ences.

Have a family member (or other representative of your choosing) and your own physi-
cian notified promptly of your admission to the hospital.

Know the name of the licensed health care practitioner acting within the scope of his
or her professional licensure who has primary responsibility for coordinating your care,
and the names and professional relationships of physicians and non-physicians who will
see you.

Receive information about your health status, diagnosis, prognosis, course of treat-
ment, prospects for recovery and outcomes of care (including unanticipated outcomes)
in terms you can understand. ou have the right to e ective communication and to par-
ticipate in the development and implementation of your plan of care. ou have the right
to participate in ethical questions that arise in the course of your care, including issues
of conflict resolution, withholding resuscitative services, and forgoing or withdrawing
life-sustaining treatment.

Make decisions regarding medical care, and receive as much information about any
proposed treatment or procedure as you may need in order to give informed consent
or to refuse a course of treatment. Except in emergencies, this information shall include
a description of the procedure or treatment, the medically significant risks involved,
alternate courses of treatment or non-treatment and the risks involved in each, and the
name of the person who will carry out the procedure or treatment.

Request or refuse treatment, to the extent permi ed by law. However, you do not
have the right to demand inappropriate or medically unnecessary treatment or services.
ou have the right to leave the hospital even against the advice of members of the med-
ical sta , to the extent permi ed by law.

Be advised if the hospital/licensed health care practitioner acting within the scope of
his or her professional licensure proposes to engage in or perform human experimenta-
tion a ecting your care or treatment. ou have the right to refuse to participate in such
research projects.

Reasonable responses to any reasonable requests made for service.

Appropriate assessment and management of your pain, information about pain, pain
relief measures and to participate in pain management decisions. ou may request or
reject the use of any or all modalities to relieve pain, including opiate medication, if
you su er from severe chronic intractable pain. The doctor may refuse to prescribe the
opiate medication, but if so, must inform you that there are physicians who specialize in
the treatment of pain with methods that include the use of opiates.

Formulate advance directives. This includes designating a decision maker if you be-
come incapable of understanding a proposed treatment or become unable to communi-
cate your wishes regarding care. Hospital sta and practitioners who provide care in the
hospital shall comply with these directives. All patients rights apply to the person who
has legal responsibility to make decisions regarding medical care on your behalf.

www.kaweahdelta.org | 17

RIGHTS & RESPONSIBILITIES

Have personal privacy respected. Case discussion, consultation, examination and
treatment are confidential and should be conducted discreetly. ou have the right to be
told the reason for the presence of any individual. ou have the right to have visitors
leave prior to an examination and when treatment issues are being discussed. Privacy
curtains will be used in semi-private rooms.

Confidential treatment of all communications and records pertaining to your care
and stay in the hospital. ou will receive a separate

“Notice of Privacy Practices” that explains your privacy rights in detail and how we may
use and disclose your protected health information.

Receive care in a safe se ng, free from mental, physical, sexual or verbal abuse and
neglect, exploitation or harassment. ou have the right to access protective and advoca-
cy services including notifying government agencies of neglect or abuse

Be free from restraints and seclusion of any form used as a means of coercion, disci-
pline, convenience or retaliation by sta .

Reasonable continuity of care and to know in advance the time and location of
appointments as well as the identity of the persons providing the care.

Be informed by the physician, or a delegate of the physician, of continuing health
care requirements and options following discharge from the hospital. ou have the right
to be involved in the development and implementation of your discharge plan. Upon
your request, a friend or family member may be provided this information also.

Know which hospital rules and policies apply to your conduct while a patient.

Designate a support person as well as visitors of your choosing, if you have deci-
sion-making capacity, whether or not the visitor is related by blood, marriage, or regis-
tered domestic partner status, unless:

• No visitors are allowed.

• The facility reasonably determines that the presence of a particular visitor would en-
danger the health or safety of a patient, a member of the health facility sta , or other
visitor to the health facility, or would significantly disrupt the operations of the facility.

• ou have told the health facility sta that you no longer want a particular person to
visit.

However, a health facility may establish reasonable restrictions upon visitation, includ-
ing restrictions upon the hours of visitation and number of visitors. The health facility
must inform you (or your support person, where appropriate) of your visitation rights,
including any clinical restrictions or limitations. The health facility is not permi ed to
restrict, limit, or otherwise deny visitation privileges on the basis of race, color, nation-
al origin, religion, sex, gender identity, sexual orientation, or disability.

Have your wishes considered, if you lack decision-making capacity, for the purposes
of determining who may visit. The method of that consideration will comply with federal
law and be disclosed in the hospital policy on visitation. At a minimum, the hospital shall
include any persons living in your household and any support person pursuant to federal
law.

18 | www.kaweahdelta.org

RIGHTS & RESPONSIBILITIES

Examine and receive an explanation of the hospital s bill regard-less of the source of
payment.

Exercise these rights without regard to sex, economic status, educational back-
ground, race, color, religion, ancestry, national origin, sexual orientation, gender identity/
expression, disability, medical condition, marital status, age, registered domestic partner
status, genetic information, citizenship, primary language, immigration status (except as
required by federal law) or the source of payment for care.

File a grievance. If you want to file a grievance with this hospital, you may do so by
writing by calling (name, address and phone number of hospital):

Kaweah Delta Health Care District Risk Management Department
400 W. Mineral King Ave., Visalia, CA 93291

Telephone: (559) 624-2340

The grievance commi ee will review each grievance and provide you with a wri en
response within 30 days. The wri en response will contain the name of a person to
contact at the hospital, the steps taken to investigate the grievance, the results of the
grievance process, and the date of completion of the grievance process. Concerns
regarding quality of care or premature discharge will also be referred to the appropriate
Utilization and Quality Control Peer Review Organization (PRO).

File a complaint with the California Department of Public Health regardless of
whether you use the hospital s grievance process. The California Department of Public
Health s phone number and address is: (local address and phone number of CDPH)

California Department of Public Health
1200 Discovery Plaza, Suite 120
Bakersfield, CA 93309

Telephone: (661) 336-0543

The Joint Commission, Division of Accreditation Operations,
Office of Quality Monitoring
One Renaissance Boulevard
Oakbrook Terrace, IL 60181

Telephone: (800) 994-6610 | Fax: (630) 792-5636

E-mail: [email protected]

These Patient Rights combine Title 22 and other California laws, The Joint Commission and
Medicare Conditions of Participation requirements. (3/17)

California Hospital Association • 1215 K Street, Suite 800 • Sacramento, CA 95814
(916) 443-7401 • www.calhospital.org

www.kaweahdelta.org | 19

WORD SEARCH

1 Our goal is to consistently deliver safe, high quality,
patient-centered care.

2 In an effort to give you the best possible service, our team will
listen carefully to you.

3 We will try hard to explain things in a way that you understand.

4 Our team will work together to respond quickly when you press
the call button.

5 We strive to keep your room and bathroom clean.

6 There are many ‘care’ noises in hospitals, but we will try to keep
the area around your room quiet at night.

7 Although all pain cannot be avoided, we will try to keep you as
comfortable as possible.

8 Knowing the purpose and side effects of new medications is
important.

9 We want you to be successful when you get home, so we will see
if you have any discharge preferences that we can help with.

10 Our desire is to serve our community with compassion and
kindness.

11 We realize our patients are our families, our friends, and our
neighbors, so we strive to give them the best possible care!

20 | www.kaweahdelta.org

WORD SEARCH

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S E J RL UCE E F AP I
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X UJ F GB UT T ONC N
P RE F E RE NCE S E S

We want to hear about your experience!
Share your story with our Patient Experience Director!

ED LARGOZA

BSCS, RN, MSN, NE-BC
PATIENT EXPERIENCE DIRECTOR
O: 559.624.5051
C: 559.300.3121
E: [email protected]
VISIT US at www.kaweahdelta.org

www.kaweahdelta.org | 21

MEET YOUR COMMUNITY HEALTH PROVIDERS

At Kaweah Delta Medical Center, our team of over 448 physicians and 100+ Advanced
Practice Providers o er compassionate, personalized care to all of our patients by paying

close a ention to every patient s medical needs.
Our Medical Sta o er a vast array of health care providers, most of them board certi-

fied, in specialties such as emergency medicine, internal medicine, and pediatrics.
For more information about doctors affiliated with Kaweah Delta,
please visit our website at www kaweahdelta org/doctors

22 | www.kaweahdelta.org

P ODIATRIC SURGE YR DR. P AUL R. M AY O, DP M

Dr. aul R. Mayo, D M is board certified by the American Board of odiatric
Surgery. He has provided residents specialty foot and ankle care in podiatry in
Tulare, Kings and Fresno County since 1998. He graduated from Hanford High
School in 198 and then went on to Cuesta College in San Luis bispo to receive
his Bachelor Degree. He received his Doctorate at California College of odiatric
Medicine. Dr. Mayo then went on to receive his surgical training at oungstown

steopathic Hospital in oungstown, hio. He is a Diplomate of the American Col-
lege of Foot and Ankle Surgeons he is an active member of American odiatric
Medical Association, California odiatric Medical Association and past president
of Midstate odiatric Medical Society. He takes pride in treating all aspects of your
foot and ankle problems.

DR. SETH J. B RAZ IER, DP M

Dr. Seth J. Brazier, D M completed his medical school training at Western Uni-
versity of Health Sciences. He went on to complete a surgical residency with an
emphasis in rearfoot reconstruction at the VA Stanford residency program. His
wife grew up in Visalia and they are happy to be back and to serve those with
foot and ankle conditions in Tulare county. He has interests in all aspects of the
foot and ankle including sports pathology, forefoot and rearfoot surgery, trauma,
and diabetic foot care. He was an NCAA Division I athlete and is an avid runner.
He is also a member of the American odiatric Medical Association and Midstate

odiatric Medical Society. Dr Brazier takes pride in his patients and getting them
back healthy and pain free.

11 N. Akers St., Visalia, CA 93291
(559) 6 36 -36 6 8
w w w .c v f o o t a n d a n k l e i n c .c o m

CARDIAC CORONARY BYPASS
SURGERY SURGERY

EXCELLENCE FIVE-STAR
AWARDTM RECIPIENT

2 YEARS IN A RO W 2 YEARS IN A RO W
(2 0 1 7 -2 0 1 8 ) (2 0 1 7 -2 0 1 8 )

We are proud to be recognized for
delivering excellence in cardiac surgery

Leheb Araim, MD, FACS, FACC Sergio Caminha, MD

Drs. Leheb Araim and Sergio Caminha provide cardiac and thoracic (chest and
lung) surgery. Both are Board certified in cardiothoracic surgery. In addition, Dr.
Araim is a Fellow of the American College of Surgeons and the American College
of Cardiology. Dr. Caminha is a former Associate in Cardiovascular Surgery at Mayo
Clinic, Minnesota.

We provide comprehensive cardiothoracic surgery at Kaweah Delta Medical Center,
recently recognized by Healthgrades as one of America’s 50 Best Hospitals for
Cardiac Surgery, among other awards. Kaweah Delta is one of just four hospitals in
California, and the only one in the Central Valley, to receive these distinctions.

Your health is the heart of our calling

202 W. Willow, Suite 405, Visalia
GoldenStateCardiac.com | 627-8600



P AIN M ANAG ME ENT + PS INE + REH BA B ILL B ARRETO, M .D.

Dr. Barreto is double board certified in hysical Medicine and Rehabilitation ( M R)
as well as ain Medicine. He attended medical school at Loma Linda University, in
southern California. Drawn by their focus on whole person care and an exceptional
learning environment, Dr. Barreto remained at Loma Linda for Residency in M R
and for Fellowship training in ain Management. After completing Residency and
Fellowship, he accepted an academic position at the Loma Linda VA Hospital, afford-
ing him the opportunity to teach M R Residents and ain Fellows the intricacies of
treating chronic painful conditions. Dr. Barreto holds a Bachelors degree in sychol-
ogy, which continues to be an invaluable asset when assisting people with the many
psychological challenges that accompany chronic pain. Having worked as a medical
director and CE of various peer review companies, Dr. Barreto is proficient at nav-
igating the tumultuous landscape of our current insurance systems. After working in

range County for nine years, he is excited to be back in Central California, where
he originally grew up. In his free time, Dr. Barreto en oys traveling, mountain biking,
and spending time with family.

HANY NASR, M D

After receiving his medical education from one of the oldest and most renowned
medical schools, Kasr El-Aini Faculty of Medicine, Cairo Egypt, Dr. Nasr then
continued on his residency and double fellowships in the US, during which time
he published multiple papers. He completed a preliminary year of surgical res-
idency then a primary residency at SUN Stony Book in New ork, where he
was elected Chief Resident. Next, he went on to finish the first of two fellowships
in spine intervention at Cedars-Sinai Medical Center Institute for Spinal Disor-
ders in Los Angeles, California. That was followed by a second fellowship in

ain Management at the University of ittsburgh Medical Center Department of
Anesthesia in ittsburgh, ennsylvania. Dr. Nasr is double board-certified with
the American Board of hysical Medicine and Rehabilitation with a board sub-
specialty in ain Medicine. After finishing his second fellowship, Dr. Nasr and
his family now reside in Visialia, California. His hobbies include restoring muscle
cars, playing squash, and playing golf.

VISALIA
201 E. Noble Ave., Visalia, CA
(559) 6 27-6 500
w w w .s t g e o r g e s p i n e .c o m
P ORTERVILLE
7 N. D St., Ste A, orterville, CA
(559) 78 2-8 4 00

Experience
Matters Most

For 40 Years We’ve Been Proudly Taking
Care of the Health of Your Children

Certified by the American Board of Pediatrics

For the past 40 years Tulare Pediatric Group has
been able to bring the best of care to thousands of
newborn babies, toddlers, children and adolescents.

So the next time the unexpected happens with
your little one, call Tulare Pediatric Group,
because experience matters most.

1062 North Cherry | Tulare, CA 93274 559.686.3824
M-F: 8 AM - 5 PM

CO MS ETIC & F MA I YL DENTIST YR SHIRLEY LEI, DDS

Dr. Shirley Lei is a general dentist in Visalia with over 10+ years of dental experience.
She graduated from the University of California San Francisco School of Dentistry
and practiced in the Bay Area for several years where she excelled in many aspects
of dentistry. She always dreamed of having a high quality practice of her own, and
was fortunate to have found and joined the practice of Dr. Megan Ide in Visalia. Dr.
Ide and Dr. Lei both share the same philosophy in dentistry and believe in quality
and excellent patient care. Dr. Lei is dedicated to providing comprehensive care for
the whole family, including preventive care and cosmetic dentistry. She attends con-
tinuing education courses to stay current with technological advances and skills to
deliver the best possible care for patients.
Dr. Lei is a member of the American Dental association and the California Dental
Association, she is currently serving on the board of Tulare-Kings Dental Society. In
her spare time, Dr. Lei enjoys yoga, traveling, and spending time with her husband,
Kevin, and her three children, Kendrick, Skyler, and Kylie.

M EGAN IDE, DDS

Dr. Megan Ide is a native Visalian and has been practicing general dentistry
in her hometown for almost 20 years. She is a graduate of Mt. Whitney High

DR. IDE & DR. LEIschool, University of California, Berkeley and University of the acific School

FAMILY DENTISTRYof Dentistry. Dr. Ide also completed a general practice residency at University

Medical center in Fresno. She is a member of the American Dental Association,
the California Dental Association, and is a member and past president of the
Tulare-Kings Dental Society. Dr. Ide’s practice includes adults and children with
an emphasis on comprehensive preventative care as well as state of the art

cosmetDic Rp.roIcDedEur&es. DShRe. eLnjEoyIs all aspects of dentistry, especially building

long-teFrmAMrelaILtioYnsDhEipNs wTiIthSTheRrYpatients.

Dr. Ide is an avid supporter of the Visalia community and is a member of the
Visalia Chamber of Commerce. She enjoys running and spending time with
family and friends. Dr. Ide lives in Visalia with her husband, Nathan, and two
children, William and Emma.

D . I & D .DRR. IDE &DDER. LEI R LEI

FFAAMMILYIDLEYNTIDSTERYNTISTRY

1045 N Demaree Street, Visalia CA 93291
559-6 25-274 4

Y. William Barsoum, MD

Board Certified
Nephrology, Hypertension

and Internal Medicine

We Specialize in:
• Kidney Diseases (both acute and chronic)
• Blood Pressure Problems
• Kidney Stones Management
• Kidney Dialysis Modalities
• Electrolyte Imbalances
• Kidney Transplant Evaluation and Management

Dr. Barsoum completed his residency and fellowship at the University
of Medicine and Dentistry of NJ (UMDNJ) where he served as chief
fellow. Also he was an assistant professor at the University of West
Virginia. He has been in practice for more than 20 years. Dr. Barsoum
is a nephrologist in Visalia, California and is affiliated with multiple
hospitals in the area, including Kaweah Delta Medical Center, Sierra
View Medical Center Porterville, Adventist Health Medical Center,
Hanford and Tulare Regional Medical Center, Tulare.

Let’s have some fun answering these questions from
Dr. Barsoum!

1. Which of these organs does High Blood Pressure affect the most?
Brain Eyes Heart Kidneys Arteries All

2. Which of these does the Kidneys need on a daily basis to prevent
Kidney Stones? Pick two.
Vitamin C Broccoli Citric Acid Carrots Vitamin B

3. Which one of these would NOT be damaging your Kidneys?
Cigarette Smoking Large amounts of Salt Exercising
Cola based beverages

4. Which chemical (Electrolyte) is important to your health?
Sodium Potassium Calcium Magnesium Phosphorous
All

When you feel better, We feel better

1700 S. Court Street • Suite D • Visalia, Ca • 93277
(559) 697-6290

Answers: 1. All; 2. Vitamin C & Citric Acid; 3. Exercising; 4. All



From L To R: Omar Araim, MD • Abdul Rahman Hamdi, MD
Matthew Campbell, MD • Lamar Mack, MD • Sid Agrawal, MD

We provide comprehensive care for most vascular conditions.

• Peripheral artery disease (PAD): blockages in the arteries of the legs, that lead to leg pain,
and foot ulcers.

••hSCVaoavuaertrhiocaVtociasdolelmeavyrbetiVneianersdsyc:eudfxlriaospreem'sraisetceenoac:smebmloooeffctmiskcuaosrgrgpeeeisdtohneiansrntvheeinFWraosmrettLeoptorrpRioe: aAvsbiidndoulfefRuatlchh,moueamnlcHnpaeemrrdecai,hkMte,eDtnd•hsLaaviMvtaaerrmMiccaaacokyr,sMecitDaif•eouMsrsateoathlfealwttChsyatemprpoebleeskllg,eoMs.fD. • Omar Araim, MD

vascular issues
•5A0bydeaorms.inWael aaroeretixcpaerntes uartydsiamgsno(AsiAngA): Sur•giPcearipl haenradl aertnerdy odivseaassceu(PlAaDr):tbrleocaktamgeseinnttheoafrtetrhiees oaf tnheeluegrsy, sthmat lead to leg pain,
antod ptrreeavtienngtycoounr tvinasuceudlagrrcoowndthitiaonds. rupture, awndhfiocoht ulmceras.y be catastrophic and life-threatening.

•CDailal lfyosr ias caocncseusltsatcioanreto: dfoary!patients with end• Vsatraicgosee rveeinnsa:lfrdomisceosamseetic(sEpidSeRr vDein)s. to painful, ulcerated varicosities of the legs.
•5A5n9.g6i2o5g.r4a1m18: a series of X-rays taken of the• Caarrtoetirdiearstearyftdeisreaasne: binlocjekacgetsioinnthoe farcteroiens torf athsetnedcky,eth,amt maaykcinaugse a stroke.
Vtihsaeliab8lo20odS. AvkeesrssSetlrseevt Sisuiibtel1e2.0 • Abdominal aortic aneurysms (AAA): Surgical and endovascular treatment of the aneurysm
•PHFUproaerlnasttfternoiraoervdsni1lo61ltes42u653nw8EMd4.iat:HPhllteeDoracnrr.dsaeSoorxnnuoiatDAtemvriide2v.e1inSa1uerBitteteh1r0ey6daristeeraisees, to prevent continued growth and rupture, which may be catastrophic and life-threatening.

and v•eDiinalsysoisfatchceesslecagrse:. fWor peatiaenltssowitph eenrdfostargme reunlatlrdaisseaosue (nESdRsD)f.or
aorti•cAanngieogurrayms:ma sser,ieasnofdX-praaysttiaeknentsof othenadrteiraielsyasftiesr.an injection of contrast dye, making

South Valley Vascular Cal•l fUthloetrabrlsoooaudnvcde:sostoenlesxvsaimsuibinlleet.thaetaritoeriens atndovdeinas oyf !the5le5gs9. W.6e a2ls5o p.e4rfo1rm18ultrasounds for
BASS MEDICAL GROUP
www.southvalleyvascular.com pVatiisenatsliwaith• cParootridtaertrervy idlilseeas•eH, aoartnicfaonerudrys•mFs,raendsnpaotients on dialysis.

HAND & WRIST SURGEON JONATHAN C. LIU,

Dr. Liu is a Board Certified Hand and Wrist Surgeon that has been practicing in our
community and taking care of both traumatic and degenerative diseases of the upper
extremity and hands. He is a Fellow of American College of Surgeons (FACS), Member
of American Society for Surgery of the Hand (ASSH), and Member of American Associa-
tion for Hand Surgery (AAHS). In addition he is also Board Certified in General Surgery.
Special training in Microvascular and Microsurgery, he also uses microscope during sur-
gery to perform replantation and revascularization of amputated fingers, hands, and arm.
Dr Liu’s education includes: Christine M. Kleinert Institute for Hand and Upper Extremity
Fellowship, Memorial Sloan Kettering Cancer Center, Monmouth Medical Center, Jersey
Shore Trauma Center, Newark Beth Israel Med Center, University of California Riverside.
Dr. Liu’s professional experience includes: Kaweah Delta Medical Center, Adventist
Health Hanford Medical Center, Kaweah Delta Woodlake Rural Health Clinic, Jonathan
C. Liu, MD Inc., and Sequoia Institute for Surgical Services Inc.

(559) 731-2009
VISALIA - 2300 West Sunnyside Avenue, Visalia, CA 93277
DOWNTOWN VISALIA - 518 North Court Street - Suite B, Visalia, CA 93291
HANFORD - 550 West Grangeville, Hanford, CA 93230





BIENVENIDO

Bienvenido a Kaweah Delta Medical Center. En nombre
de todo el equipo médico, gracias por elegirnos para sus
necesidades de atención médica.
Consideramos nuestro trabajo como un llamado a servir a
nuestra comunidad y como una oportunidad para brindar
experiencias personales, profesionales y compasivas, a
cada persona, en cada momento.
Kaweah Delta es ampliamente reconocido como un líder
de atención médica en el Valle Central, y estamos com-
prometidos a demostrarlo a cada paciente que entra por
nuestras puertas.
Las visitas al hospital pueden ser estresantes para los paci-
entes y sus familias, por lo que hemos creado esta guía para responder a muchas de sus
preguntas y hacer que su estancia con nosotros sea lo más cómoda y positiva posible.
Estamos aquí para brindarle servicios y atención médica seguros, de alta calidad y cen-
trados en el paciente. Si tiene alguna pregunta o inquietud, consulte a su enfermera o
comuníquese con la Oficina de Experiencia del Paciente al (559) 624-5151.
Nuevamente, gracias por elegir Kaweah Delta y permitirnos servirlo.

Gary Herbst
CEO
Kaweah Delta Health Care District

34 | www.kaweahdelta.org

SOBRE NOSOTROS

Kaweah Delta se enorgullece de brindar atención médica comprensiva en el conda-
do de Tulare. Somos un hospital con más de 581 camas atendidas por más de 5,000
profesionales y empleados médicos dedicados. Estamos comprometidos a satisfacer las
necesidades de salud de la comunidad a través de la última tecnología en medicina, ser-
vicios preventivos de alta calidad y centros de salud y clínicas especializadas. Nuestros
impecables estándares de salud y seguridad nos han otorgado una serie de premios y
reconocimientos nacionales, que son un testimonio del trabajo incansable de nuestro
equipo médico y personal hospitalario, quienes brindan los más altos niveles de cuidado
a nuestra comunidad. Hemos estado satisfaciendo las necesidades de salud del condado
de Tulare por casi 55 años y nos esforzamos por brindar experiencias consistentemente
personales, profesionales y compasivas.

NÚMEROS IMPORTANTES

NÚMERO PRINCIPAL: (559) 624-2000
ADMINISTRACIÓN DE CUIDADOS: (559) 624-2235
CUIDADO DE CAPELLÁN: (559) 624-2263
SERVICIOS FINANCIEROS: (559) 624-4200
REGISTROS MÉDICOS: (559) 624-2218
EXPERIENCIA DEL PACIENTE: (559) 624-5151
GESTIÓN DEL RIESGO: (559) 624-2340
Sitio Web: kaweahdelta.org

El contenido de esta guía del paciente ha sido proporcionado con propósitos educativos solamente por Kaweah Delta Health Care District.
Kaweah Delta Health Care District se ha reservado el derecho de utilizar imágenes libres de derechos de autor y las ilustraciones proporcionadas
por Kaweah Delta Health Care District, AdobeStock y Big Stock Photo.

www.kaweahdelta.org | 35



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DÉJANOS SABER ANTES DE IR!

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alta? casa?

DURANTE SU ESTANCIA

Y PROTECCIÓN
Para proteger su bienestar personal mientras le brindamos la mejor atención médica
posible, Kaweah Delta ha implementado procedimientos y prácticas de seguridad claves
para reducir la posibilidad de errores de seguridad. Hay algunos riesgos comunes que
son inherentes en todos los hospitales. Por favor revise estos consejos simples para
evitar o minimizar esos riesgos:
PULSERA DE IDENTIFICACIÓN
Una vez que sea admitido, se le dará una pulsera de identificación con su nombre y
número de registro médico. Para su seguridad, no retire la pulsera hasta que lo den de
alta del hospital.
RECONOZCA SU MEDICACIÓN
Nuestras enfermeras siguen un procedimiento cuidadoso para garantizar que los
medicamentos correctos se administren al paciente adecuado. Nuestras enfermeras
explicarán el propósito y los efectos secundarios comunes de los medicamentos nuevos.
Si los medicamentos que recibe no le resultan familiares, infórmele a su enfermera. Es
probable que, a pesar de su apariencia, el medicamento sea correcto. Pero siempre es
aconsejable ser un paciente informado.
CAMBIO DE CONDICIÓN
Tomamos en serio sus preocupaciones con respecto a la forma en que se siente. Si ust-
ed o un miembro de su familia cree que ha habido un cambio en su condición, informe
de inmediato a un miembro del equipo de atención médica (cuidador, enfermera, médi-
co, etc.). Puede estar seguro de que se atenderá cualquier preocupación que exprese.
AMBIENTE QUE LIBRE DE TABACO
Para la salud, seguridad y comodidad de todos, somos un entorno libre de tabaco en
todas las áreas interiores y exteriores todas las calles, banquetas y estructuras de esta-
cionamiento alrededor. El uso de todos los productos y dispositivos relacionados con el
tabaco, como cigarrillos electrónicos y tabaco de mascar, también está prohibido en la
propiedad del hospital. Los materiales educativos para el paciente que dejan de fumar
están disponibles a través de su enfermera. Recursos e información adicionales están
disponibles llamando al 1 (800) -NO-BUTTS.

38 | www.kaweahdelta.org

DURANTE SU ESTANCIA

PREVENCIÓN DE CAÍDAS
La buena comunicación entre pacientes, visi-
tantes y personal de enfermería es clave para
prevenir caídas. Los visitantes pueden ayudar
a prevenir caídas al mantenerse alerta a las
necesidades y capacidades de la persona que
están visitando y notificar a una enfermera con
cualquier preocupación. Los pacientes deben
usar la luz de llamada para solicitar ayuda para
levantarse de la cama, y deben usar calzado an-
tideslizante (si es un zapato, necesita una correa
para atras o la parte de atrás cubierta, chanclas o pantuflas son peligrosas) cuando están
en movimiento. Los pacientes con alto riesgo de caídas necesitan tener un compañero
de cuidado o enfermera con ellos durante todas las actividades del baño.

LA HIGIENE
Kaweah Delta exige que todos los proveedores
de atención médica, incluidos los médicos,
las enfermeras y demás personal, se laven las
manos antes y después de realizar cualquier
procedimiento “práctico” con los pacientes.
Abrumadora evidencia muestra que lavarse
las manos es la precaución más importante
que cualquier persona (incluso su médico
o enfermera) puede tomar para prevenir la
propagación de infección. Si nota que algún miembro de su equipo de atención médica
ha olvidado lavarse las manos, recuérdeles - es para el beneficio de todos.

AMBIENTE SILENCIOSO
Entendemos la importancia que tiene el descanso
en el bienestar mental y físico de nuestros pacientes.
En Kaweah Delta, promovemos H.U.S.H. (Ayúdenos
a Apoyar la Curación) en la que los proveedores de
atención, los pacientes y los visitantes se unen para
minimizar el ruido. Dos formas simples de ayudar son:
1) usar voces suaves y 2) limitar visitantes a dos perso-
nas a la vez.

www.kaweahdelta.org | 39

PLANIFICACIÓN DE ATENCIÓN AVANZADA

Queremos estar seguros de que los valores y preferencias de cada paciente guíen
la atención médica recibida. El proceso de discutir los valores en el contexto de su
atención médica e identificar los objetivos de su cuidado, lo que se llama planificación
de atención avanzada, es una parte importante de la comunicación entre los médicos y
los pacientes. Involucre a su médico en la planificación de atención avanzada. Además,
los pacientes pueden completar una directiva anticipada que registra estos valores e in-
dica a quiénes les gustaría hablar por ellos si no pueden. Pídale a su médico, enfermera
o trabajador social una directiva anticipada para completar si aún no la tiene.
OTROS PUNTOS IMPORTANTES
• Asegúrese de saber quién está a cargo de su cuidado. Esto es particularmente impor-

tante cuando muchas personas participan en su tratamiento o cuando tiene muchos
problemas de salud.
• Asegúrese de que sus profesionales de atención médica sepan quién es usted. Todos
los médicos, enfermeras u otros miembros del personal deben revisar su pulsera de
identificación antes de cualquier examen y tratamiento.
• Hable si tiene preguntas o inquietudes. Usted tiene derecho a conocer su cuidado y
hacer preguntas a cualquier miembro de su equipo de cuidado.
• Si se realiza un examen, no suporga que ninguna noticia es una buena noticia. Siempre
pregúntele a su médico por los resultados.
• Cuando se trata de cirugía, esté informado. Asegúrese de que usted, su médico y su
cirujano estén de acuerdo en qué se debe hacer exactamente.
• Obtener un defensor. Pida a un familiar o amigo de confianza que actúe como defen-
sor para proteger sus mejores intereses, especialmente cuando puede estar distraído
por el estrés de la enfermedad.
Si algo sobre su cuidado o ambiente parece inseguro o si identifica algo que se puede
mejorar, comuníquese con la Oficina de Experiencia del Paciente al (559) 624-5151.

40 | www.kaweahdelta.org

EL CONTROL DE DOLOR

¿QUÉ ES EL CONTROL DE DOLOR?

El control de dolor son los cuidados y medicina que se usa para disminuir su dolor
y así usted pueda cuidar de sí mismo. La meta del control de dolor no es eliminar el
dolor; seguido esto no es posible ni seguro. La meta es ayudarle a que pueda respirar
profundamente con más facilidad, poder voltearse en cama, caminar y mantener una
vida social. Las medicinas pueden ser diferentes basadas en lo que le esté causando
su dolor, el tipo de dolor y lo que ha funcionado para usted en el pasado.

Sus doctores y enfermeras le pueden ayudar para que usted entienda su tipo de dolor,
cuánto dolor usted puede tener y cuánto tiempo le puede durar.

Las medicinas para el dolor pueden incluir pastillas, cremas, bombas, films,
o inyecciones:
• Opiáceos (morfina, hidromorfona, hidrocondona, etc.)

• No opiáceos: Acetaminofen (Tylenol), NSAIDs (ibuprofeno-Motrin, naproxen- Aleve,
celecoxib-Celebrex, etc.), medicamentos para el dolor de nervios (gabapentin y
pregabalin)

Su enfermera, doctor y farmacéutico le puede hablar más acerca de sus medicinas. Cada
una de estas medicinas puede tener diferentes efectos secundarios y riesgos.

¿QUÉ MÁS ME PUEDE AYUDAR CON MI DOLOR?
Hay cosas fáciles que usted, su familia o sus enfermeras pueden hacer para ayudarle
a tener menos dolor. El descansar mucho, usar cobijas calientitas, fomentos de calor
o fríos, más almohadas, el caminar una corta distancia, o moverse en cama le pueden
ayudar. También puede completar rompe-cabezas, colorear libros, y usar la computa-
dora y tabletas para ayudarle a distraerse del dolor.

Lo que usted puede hacer para disminuir su dolor es respirar profundamente o tratar
de mantenerse calmado y relajado. El respirar profundamente le puede ayudar a re-
lajarse y disminuir su dolor o cierre sus ojos e imagine que está en un lugar tranquilo.
Piense en las imágenes y sonidos que a usted le gustan.

La terapia ocupacional y/o física también le puede ayudar a mejorar su dolor.

¿CÓMO HABLO ACERCA DE MI DOLOR CON MI EQUIPO DE CUIDADOS?
Se le preguntará muchas preguntas acerca de su dolor:

•¿Qué tanto dolor tiene en la escala de dolor del 0-10?

• Por favor hábleme acerca de su dolor. ¿Cómo lo siente? ¿Agudo, punzante, sordo,
adolorido, con ardor?

•¿Su dolor está mejor, peor, o igual que antes?

Entre más le pueda hablar a su equipo médico acerca de su dolor, mejor le podrán ayudar.

¿CÓMO VA A ESTAR MI DOLOR DESPUÉS DE SALIR DEL HOSPITAL?
Recuerde que puede tener más dolor cuando se vaya a casa. Cuando regrese a su vida
normal, es importante que tome sus medicinas según le hayan indicado. Siga haci-
endo las cosas listadas anteriormente, tal como descansar y respirar profundamente
para calmar el dolor. Hable con sus doctores y enfermeras y lea las instrucciones del

www.kaweahdelta.org | 41

EL CONTROL DE DOLOR

hospital para ver si hay alguna razón por la cual tenga que ir a ver a su doctor o ir al
departamento de emergencias.

¿QUÉ DEBO HACER CON LAS MEDICINAS EXTRAS QUE TENGO EN CASA?
Mantenga las medicinas en un lugar seguro y manténgalas fuera del alcance de otros
(niños, amigos, familia, visita).

Evite dejar medicamentos o envases de pastillas en el mostrador, la mesa, o la mesa
de noche en plena vista

Ponga seguro a los estuches de viaje cuando viaje con medicina recetada.

NO tire medicinas en la tasa del baño - la excepción a esto son los parches transdér-
micos, por ejemplo, Duragesic (fentanyl) o Butrans (buprenorphine).

Tire las medicinas extras a la basura:
1. Remueva o tache su nombre y el nombre de la medicina en la etiqueta.

2. Mezcle medicina con agua o refresco y añada una sustancia indeseable como arena
para gatos, tierra, especies en polvo, o granos de café

3. Cierre y selle los frascos de medicina con una cinta fuerte.

4. Ponga los frascos sellados en una caja o bolsa que no sea transparente.

5. Tire la bolsa al basurero un poco antes de que recojan la basura.

Lugares en la comunidad que recibirán sus medicinas:
*Por favor comuníquese con cada lugar antes de llevar sus medicinas para asegurarse
que aceptarán sustancias controladas.

1. Ubicación de buzón

Walgreens- por la Walnut Ave y Court St. (559) 635-7810

2. Eventos de recolección de medicina

El evento “Got Drugs” por parte del Drug Enforcement Administration (DEA, por sus
siglas en inglés). Sucede un sábado en abril y en octubre de cada año.

Llame al departamento de policía de Visalia (559) 734-8116 o a la ciudad de Visalia al
(559) 713-4531 para más información.

¿No vive en Visalia? Encuentre su programa local de devolución o envío por correo en:

3. Número telefónico de DEA Office of Diversion: 1-800-882-9539

En línea: www.deadiversion.usdoj.gov/drug_disposal/takeback/

4. Número telefónico para el National Safety Council: 1-800-621-7615

En línea: www.NSC.org/disposalresources

42 | www.kaweahdelta.org

CONOZCA A SU PERSONAL DEL HOSPITAL

Todos los empleados de Kaweah Delta (médicos, enfermeras, residentes médicos y
personal) visten su identificación con foto de manera destacada. Aunque aseguramos
las instalaciones, le pedimos que primero avise a una enfermera por la luz de llamada
y luego interrogue a cualquier persona desconocida para usted que ingrese entre a su
cuarto de hospital o sala de examen sin una tarjeta de identificación con foto. Kaweah
Delta Medical Center es un centro médico académico y un hospital educativo, por lo
que un equipo de médicos lo atenderá y es posible que vea a muchos médicos.
A lo largo de su atención médica, se pondrá en contacto con muchas personas. Se
espera que todos los empleados, incluidos los médicos, se presenten, le hagan saber qué
función tienen en su atención médica, qué planean hacer, cuándo van a hacerlo, qué
efecto tendrá en usted y qué esperar después. Si tiene alguna pregunta, por favor no
dude en preguntar.
Médicos: Su equipo de médicos está dirigido por un médico tratante, que está a cargo
de su cuidado. Los médicos, incluido el médico tratante, pueden rotar dentro y fuera de
su atención. En otras palabras, los residentes y su médico tratante pueden cambiar du-
rante su estadía y puede resultar en que su tratamiento s por parte de muchos médicos.
Nuevos médicos se presentarán a medida que se unan al equipo. Cada médico de su
equipo contribuye a su cuidado; y, como paciente, está contribuyendo a la educación y
capacitación de futuros médicos.
Los Residentes son doctores que recientemente se graduaron de la escuela de medici-
na. Trabajan bajo la guía de un médico tratante. Como paciente, usted está contribuyen-
do a la educación y capacitación de futuros médicos.

www.kaweahdelta.org | 43

CONOZCA A SU PERSONAL DEL HOSPITAL

Las Enfermeras Registradas brindan un vínculo crítico entre el paciente y el equipo
de atención médica. Además de contribuir a su cuidado, las enfermeras comunican
sus necesidades a sus médicos y otros miembros del equipo y le informan sobre sus
medicamentos, tratamiento en el hospital y la atención domiciliaria posterior a la hos-
pitalización. Las enfermeras registradas también supervisan a otros trabajadores de la
salud, como los socios de atención, para garantizar que se satisfagan sus necesidades de
comodidad e higiene.

Las Enfermeras a Cargo asumen un papel de liderazgo en las operaciones cotidianas
de una unidad de enfermería. Pueden servir como un recurso para usted si necesita
asistencia adicional.

Los Gerentes de Enfermería/Directores de Enfermería son líderes que son respons-
ables de los resultados clínicos y el servicio que se brinda en su unidad. Proporcionan
dirección, supervisión y apoyo de los médicos.

Los Farmacéuticos son miembros importantes de su equipo de atención médica, prepa-
ran meticulosamente los medicamentos y controlan el tratamiento farmacológico para
determinar la efectividad, los posibles efectos secundarios, las alergias y las posibles
interacciones entre alimentos y medicamentos.

Los Capellanes (559) 624-2263 son parte de su equipo de atención médica y están
disponibles para reunirse con usted para apoyar sus necesidades de atención espiri-
tual durante su estadía. Los Capellanes pueden escuchar sus inquietudes, compartir
sus luchas de fe, ayudarlo a usted y a los miembros de su familia a buscar paz interior
y fortaleza, y traerles escrituras o escrituras sagradas de su tradición de fe específica.
También pueden ayudarlo a acceder / recibir sacramentos religiosos, ayudarlo a ponerse
en contacto con líderes religiosos de su tradición de fe y / o ayudar con otras necesi-
dades espirituales. Si desea una visita del capellán de su unidad, informe a su enfermera
o llame al Departamento de Cuidado Espiritual.

Los Administradores de Casos (559) 624-2235 trabajan con usted, su familia y su
equipo de atención médica para coordinar su estadía en el hospital. También están dis-
ponibles para ayudar con la planificación y la coordinación de su transición del hospital a
la casa o a otras instalaciones de cuidado.

Los Defensores de la Descarga trabajan en colaboración con los administradores de
casos para ayudarlo a trasladarse a un centro de atención continua u hogar. Su objetivo
es que tenga una transición exitosa fuera del hospital y que lo apoye en su camino hacia
una mejor salud.

Los Trabajadores Sociales pueden ayudarlo a usted y
a los miembros de su familia con cualquier problema
personal, emocional y / o familiar y dificultades debido
a su enfermedad o lesión. Se pueden organizar apoyo
individual, familiar y de grupo para enfermedades
repentinas, separación del hogar y del trabajo, duelo,
abuso de sustancias, violencia doméstica y otros asun-
tos, así como referirlo a recursos comunitarios.

Los Dietistas trabajan estrechamente con su equipo
de cuidado médico y se aseguran de que esté reci-
biendo el equilibrio adecuado de comidas nutritivas
durante su estadía.

44 | www.kaweahdelta.org

SU COMODIDAD

SEGURIDAD
(559) 624-5597

Si tiene preguntas o inquietudes sobre la segu-
ridad al visitar pacientes, de día o de noche, por
favor
cumuníuese con Seguridad.

SERVICIO DE ESTACIONAMIENTO
Los servicios de estacionamiento se encuentran
en nuestra entrada Mineral King y son gratuitos
para pacientes y visitantes

Horario: 9 a.m.-6 p.m. Lunes-Viernes; 11 a.m.-
7 p.m. Sábado-Domingo

Para recuperar un vehículo estacionado con
este servicio fuera del horario de atención,
llame a Seguridad al (559) 624-5597.

HAGAR DE CUIDODOS TEMPORALES
(559) 624-2396

Las personas cuyos seres queridos están hos-
pitalizados y no tienen un lugar donde alojarse
pueden calificar para alojamiento para mantenerlos cerca gracias a una asociación comu-
nitaria forjada por Visalia Rotary Clubs y Kaweah Delta Health Care District. Póngase en
contacto con un trabajador social para evaluar la disponibilidad.

SERVICIOS DE CAPELLÁN
(559) 624-2969

Brindamos servicios interreligiosos de capellanes entrenados. El cuidado espiritual
atiende a personas de todas las religiones, incluida la consejería no religiosa para perso-
nas sin una tradición de fe. No tiene que abstenerse de su camino espiritual durante su
estadía en Kaweah Delta.

SERVICIOS FINANCIEROS
(559) 624-4200

Nos comprometemos a cumplir con nuestra misión
de proporcionar servicios de atención médica de
alta calidad, orientados al cliente y financieramente
fuertes para satisfacer las necesidades de las per-
sonas a quienes servimos. Si tiene preguntas sobre
cobertura, asistencia financiera o cómo pagar su
factura, llámenos.

REGISTROS MÉDICOS
(559) 624-2218

Un paciente, o su representante legal, puede inspeccionar y/o obtener una copia de sus
registros médicos, o pedir que se envíen copias de los registros médicos a otra insta-
lación. Para obtener información sobre registros médicos, llámenos.

www.kaweahdelta.org | 45

SU COMODIDAD

INTÉRPRETES
(559) 624-5902

Las diferencias de idioma nunca deben ser una barrera para la atención médica de
calidad. Contamos con intérpretes para más de 150 idiomas diferentes que representan
a pacientes sin costo.

ACCESO AL INTERNET
Kaweah Delta ofrece internet inalámbrico. Para conectarte al Internet, busque la red de
“guest”. No se requiere contraseña.

HORAS DE VISITA
Horario: 8 a.m.-9 p.m.

No se permiten niños menores de 13 años en las unidades de cuidado del paciente.
Puede solicitar una excepción poniéndose en contacto con la seguridad.

FARMACIA MINORISTA
(559) 624-4880

Kaweah Delta brinda servicios de prescripción a
los pacientes y brinda a la comunidad una farmacia
minorista que se encuentra a pasos del hospital,
donde las personas pueden obtener sus recetas de
manera conveniente.

Horario: 9 a.m.-5: 30 p.m. Lunes-Viernes; Cerrado:
Sábado-Domingo

CENA CASUAL
Cafetería
Ubicación: Primer piso de Mineral King Wing

Siren Grill
Ubicación: El Siren Grill se encuentra al lado oeste de la entrada Acequía. Está estacio-
nado al lado este del estacionamiento.

Horario: 5:30 a.m.-7 p.m. daily

DE COMPRAS EN KAWEAH DELTA
Tienda de Regalos Courtyard
Ubicación: al lado del lobby Mineral King

Horario: 10 a.m.-8 p.m. Lunes-Viernes; 10
a.m.-4 p.m. Ságado-Domingo

Guardería
Ubicación: Tercer piso del ala Acequia

Horario: 9 a.m.-4: 30 p.m. Lunes-Viernes;
Cerrado: Ságado-Domingo

46 | www.kaweahdelta.org

DERECHOS Y RESPONSABILIDADES

USTED TIENE EL DERECHO A:
1. Recibir una atención considerada y respetuosa, y a sentirse cómodo. Usted tiene derecho a
ser respetado por sus valores, creencias y preferencias culturales, psicosociales, espirituales y
personales.

2. Que le avisen de inmediato a un familiar (u otro representante de su elección) y a su propio
médico que ha sido admitido en el hospital.

3. Saber el nombre del profesional de atención médica certificado que actúa en el marco de su
certificación profesional y que tiene la responsabilidad principal de coordinar su atención, y los
nombres y las relaciones profesionales de los médicos y empleados de salud que lo verán.

4. Recibir información acerca de su estado de salud, diagnóstico, prognosis, tratamiento,
posibilidades de recuperación y resultados de la atención (incluidos los resultados no esper-
ados) con términos que usted pueda comprender. Tiene derecho a tener una comunicación
efectiva y participar en el desarrollo e implementación de su plan de atención.

También puede participar en cuestiones éticas que surjan durante su atención, incluidos te-
mas sobre resolución de conflictos, negación a recibir servicios de resucitación, y continuación
o retiro del tratamiento para mantener la vida.

5. Tomar decisiones sobre su atención y recibir toda la información sobre cualquier tratamien-
to o procedimiento propuesto que pueda necesitar para dar su consentimiento informado
o negarse al tratamiento. Excepto en casos de emergencia, esta información incluirá una
descripción del procedimiento o tratamiento, los riesgos médicamente significativos que
implican, los tratamientos alternativos o no tratamientos, y los riesgos que cada uno incluye, y
el nombre de la persona que realizará el procedimiento o tratamiento.

6. Solicitar o negarse a recibir tratamiento, en la medida que lo permita la ley. Sin embargo,
usted no tiene derecho a exigir tratamientos o servicios inadecuados o que no sean médica-
mente necesarios. Tiene derecho a abandonar el hospital incluso en contra de la recomen-
dación de los miembros del personal médico, en la medida que lo permita la ley.

7. Ser notificado si el hospital o el profesional de atención médica certificado que actúa en el
marco de su certificación profesional proponen participar o realizar experimentos en humanos
que afecten su atención o tratamiento. Tiene derecho a negarse a participar en tales proyec-
tos de investigación.

8. Recibir respuestas razonables a toda solicitud razonable que realice sobre los servicios.

9. Recibir una evaluación y un control adecuados de su dolor, información sobre el dolor y me-
didas para el alivio del dolor, y a participar en decisiones acerca del control del dolor. También
puede solicitar o rechazar el uso de cualquiera o de todas las modalidades para aliviar el dolor,
incluidos los medicamentos opiáceos si sufre de dolor crónico grave persistente. El médico
puede negarse a recetar medicamentos opiáceos, pero si es así, debe informarle a usted que
existen médicos que se especializan en el tratamiento del dolor con métodos que incluyen el
uso de opiáceos.

10. Formular instrucciones anticipadas. Esto incluye designar a una persona que tome las
decisiones si usted no puede comprender un tratamiento propuesto o si no puede comunicar
sus deseos con respecto a la atención. El personal y los profesionales de la salud que propor-
cionan atención en el hospital cumplirán dichas instrucciones. Todos los derechos del paciente
se aplican a la persona que tiene la responsabilidad legal de tomar las decisiones relacionadas
con la atención médica en su nombre.

www.kaweahdelta.org | 47

DERECHOS Y RESPONSABILIDADES

11. Que su privacidad sea respetada. La discusión del caso, las consultas, los exámenes y el
tratamiento son confidenciales y se deben realizar con discreción. Tiene derecho a que le
indiquen la razón de la presencia de cualquier persona. También tiene derecho a que las visitas
se retiren antes de un examen y cuando se habla de temas relacionados con el tratamiento. Se
usarán cortinas para privacidad en habitaciones semiprivadas.

12. Recibir tratamiento confidencial de todas las comunicaciones y registros relacionados
con su atención y permanencia en el hospital. Usted recibirá un “Aviso sobre prácticas de
privacidad” (Notice of Privacy Practices) por separado que explica en detalle sus derechos a la
privacidad y cómo podemos utilizar y divulgar la información protegida sobre su salud.

13. Recibir atención en un entorno seguro, donde no haya abuso mental, físico, sexual ni ver-
bal, ni tampoco abandono, explotación o acoso. Usted tiene derecho a acceder a servicios de
protección y defensa, lo que incluye notificarles a las agencias del gobierno sobre abandono o
abuso.

14. No tener restricciones ni estar aislado de ninguna forma por decisión del personal como
medio de coerción, disciplina, conveniencia o represalia.

15. Recibir una atención razonablemente continua y saber por adelantado la hora y el lugar de
las citas, así como también la identidad de las personas que proporcionan la atención médica.

16. Ser informado por el médico, o un representante del médico, de los requisitos y opciones
de atención médica continua luego de ser dado de alta del hospital. También tiene derecho a
participar en el desarrollo e implementación de su plan para ser dado de alta. Si lo solicita, un
amigo o un familiar también pueden recibir esta información.

17. Conocer las reglas y políticas del hospital que se aplican a su conducta mientras sea paci-
ente del hospital.

18. Designar un acompañante así como también visitas que usted elija, si tiene la capacidad de
tomar decisiones, independientemente de que la visita sea un familiar de sangre, por matrimo-
nio o una pareja de hecho registrada, a menos que:

• No se permitan visitas.

• El establecimiento determine de manera razonable que la presencia de una visita en
particular podría poner en peligro la salud o la seguridad de un paciente, de un miembro
del personal del establecimiento de salud o de otras visitas en el establecimiento, o podría
interrumpir de manera significativa las funciones de dicho establecimiento.

• Usted le haya notificado al personal del establecimiento de salud que ya no desea que una
persona determinada lo visite.

Sin embargo, un establecimiento de salud puede establecer restricciones razonables para
las visitas, incluidas restricciones sobre los horarios de visita y la cantidad de personas.
El establecimiento de salud debe informarle a usted (o a su acompañante, cuando corre-
sponda) sobre sus derechos de visita, incluidas las restricciones o limitaciones clínicas. El
establecimiento de salud no puede restringir, limitar o, de otro modo, negar los privilegios
de visita por razones de raza, color, nacionalidad, religión, sexo, identidad de género, orient-
ación sexual o discapacidad.

19. Que sus deseos sean tenidos en cuenta si no tiene la capacidad de tomar decisiones
para determinar quién lo puede visitar. El método de dicha consideración cumplirá con la ley

48 | www.kaweahdelta.org

DERECHOS Y RESPONSABILIDADES

federal y se divulgará en las políticas del hospital sobre las visitas. Como mínimo, el hospital
incluirá toda persona que viva en su hogar y acompañante de conformidad con la ley federal.

20. Evaluar y recibir una explicación de la cuenta del hospital, independientemente de la
fuente de pago.

21. Ejercer estos derechos sin importar su sexo, situación económica, nivel de educación, raza,
color, religión, ascendencia, nacionalidad de origen, orientación sexual, identidad/expresión de
género, discapacidad, condición médica, estado civil, edad, concubinato registrado, infor-
mación genética, ciudadanía, idioma primario, estatus migratorio (excepto según lo requerido
por ley federal) o la fuente de pago para su atención médica.

22. Presentar una queja. Si desea presentar una queja con este hospital, puede hacerlo por
escrito o por teléfono (nombre, dirección y número de teléfono del hospital):

Kaweah Delta Health Care District Risk Management Department
400 W. Mineral King Ave., Visalia, CA 93291

Telephone: (559) 624-2340

El comité de quejas analizará cada queja y le dará una respuesta por escrito dentro de 30 días.
La respuesta por escrito incluirá el nombre de la persona con la que debe comunicarse en el
hospital, las medidas tomadas para investigar la queja, los resultados del proceso conciliatorio,
y la fecha de finalización del proceso conciliatorio. Las inquietudes relacionadas con la calidad
de la atención o el haber sido dado de alta prematuramente también se derivarán a la Orga-
nización de Revisión Profesional de la Utilización y Calidad de los Servicios (Utilization and
Quality Control Peer Review Organization [PRO]) correspondiente.

23. Presentar una queja en el Departamento de Salud Pública de California (California Depart-
ment of Public Health, CDPH), independientemente de que utilice el proceso de quejas del
hospital. El número de teléfono y la dirección del Departamento de Salud Pública de California
son: (dirección local y número de teléfono del CDPH)

California Department of Public Health
1200 Discovery Plaza, Suite 120
Bakersfield, CA 93309

Telephone: (661) 336-0543

The Joint Commission, Division of Accreditation Operations, Office of Quality Monitoring
One Renaissance Boulevard
Oakbrook Terrace, IL 60181

Telephone: (800) 994-6610 | Fax: (630) 792-5636

E-mail: [email protected]

These Patient Rights combine Title 22 and other California laws, The Joint Commission and
Medicare Conditions of Participation requirements. (3/17)

California Hospital Association • 1215 K Street, Suite 800 • Sacramento, CA 95814
(916) 443-7401 • www.calhospital.org

www.kaweahdelta.org | 49

SKILLED NURSING & REHAB FACILITIES

Skilled Nursing Facilities are licensed by the Department of Health Services and have to
meet the inspection and regulation requirements.

A er a major surgery or treatment at a hospital for an illness, the patients are referred to
a skilled nursing facility for rehabilitation.

SOME CONDITIONS THAT REQUIRE A TRANSFER TO A SKILLED NURSING
FACILITY OR REHAB INCLUDE:
• Stroke or brain injuries

• Knee or leg surgeries

• oint replacement surgeries for hip, shoulder or knee

• Other medical conditions including Alzheimer s or Parkinson s

Any illness that leads to loss of mobility or surgery related care that cannot be managed
at home can lead to transfer to a skilled nursing facility. When illnesses have a long re-
covery period and the patient does not have help at home or certain chronic conditions
including breathing problems can also necessitate the use of rehab facilities.

Skilled nursing facilities involve trained specialists who can assist in rehabilitating the
patient.

SOME SERVICES INCLUDE:
• Wound care, dressing and medicine management

• Physiotherapy to strengthen muscles and aid in regaining mobility. Certain brain inju-
ries require relearning activities like climbing, walking, si ng or eating

• Occupational therapy

• Specialized therapists to assist in problems with speech or swallowing

FACTORS TO CONSIDER WHEN CHOOSING A NURSING CARE FACILITY
• Check for licenses and certification to provide Medicare coverage

• Location of the facility

• Number of specialists, their qualifications and expertise

• The kind of services provided by the facility

• Check for cleanliness of the surroundings, linen and other equipment

• Ask if food is provided according to the dietary requirements

• Check if the facility has a quality assurance program and protocols in place

• See if the facility has well maintained rooms with all amenities

• Check if the facility focused on ge ng you back on your feet as soon as possible

The best skilled nursing facility is one which helps you get back to your normal routines
as quickly and comfortably as possible.

50 | www.kaweahdelta.org


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