South Texas Veterans Health Care System

Patient Information Handbook South Texas Veterans Health Care System

I would like to welcome you to the South Texas Veterans Health Care System (STVHCS). The STVHCS is comprised of two medical centers, Audie L. Murphy Division in San Antonio and Kerrville Division in Kerrville, satellite clinics in Corpus Christi, Harlingen, Laredo, McAllen, Victoria and San Antonio and community based outpatient clinics throughout South Texas.

Our employees are dedicated to working toward one purpose – providing you the best possible health care. We welcome the opportunity to serve you, as you are the most important person in our medical center.

We hope that this “Patient Information Handbook” will answer most of the questions you may have and help you feel more comfortable with the services provided by the STVHCS. We encourage your comments and suggestions on how we can improve the care we provide to you. Your input will help us to continue to meet our goal of providing quality health care.

Sincerely,

Marie L. Weldon, FACHE Director

Mission

The mission of the South Texas Veterans Health Care System (STVHCS) is to improve the health and quality of life of our patients providing appropriate, compassionate and quality care, to conduct education and research activities, and to support the Department of Defense.

Vision

The vision of the STVHCS is to be the health system of choice for all veterans and all other eligible beneficiaries and to be recognized as a center of excellence and an employer of choice.

Values

The values of the STVHCS are: . Commitment . Compassion . Ethics . Excellence . Integrity . Innovation . Respect Innovation . Integrity . Trust

Table of Contents

Admission to the Medical Center 18 Advance Directives 16 Barber 26 Benefit Counselors 33 Billing (Revenue OFFICE/MCCF) 27 Chaplain Service 33 Clinic Appointments 27 Clothing 22 Dedicated Acute-assessment Rapid Response Team (DARRT) 19 Dental Service 34 Depression 14 Diabetes Education 34 Discharge from the Medical Center 18 End of Life Information 17 Escort Service for Cognitively Impaired Veterans 37 Ethics Advisory Committee 15 What do I do if I have an Ethical Issue? 16 Extended Care Services 20 Falls-Prevention of 42 Hand Hygiene 23 Identification Arm Bands 22 Infection Control 23 Laboratory Hours 28 Lodging 28 Lost items 25 Medication 23 Medical Administration Service 29 MyHealtheVet Website 31 Nutrition Service (Meals) 29 Off-Unit Notification 22 Organ Donation 17 Pain Management 15 Parking 25 Patient Advocate 34 Patient Education Resource Center (PERC) 30 Patient Rights and Responsibilities 11 Patient Travel 31 Personal Items 22 Pharmacy 35 Police Notification Procedure 41 Primary Care 35 Prohibited Articles 21 Recreation 35 Release of Information 32 Respiratory Therapy 36 Restraints 41 Safety 39 Social Workers 36 Spinal Cord Injury Unit 36 Staying Healthy 42 Telecare Services 32 Telecommunication Device for the Deaf 37 Telephones 25 Valuables 21 VA Shuttle Service 27 Veterans Canteen Retail Store and Food Court 32 Visiting Hours 26 Visual Impairment Services Team (VIST) 37 Voluntary Service 38 Weight Management 42 Women Veterans Program 38 South Texas Veterans Health Care System

Audie L. Murphy Division (ALMD) Medical Center

7400 Merton Minter Blvd. Emergency Open 24 hours San Antonio, TX 78229

Phone: (210) 617 5300 Toll free: (866) 560 6773

Kerrville Division (KD) Medical Center

3600 Memorial Blvd. Urgent Care open 24 hours Kerrville, TX 78028

Phone: (830) 896 2020 Toll Free: (866) 487 1653

Frank M. Tejeda VA Outpatient Clinic

5788 Eckhert Rd. San Antonio, TX 78240 Phone: (210) 699 2100

South Bexar Outpatient Clinic

4610 East Southcross Blvd. Suite 100 San Antonio, TX 78222 Phone: (210) 648-1491

North Central Federal Health Clinic

17440 Henderson Pass San Antonio, TX 78232 Phone: (210) 483 2900

Victoria VA Outpatient Clinic

1502 East Airline, Suite 40 Victoria, TX, 77901 Phone: (361) 582 7700

Community Based Outpatient Clinics (CBOC)

Note: STVHCS Fee Services Section must assign Veterans a contract CBOC. Prior to seeking care, please call the following: CBOC care in the San Antonio Area: Call (210) 949 3453. All other CBOC care: Call (210) 949 3753. You can also call the Telecare Nurse for information about CBOCs in your area at (210) 949 3994 or from anywhere in Texas (888) 686 6350.

Frequently called Numbers or Extensions

San Antonio Kerrville

Main Hospital Number (210) 617 5300 (830) 896 2020 Toll free (877) 469 5300

Telecare (210) 949 3994 Toll Free (888) 686 6350 (Health Information 24 Monday – Friday (Days) Weekends, after hours & hours/day) holidays

Automated Medication (800) 209 7377 (800) 209 7377 Refill Program

Admissions Ext 14800 (830) 792 2512

Agent Cashier Ext 15995 (830) 792 2550

Appointments/Scheduling Ext 15173 (830) 792 4444

Beneficiary Travel Ext 15999 (830) 792 2418

Billing/Insurance Information Ext 15269 (830) 792 2435

CHAMPVA (210) 616-8130 (210) 616-8130

Chaplain Ext 15441 (830) 792 2542

Dental (210) 949-8900 (830) 792 2461

Disabled American Veterans Ext 15189 (830) 792 2509

Eligibility Ext 15184 (830) 792 2514

Home Health & Extended Care (210) 617 5115 (830) 792 2645

Laboratory Ext 14996 Ext 12330

San Antonio Kerrville

Medical Administration Ext 15137 Ext 12113

Palliative Care (210) 617 5115 (830) 7922484

Paralyzed Veterans of America Ext 15275 Call ALMD 15275

Patient Representative Ext 1514 (830)792 2414

Pharmacy Ext 15174 (830) 792 2422

Police Ext 15224 (830) 792 2520

Release of Information Ext 15610 (830) 792 2503

Respiratory Therapy Ext 14877 Ext 12249

Shuttle Ext 15999 Ext 12418

Social Work Ext 15113 (830) 792 2462

Texas Veterans Commission Ext 15175 (830) 792 2553

TRICARE (210) 616-8408 (210) 616-8408

Voluntary Service Ext 15107 (830) 792 2580

Women Veterans Program Ext 68181 Ask operator to page Janeth Del Toro

Patient Rights and . You or someone you choose have Responsibilities the right to keep and spend your own money. You have the right to Veterans Health Administration (VHA) receive an accounting of VA held is pleased you have selected us to funds. provide your healthcare. We want to . Treatment will respect your improve your health and well-being. personal freedoms. In rare cases, We will make your visit or stay as the use of medication and physical pleasant for you as possible. As part restraints may be used if all other of our service to you, to other veterans efforts to keep you or others free and to the nation, we are committed to from harm have not worked. improving healthcare quality. We also . As an inpatient or long-term care train future healthcare professionals, resident you may wear your own conduct research and support our clothes and keep personal items. country in times of national This depends on your medical emergency. In all of these activities, condition. our employees will respect and . As an inpatient or long-term care support your rights as a patient. resident, you have the right to Respect and Nondiscrimination social interaction, and regular . You have the right to be free from exercise. You will have the mental, physical, sexual and verbal opportunity for religious worship abuse, neglect and exploitation. and spiritual support. You may . You will be treated with dignity, decide whether or not to participate compassion and respect as an in these activities. individual. . As an inpatient or long-term care . Your privacy will be protected. You resident, you have the right to will receive care in a safe communicate freely and privately. environment. We will seek to honor You may have or refuse visitors. your personal and religious values You have access to public and beliefs.

11 telephones. You may participate in Your medical record will be kept civic rights. confidential. Information about you . As a long-term care resident, you will not be released without your can organize and take part in consent unless authorized by law resident groups at the facility. Your (i.e. State public health reporting). family also can meet with the You have the right to information in families of other residents. your medical record and may . In order to provide safe treatment request a copy of your records. environment for all patients and This will be provided except in rare staff you are asked to respect other situations where your VA physician patients and staff and to follow the feels the information will be harmful facilities rules. Avoid unsafe acts to you. In that situation, you have that place others at risk for the right to have this discussed accidents or injuries. Please with you by your provider. immediately report any condition You will be informed of all you believe to be unsafe. outcomes of care, including any Information Disclosure and injuries caused by your medical Confidentiality care. You will be informed about You will be given information about how to request compensation for the health benefits that you can injuries. receive. The information will be Informed consent is obtained. provided in a way you can Consent is obtained for recording understand. or filming made for purposes other You will receive information about than the identification, diagnosis, or the costs of your care, if any, treatment of the patients. before you are treated. You are Participation in Treatment responsible for paying for your Decisions portion of the costs associated with • You and any persons you choose your care. will be involved in all decisions about your care. You will be given

12 information you can understand (including over the counter and about the benefits and risks of herbals) and medical history. Also, treatment. You will be given other share any other information that options. You can agree to or affects your health. You should refuse treatment. Refusing ask questions when you don’t treatment will not affect your rights understand something about your to future care but you have the care. This will help in providing responsibility to understand the you the best care possible. possible results to your health. If You have the right to have your you believe you cannot follow the pain assessed and to receive treatment plan you have a treatment to manage your pain. responsibility to notify the treatment You and your treatment team will team. develop a pain management plan As an inpatient or long-term together. You are expected to help resident, you will be provided any the treatment team by telling them transportation necessary for your if you have pain and if the treatment plan. treatment is working. You will be given, in writing, the You have the right to choose name and professional title of the whether or not you will participate provider in charge of your care. As in any research project. Any a partner in the healthcare process, research will be clearly identified. you have the right to be involved in Potential risks of the research will choosing your provider. You will be identified and there will be no be educated about your role and pressure on you to participate. responsibilities as a patient. This You will be included in resolving includes your participation in any ethical issues about your care. decision-making and care at the You may consult with the Medical end of life. Center’s Ethics Committee and/or Tell your provider about your other staff knowledgeable about current condition, medicines health care ethics.

13 If you or the Medical Center You will not be penalized or retaliated believes that you have been against for filing a complaint. neglected, abused or exploited, you will receive help. Depression Complaint The next time you visit your health . You are encouraged and expected care provider, before you say, “I’m to seek help from you treatment fine”: team and/or patient advocate if you Ask yourself if you feel: have problems or complaints. You . Nervous or empty will be given understandable . Guilty or worthless information about the complaint . Very tired and slowed down process available to you. You may . You don’t enjoy things the way complain verbally or in writing, your used to without fear of retaliation. . Restless or irritable . You have a right to access . Like no one loves you protective and advocacy services. . Like life is not worth living Contact Social Services for a list of Or if you are: advocacy groups available. . Sleeping more or less than usual If you are concerned that your privacy . Eating more or less than usual rights have been violated, you may file . Having persistent headaches, a complaint to VHA or to the Secretary stomach aches or chronic pain of the U.S. Department of Health and These may be symptoms of Human Services. To file a complaint depression, a treatable medical illness. with VHA you may contact your VA health care facility Privacy Officer, the Your doctor can only treat you if VHA Privacy Officer, or VHA via you say how you are really feeling! http://www.va.gov or dial 1-877-222- 8387. Complaints do not have to be in writing, though it is recommended.

14 Pain Management Concerned health care providers Pain is a very personal experience and who are committed to pain may be different for everyone. The prevention and management and health care team (doctors, nurses, respond quickly to your reports of pharmacists, therapists) wants to work pain and who believe your reports with you to manage your pain. of pain. Remember to Use the Pain Scale Tell your healthcare provider: 0 - no pain - 10 - worst possible pain How much it hurts; 0 1 2 3 4 5 6 7 8 9 10 Where it hurts; How the pain feels…sharp, dull, burning, aching or tingling; When the pain started;

What makes the pain better;

What makes the pain worse; Ethics Advisory Committee Whether the pain is constant or What are Ethical Issues? whether it comes and goes; Ethical issues can occur when we How the pain affects your daily life; express our values or morals about Past treatments for pain. health care. People who work in the Pain Care Bill of Rights health care profession notice that they As a person with pain, you can occur when we make important expect the following: decisions. We especially notice that Pain management will be part of they occur when we make decisions your treatment plan; about: Information about pain; Informed Consent; Information about different End of Life decisions; methods of pain relief. Appropriate management of pain; Dedicated pain relief specialists Decisions to withhold and/or who provide appropriate state of withdraw life-sustaining treatment; the art pain management

15 Decisions to accept or reject Audie L. Murphy (210) 617-5300 treatment (drug therapy); Kerrville Division (210) 896-2020 Chemotherapy, feeding tubes, Living Will

operations; A Living Will allows you to tell your Decisions about Organ/Tissue doctor what treatments you want if you Donation. cannot talk or make decisions. For example: What do I do if I have an Ethical . Do you want medical staff to use Issue? heroic measures to bring you back Discuss the issue with your physician to life if you suddenly die? or health care provider. Under most . Do you want to be fed artificially if circumstances, your issue can be you are unable to eat and are resolved by talking with your health chronically ill? care team. If the problem is not . Do you want dialysis if your resolved to your satisfaction you can kidneys stop working and you are contact a member of the Ethics team. chronically ill?

Out of Hospital Do Not Resuscitate Advance Directives Order It is important for you to talk with your An Out of Hospital DNR is the same family or significant other about health order written by you and your doctor care treatments you want in case you that states that you desire to die cannot make decisions for yourself. naturally. Veterans usually buy a There are several VA documents that bracelet or necklace that they wear so you can fill out that will help your that Emergency Medical Services staff doctor and health care team know will know that they desire to die what treatments you want if you ever naturally and not be resuscitated. Talk get very sick and are not able to talk or with your VA Primary Care Provider make sense to others. about a Texas Out of Hospital DNR The On-Call Ethics Team Member can form and how to fill it out. Note: A be contacted through the operators at: copy of the VHA Advance Directive

16 Form is located at the back of the Organ Donation handbook. Veterans Health Life-Threatening Emergency Care Administration Policy In Behavioral Health and Long Term supports the Veteran’s Care Settings emergency care, to right to be an organ donor. Routinely include first aid and basic life support you will be asked if you are an organ (cardio-pulmonary resuscitation) will donor: be provided within the hospital system. Facts about organ donation: You will be treated immediately on the . Veterans of all ages are possible unit to which you are assigned. If you donors. A decision to donate does require a higher level of care, you will not change the high quality care be transferred to an acute you receive. medical/critical care unit or the Urgent . Organs and tissues that can be Care Department at your facility or donated are: heart, kidneys, bones, another organization as appropriate. intestines, ligaments, tendons, heart valves, eyes, liver, pancreas “End of Life” Information and skin. For information on burial benefits . All major religions approve of organ such as VA cemeteries, and tissue donation. . Your family does not pay any cost headstones, burial flags, if you donate organs or tissues. transportation & reimbursement . Donating does not interfere with a of expenses contact the VA funeral, nor does it change the look Detail Office: of the body. Audie L. Murphy . Organ donation gives someone (210)617-5300 ext. 15656 else a second chance at life. . At the time of death, the Texas Kerrville Organ Sharing Alliance decides if (830) 896-2020 ext. 12113 organs or tissues can be used.

17 What to do: All Admissions report to the . Talk to your family about being an Admission/Outpatient Area (Room 112 organ and tissue donor. on first floor). . On admission to the hospital, patients are asked if they are an Discharge from the Medical organ donor. By signing a release Center of information for organ donation, Patient Discharge Planning you are giving permission that the We realize that one of the first things Texas Organ Sharing Alliance be most people think about when they’re contacted at the time of death. admitted is when they get to go home. For more information contact the Getting you well enough to leave the Texas Organ Sharing Alliance at hospital is our goal too. It is important (210) 614-7030 or the Organ Donor for you and your family to understand Referral Line at 1-800-275-1744. the plans for your discharge from the

hospital. The information below will Admissions to the Hospital help you plan for your discharge. If you have questions or concerns Don’t hesitate to ask if you have anytime during your stay at the questions. Medical Center, ask a member of your Preparation for Discharge health care team. They can help you Your doctor will tell you and your care find just the right person to address team a likely date for leaving the your needs. hospital. It is possible that this date Audie L. Murphy (ALMD) may change depending on your Monday - Friday 8AM - 4:30 PM progress, test results, etc. You will be Go to Station 6 (first floor near the given written discharge instructions on Urgent Care/Triage area) the day of your departure. These After-hour Admissions discharge instructions will include Go to Station 1 (first floor near the information on: Urgent Care/Triage area) Kerrville Division Admissions:

18 Medications that you are to After you go home continue or to begin taking after Follow the instructions you were you leave the hospital; given by your doctor and nurse. Special instructions on how to care Take your medicines as you were for yourself when you leave the told. hospital; If you were given a number to call Follow-up care, such as doctor to make an appointment, call as appointments or therapy. soon as you can. It is important that you review and understand the information on the Dedicated Acute-assessment discharge instructions. Please ask Rapid Response Team questions of your doctor or nurse if (DARRT) there is something that you do not Communicating effectively with understand. patients and families is very important Day of Discharge to South Texas Veterans Health Care Discharge time is typically 11:00 System. When families see a change AM. We appreciate your in the patient’s condition, for example assistance in respecting this time something just doesn’t seem right, the schedule to enable your room to be patient or family can call for the ready for the next patient. DARRT team. DARRT stands for Make sure you have all of your “Dedicated Acute-assessment Rapid personal belongings. Response Team.” This is what you are Please let your nurse know if you to do: need help arranging transportation. Pick up the phone in the patient’s Be sure to stop at the nurse’s desk room. and let the staff know that you are Call 15555 for the operator. leaving at the time of discharge. The patient or family will say… “I The phone number of the Telecare am a family member of (Mr. nurse in case you have questions. Jones). I need the DARRT team. I

am on the (5th) floor in room

19 number (517).” (The items in 1. Home Health Care: If you need parentheses are just examples, skilled care in the home, the doctor please use your family members may write an order for the VA to name and floor/room number). arrange home health care. This is Hang up the phone when finished usually needed when you have a speaking to the operator. wound that you need to learn to take This is what you can expect to care of, need to be educated about a happen: new disease or have a health problem A Registered Nurse from the ICU than needs to be monitored. Medicare and a Respiratory Therapist will provides the best home care benefits respond within 10 minutes. for most Veterans. If you don’t have They will be able to help the Medicare benefits, the VA can provide patient. services through other funding.

They may transfer the patient to 2. Home Based Care: This is a ICU if needed or they will assist the program that offers clinic staff to make patient where they are. visits in your home. The nurse, social South Texas Veterans Health Care worker, rehabilitation therapist, System seeks and respects input from dietitian or physician can come to your patients and family members. Thank home. This program is for veterans you for your assistance providing the who have a very difficult time getting to best care to veterans. clinic. In addition, there is an Adult Day Health Care for veterans who need a Extended Care Services special team to help adjust to chronic The VA provides many services to illness and re-integrate into community help veterans in the community. You care. may be referred to one of the following 3. Nursing Home Care: Veterans who programs to help you recover from the are ready to be discharged whose current hospital stay or prevent care cannot be successfully carried re-hospitalization. out at home may be referred to a nursing home. You may be referred to

20 one of the VA’s nursing home care Agent Cashier, ask a staff member to units or to a community nursing home. contact the Agent Cashier: 4. Palliative Care: Veterans who Audie L. Murphy extension 15999 have severe symptoms form chronic Kerrville extension 12250 illness or those who have a terminal Financial Transactions are made by illness may be referred to our Palliative obtaining a withdrawal slip from the Care Program. Palliative care is a Travel Clerk located at ALM Room special kind of care that provides 113 and KD Room 146C. support for people in the final phase of The Agent Cashier may cash the a terminal illness. Palliative Care following: helps patients to live their last days U.S. government checks; with dignity and quality at home or in a Traveler's checks; home-like setting. Certified checks drawn in your

name; For more information about Cashier's checks; discharge planning call: Postal, telegraphic or bank money Audie L. Murphy (210) 617 5115 orders; Kerrville (830) 792 2484 Checks and money orders must be endorsed in the presence of the Valuables Agent Cashier; Personal checks require clearance You are advised to keep all valuables from the bank, which usually takes at home. The Medical Center is not two weeks. responsible for money or other valuables that you might bring and store in your room. We ask that you Prohibited Articles keep no more than $10 cash on hand. Patients are prohibited Any additional money should be from possessing deposited with the Agent Cashier, alcoholic beverages, Monday through Friday except narcotics, firearms, holidays. If you are unable to go to the cameras, ammunition, knives, other

21 weapons, lighter fluid, non-safety Identification Arm Bands matches, straight-edge razors and Upon admission, you will be given an medicine not prescribed by a health ID wristband. Please wear your care provider or medicine from home. wristband at all times. Lost ID Patients possessing any type of wristbands should be reported to the weapon are required to turn them over health care team right away. to the Medical Center Police Service located in the main lobby. Electrical Off-Unit Notification appliances are not permitted except Please remain on the unit so the under unusual circumstances and health care team can find you. You must be inspected prior to use. may request permission to leave the

unit for short periods. If you must Clothing leave, you should notify your nurse All medical and surgical patients are before leaving and when you return. expected to wear VA provided pajamas, robe and slippers or shoes. Personal Items Patients on the Transitional Care You will be assigned a small clothing Units, Extended Care Treatment locker on the unit. If possible, mark Center, and Psychiatry are permitted your possessions with your name. and encouraged to wear their personal Items that do not fit into the locker clothing unless otherwise indicated. should be sent home or stored in the All patients are asked to keep one set Patients’ Clothing Room. Valuables of clothing and footwear with them for should be turned in for safekeeping in discharge. Have personal items with the Patients' Clothing Room or sent you when you check in such as tooth home. The hospital cannot be brush, shaving kit, deodorant and responsible for any valuables you toiletries. keep with you on the unit.

If you are unable to provide your own toilet articles or

other necessities, contact your nurse.

22 Medications proper precautions, germs can easily Tell your doctor about any spread among patients, visitors and medications you are taking. staff. Your cooperation is essential and appreciated. If you brought medications with Hand Hygiene is the best way to stop you, the admitting clerk will give the the spread of germs. Washing hands medications to a relative or with soap and water and/or using significant other so that they can be alcohol-based hand products taken home. All medications not contribute to decreasing infections taken home will be destroyed. among patients in clinics and in All medications will be ordered by hospital settings. As a patient you your doctor and given to you by a should frequently perform hand nurse while in the hospital. hygiene. Family members and visitors It is important that you are at your should wash their hands before bedside to receive medications. entering and when leaving the patient During admission to the hospital, rooms. If hands are clean (no visible your medications might change. dirt, grease or saliva) you are After discharge you should take encouraged to use the alcohol based only those medications prescribed hand products that are placed in the by your doctor as part of your hallways and patient rooms. discharge treatment plan. Be sure

to read the labels carefully. Take

the medicines as directed and do

not stop taking the medicine

without medical advice.

Infection Control

Preventing the spread of infections in the health care setting is everyone’s responsibility. This includes patients, family members and visitors. Without

23 Respiratory Etiquette Program Stop the spread of germs that make you and other sick! If you seek care in the STVHCS and have a cough, the hospital staff will ask you to do the . Clean with alcohol based hand following: cleanser. . Cover your mouth and nose with a tissue when you cough or sneeze;

Note: You make be asked to put on a surgical mask to protect others.

. If you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands;

Please let family and friends know that if they are ill they should not visit or

come with you to the hospital or . Put your used tissue in the trash clinics. If you have any questions can; about the spread of germs and infections that are in the hospital, please ask your nurse or ask to speak to an Infection Control Professional.

. Clean your hands after coughing or sneezing;

. Wash with soap and water or;

24 Parking at STVHCS Lost items At San Antonio (ALMD): If you are admitted to the medical Valet parking is center, contact your nurse if you have available at no charge (tipping is lost something. He/she will provide not allowed). Drive your car to the you with instructions. If you are an main entrance of ALMD and an outpatient and have lost something, employee will assist you. check with the information window in Also, a courtesy passenger cart is the front lobby of ALMD or the available in the ALMD parking lot if operator at the KD. you chose to park your own car. The carts pick up anyone wanting a Telephones ride and deliver them to the main You may receive calls entrance and the ECTC entrance. at your bedside phone There is no parking space available between 8:00 a.m. until 9:00 p.m. each at ALMD for your automobile while day. Patients with disabilities or you are admitted to the hospital. special needs should contact their Please make arrangements for nurse. There is no charge for local safekeeping and storage of your calls. automobile off hospital grounds. Audie L. Murphy Division If you are admitted emergently (not Local calls: Dial 9 + number scheduled), the VA police will allow Long distance: one night of parking. If you need Dial 9 + 0 + area code + number more than one night, contact the Kerrville Division police at ALMD at ext. 15168. Local calls: Dial 7 + number At Kerrville (KD): Long Distance: Both short term and long term Dial 9 + your phone company parking is available at the Kerrville Division. Check with the VA police by the main elevator on first floor of KD or call ext. 12162 or 12210.

25 Visiting Hours who is caring for the safety of the minor. The patient's physician may make exceptions based on age, the patient's best interest, impact on other patients, and the safety of the minor.

The South Texas Veterans Health Intensive Care Units (ICU) and Care System has a liberal visitation Medical-Surgical Units policy in most areas. The hospital Visiting hours allow a family member, allows for the presence of a support friend, or other individual to be present individual of the patient's choice, with the patient for emotional support unless the individuals presence during the course of the day. Mental Health Units: infringes on others rights, safety, or is medically or therapeutically Weekdays- 5:00 p.m. to 8:30 p.m. contraindicated. The individual may or Weekends and Holidays- 1:00 p.m. to may not be the patient's surrogate 8:30 p.m. decision maker or legally authorized Friends may visit in the dayroom or designated areas. Exceptions are representative. The patient's physician can limit or extend the made by the patient's physician and visitation practice. Any limits or noted in the patient's medical record. extensions to visitation will be noted in All visitors are requested to enter and the patient's medical record. exit the hospitals through the main Children under the age of 18 (minors) entrances. may visit if the patient’s nurse determines that the visit is in the best STVHCS Services interest of the patient and the child has Barber no evidence of communicable Barber service is available diseases. A responsible adult must in the barbershop or by making an accompany the minor at all times. A appointment through the unit nurse for responsible adult is defined as a patients confined to their bed. parent or person over the age of 18

26 ALMD barber shop is located in Room If you have any questions about VA 038 (ground level) 7:00 a.m. - 1:00 billing activity, contact the Revenue p.m. and 1:30 p.m. - 3:00 p.m. Office at 210-616-8100. Office Hours Monday – Friday. are: 8:30 a,m. – 4:00 p.m. Monday – KD Barber shop is located in room Friday. 005 (ground level) Tuesday and Thursday 12:30 p.m. - 3:30 p.m. VA Shuttle Service

A no charge VA shuttle runs between Billing (Revenue Office/MCCF) Audie L. Murphy VA Hospital and the The mission of the VA Medical Care Kerrville VA Hospital. Others shuttles Cost Fund (MCCF) Program is to run between FTOPC, Villa Serena, maximize the recovery of funds due and the Outpatient Clinics and Audie VA for the provision of health care L. Murphy Hospital. The shuttle is for services to veterans, dependents and patients who are receiving care. others using the VA system. For more information contact your Legislation has authorized the local VA facility. Revenue Office to: Submit claims to and recover Clinic Appointments payments from veterans’ third party “Don’t Be a No Show” health insurance carriers for Clinic appointments treatment of non-service-connected are prescheduled visits. conditions You should make every Recover co-payments from certain effort to keep your veterans for treatment of non- scheduled appointment. service-connected conditions However, if you must Recover co-payments for reschedule your appointment, please medications from certain veterans contact the appropriate clinic clerk to for treatment of non-service- request a cancellation and obtain connected conditions. another appointment. When reporting for a clinic appointment we ask that

27 you check in no earlier than 15 Laboratory minutes prior to the scheduled Hours for appointment time. Every effort will be Outpatients made to see all patients at their Audie L. Murphy scheduled time; however, in some 7:00 a.m. – 7:00 p.m. Monday - Friday cases due to unforeseen Frank Tejeda OPC circumstances this may not always be 7:30 a.m. – 3:45 p.m. Monday - Friday possible. Kerrville Don’t “walk-in” to the clinic without 7:00 a.m. – 4:30 p.m. Monday - Friday an appointment. If you have an emergency, go the nearest emergency Lodging room. If you feel that you need to be Lodging is available under certain seen before your scheduled circumstances. appointment, you can call the Telecare 1. Lodgers must: nurse or your primary care nurse for advice. Telecare nurses are available Medically clear through Emergency Department 24 hours a day at 1-888-686-6350 or in San Antonio call 210-949-3994. Obtain written clearance (lodging ticket) from ALMD Present lodging ticket at the hotel Interpreter Services desk with ID upon check-in. A list of VA staff members is available 2. Only patients living outside a 50- who are fluent in a variety of mile radius of the ALMD or KD are languages and American Sign eligible for lodging. Exception: Language. Please ask your health Patients scheduled for outpatient care team if you or your family need surgical or medical procedures the the services on an interpreter. following day may be lodged for one

night when medically indicated.

28 3. Lodging is only prior to scheduled Eligibility Reform Act appointments and is usually only for Change of address one night. Update Next of Kin List Exception to the one night stays for Release of information for your lodging medical records Patients scheduled for outpatient Eligibility Questions: contact a surgical or medical procedures Health Benefits Advisor. may be lodged one night prior to Audie L. Murphy – first floor, Station the procedure and one night “7” extension 15184 following the procedure. Kerrville - first floor, Room 112 Radiation and chemotherapy extension 12123 patients who meet the eligibility requirements may lodge more than Nutrition Service (Meals) one night. Meals in the hospital will be 4. When a patient is in need of ordered by your doctor and lodging contact the following: planned by a dietitian. The Admitting Office on first floor, dietitian will be available to

station “6” at ALMD talk with your family about Admissions area at KD the diet ordered for you. Any friend or relative who prepares your meals will Medical Administration be invited to listen to the diet Service instructions. You may request a visit with the The Medical Administration staff is available to assist you with the dietitian by contacting your nurse. following: The unit staff will tell you when and where meals will be served. Eligibility for care Do not keep food that will spoil or Agent Orange Registry attract insects at your bedside. POW Registry Store food in non-breakable Nuclear Testing Examination containers only.

29 Food Preference Program Management, Nutrition, Alcohol Audie- 949-FOOD (3663) and Smoking Cessation, etc); Support groups for veterans and Patient Health Education their families; Closed Circuit TV at ALMD with health care information; Health Education Materials available in waiting areas and from

your healthcare providers. It is your right to get the information Patient Education Resource Center you need to understand your health, (PERC) health problems and health care. The PERC is a place Please take an active part in learning where a wide variety about your health. of health, wellness Tell us what you want to learn and medical Ask us to help you get the care you information is available for both the need veteran patient and their families. The Tell us if you need special help with entire center is dedicated to patient hearing, seeing or understanding health education and general Ask us for more information on all resources. Our goal is to provide education classes and support access to current health information. groups available. Where is the PERC located? The STVHCS offers a variety of ways The PERC is located on the 3rd Floor, to get Health Information so you can D304.3A. Hours of operation are take an active role in your healthcare between 8:00 a.m. - 4:00 p.m., as a partner with your providers: Monday – Friday except federal Patient Health Educator at holidays. If you cannot visit the PERC, extension 17090 at ALMD; call us at 210-949-9250 or toll free at Special classes for veterans and 1-877-469-5300 ext. 19250 and we their families (Diabetes, Weight can mail or fax you information.

30 How can the PERC help you? available will help veterans partner Staff is available to assist you in with healthcare providers to achieve obtaining and answering health their best possible health. All your related questions. personal data will be secure and Pamphlets are available on a wide private in your own eVAult. And you variety of health topics. will be able to share your online Online access to health information with anyone you information. designate. Today's healthcare is Quick access to medication really a strategic partnership between information patients and providers. My HealtheVet Health videos is a powerful tool to help you better Current magazines understand and manage your health. It Local newspapers is a powerful tool for sharing Patients or family members are information with your family, with your encouraged to ask the PERC staff for caregivers, with anyone you choose. assistance in locating health-related My HealtheVet puts you at the center information. Web-based medical and of your VA care. The My HealtheVet drug information databases are used (MHV) web site is located at to provide information requested by www.myhealth.va.gov. patients. My HealtheVet Computers are located in the PERC. Patient Travel Certain veterans are eligible for travel My HealtheVet Web Site cost reimbursement. If you have any questions or would like to file a claim, Beneficiary Travel is located at: Audie L. Murphy first floor by the Agent Cashier, Room X113, ext. My HealtheVet is a web-based 15603 application designed specifically for Kerrville first floor in Room 146C, veterans and their families. The tools extension 12418.

31 Release of Information tell you how to treat the problem at The Federal Privacy Act and Freedom home. The VA TeleCare Nurse can of Information guidelines protect also give you advice, information, Information contained in VA medical counseling and referrals to the nearest records. If you need information VA Medical Center or Clinic. Call the released from your VA file, you will VA TeleCare Nurse at the first sign of need to complete the appropriate form. a problem. Early treatment is a key ALMD - Release of Information is factor in dealing with many health care located on the first floor, room problems. Please be prepared to give Q106, in the Medical the nurse the following important Administration Offices, extension information: 15610 1. Your full name; KD - Release of Information is 2. Your social security number; located in main building, extension 3. Your current address; 12122. 4. Phone numbers and area code where you can be reached; 5. Your reason for calling the Telecare Services Tele-Care Nurse.

Call Toll Free: 1(888) 686-6350 or

in San Antonio 210-949-3994

Veterans Canteen Retail Store

The VA now offers telephone advice And Food Court services to veterans 24 hours a day, ALMD 65 days a year. Call the TeleCare Retail Store

Nurse if you have symptoms, (1st Floor Lobby Area) questions, or need advice about any 7:00 a.m. to 4:00 p.m. Monday - Friday health problem. If your symptoms are Weekends & Veterans Day Hours: not serious, you may not need an 8:00a.m. - 2:30 p.m. appointment. The TeleCare Nurse will Food Department

32 Hours: 7:00 a.m. to 6:00 p.m. the third floor, room #336. Phone Monday through Friday number is 830 792 2553. Weekend Hours: 8:00 a.m. to 2:30 p.m. Chaplains Vending machines are open 24 hours Chaplains are available a day. for spiritual visits Kerrville Monday through Friday Retail Store (Basement) and for urgent needs seven days a Hours: 7:30 a.m. to 3:45 p.m. week, 24 hours a day. Services of Monday - Friday worship are provided in the hospital (Closed on weekends and holidays) chapel. The times of Services are Food Department (Basement) announced on the Chapel Bulletin Hours: 7:30 a.m. - 1:45 p.m. Monday Board. Family and friends may attend through Friday (Closed weekends) with you. Hospital clothing is proper Vending machines are open 24 hours dress for all services. Although a day. chaplains visit the units and outpatient clinics frequently, you may see any of People who can help you at the chaplains in their offices or you the STVHCS? can request a chaplain by contacting any staff person. Benefits Counselors Audie L. Murphy Veteran’s Benefits Counselors and Sunday services are televised on Texas State Veterans Affairs Channel 13, Protestant Worship Counselors are available to visit with Service at 9:45 a.m. and Mass at 11 veterans and their families: At Audie a.m. Religious literature may be L. Murphy the counselors visit the obtained in the main Chapel, located units Monday through Friday to see on the second floor. each new patient. You may also visit Kerrville their offices on the first floor. At Worship services are provided in the Kerrville, the Texas Veterans hospital chapel located on the ground Commission is in the main building on

33 level of the main building. The Chapel 1-day class from 8:00 a.m. – 3:30 p.m. Bulletin Board maintains a current every Tuesday in the Patient listing of Chaplain Service activities. Classroom in 1G at the Audie L. Protestant Service is at 9 a.m. and Murphy Hospital. Catholic Mass at 11:00 a.m. Religious For an appointment please call literature may be obtained in the Barbara Walz, RN, CDE chapel. (210) 617-5300 ext. 16754 Diabetes classes at the STVHCS Dental Service Outpatient Clinics The STVHCS Dental Most of the outpatient clinics have Service provides a full diabetes classes. Please contact the range of dental treatment to eligible outpatient clinics for dates and times. veterans. ALMD Dental Clinic Patient Advocate (210) 949-8900 As your Patient Advocate, we want to Frank Tejeda Outpatient Clinic function as a link between you and the (210) 699 2100 ext 13104 hospital staff. If you have a concern or Kerrville Division compliment, please ask to see us. We (830) 896 2020 ext 12194 are here to assist you. Do not hesitate to express your concerns. By Diabetes Education identifying problem areas, you a The diabetes education assisting in improving patient care. program will teach you Your suggestions for improved care how to balance food and service are welcome. with activity, how to Patient Advocates check your blood sugar, use a blood Audie L. Murphy glucose meter and help you with your Mary C. Scott, Room L126 medications. 210 617-5235 Patients are scheduled for individual David Q. Ramirez, Room L127 appointments. In addition, there is a 210 617-5214

34 David Caudill. Room L129 Primary Care 210 617-9419 Primary Care Kerrville means Diane McIntosh having one provider 830-792-2414 (doctor or nurse

practitioner) who Pharmacy takes care of most of your health care Pharmacy Service needs. Sometimes you need a is part of your specialist for complex problems. Your treatment team Primary Care provider will arrange for and is available to a specialist appointment and continue all patients. Pharmacists are available to oversee your care. to provide medication counseling to you and your family. Pharmacists will Recreation provide medication information such A variety of activities are available in as dosage and possible side effects. the Recreation Center (first floor at the Audie L. Murphy Outpatient ALMD, ground level at the KD) for Pharmacy is open from 8:00 a.m. to inpatients, outpatients, and families in 8:00 p.m. Monday – Friday. an effort to maintain/increase leisure Kerrville Outpatient Pharmacy is open interests. Activities may include from 8:00 a.m. - 5:30 p.m. parties, shows, competitive games and Monday - Friday. movies. Check bulletin boards for For Prescription refills use the times of activities. Your doctor may Automated Refill Line: prescribe Recreation Therapy as part 1 (800) 209-7377 and follow the of your overall treatment while directions. You will need: hospitalized. Recreation Therapy is Your complete Social Security the treatment of illnesses and Number disabling conditions through the use of Your Prescription numbers in order therapeutic recreation activities, to refill your medications. leisure education and leisure

35 participation. These programs are Social Workers designed to increase function, Social workers are assigned to each enhance development and prevent inpatient unit, to each medical team disability. Recreation Therapy is given within the hospital and to each under the supervision of a Recreation outpatient clinic and primary care Therapist. team. Social workers are highly trained to help with the following: Respiratory Therapy . social, emotional, and family Respiratory Therapy problems provides services to . obtaining community resources patients in the hospital, such as meals and shelter in clinics, as well as in . obtaining home services such a the home. Respiratory home health aides Therapy provides a wide range of . planning your care after discharge pulmonary and respiratory testing as If you need to contact a social worker, well as providing oxygen and call the Social Work office at: breathing equipment used in the Audie L. Murphy (210) 617-5113 home. Respiratory Therapy personnel Kerrville (830) 792-2462 educate patients, family members and caregivers in the most current, up-to- Spinal Cord Injury Center date treatments available. The Spinal Cord Injury Center (SCIC) For more information call: in the Audie Murphy Division of the ALMD Respiratory Therapy South Texas Veterans Healthcare (210) 617-5300 ext 14877 System is proud to serve the needs of KD Respiratory Therapy veterans with spinal cord injuries and (830) 896-2020 ext 12249 dysfunction. In addition, we accept under an established sharing agreement, active duty members of the armed services who suffer or develop a spinal cord injury or

36 dysfunction. To access our Spinal VIST is a program that works to help in Cord Injury program, a referral or the adjustment to sight loss. Some consult is needed. After verification of training is provided locally and some at eligibility, and exchange of needed a Regional Blind Rehab Center. The medical documentation, we will VIST office is located at 8410 arrange for transfer to our facility. We Datapoint, Suite 200. For more encourage family and friends to information contact : arrange for a visit to the facility prior to Larry Belote at (210) 949-8927. the transfer. This visit will include a tour of the Center. At the tour, Telecommunication Device for educational materials will be given to the Deaf (TDD) help all involved understand the issues A telecommunications device for the facing spinal cord injured veterans. deaf (TDD) is an electronic device for The SCIC provides a vast array of text communication via a telephone services to the veteran using an line. A TDD is used when one or more interdisciplinary approach to care both of the parties have hearing or speech in inpatient and outpatient treatment difficulties. TDD phones are available settings. Our staff is very dedicated to at both the Audie L. Murphy and serving the needs of the SCI patient Kerrville Hospital Divisions. Please on a continuum of care appropriate to contact Social Work Service during the individual’s needs. To Contact the normal business hours or Nursing Spinal Cord Injury Center call: (210) Service after hours for inpatient TDD 617 5300 ext 16838. use or for business related to inpatient

care. Visual Impairment Services Escort Service for Cognitively

Team (VIST) Impaired Veterans VIST provides unique Escort service is available rehabilitation and for cognitively impaired equipment to veterans who are legally veterans at both the Audie blind or significantly visually impaired.

37 L. Murphy and Kerrville Hospital in the hospitals, clinics, Vet Centers, Division. Inpatients are routinely Fort Sam Houston National Cemetery, escorted to and from appointments by Transportation Network and staff and or volunteers. Escort service community-based programs to is also available for the outpatient enhance the services offered to veteran who needs assistance for veterans. To contact voluntary scheduled appointments. Contact service: Voluntary Service at Audie extension Audie L. Murphy: (210) 617-5107 or 15107 or Kerrville at 12183 in advance stop by the office in Building #4 (in of the need. front of the main hospital entrance). Kerrville: (830) 896-2020 ext 12183 Voluntary Service Room 021A (Basement).

Women’s Veterans Programs

Voluntary Service manages a Women Veterans Coordinators (WVC) Volunteer Program that consists of are located at ALMD and KD. They volunteers and voluntarily sponsored can provide you with information about patient activities. Through the support the with information about the Women of volunteers and donations, Voluntary Veterans Health program and assist Service provides direct services to with arrangements for Pap smears, veterans. Most of the patient mammograms, women's health recreation activities are sponsored by examinations, or for counseling related an organization. Patients also benefit to sexual trauma that occurred on from donations of books, clothes, active duty. At each Satellite Clinic toiletries, stamps, cards and other division, there is a representative for table games. In addition, monies the Women’s Veteran Health Program. contributed assist with crisis situations Audie L. Murphy and special needs. Volunteers serve Barbara Hector at ext. 68181

38 Kerrville Know what the treatment will Janeth Del Toro at (830) 896-2020 include and how long the treatment and ask the operator to page her. should last. 2. Know all your medicines. Patient Safety- STVHCS Cares Bring all your medicines you are About Your Safety taking with you including all prescribed medicines, over the South Texas Veterans Health Care counter medicines, vitamins, food System is committed to providing safe supplements, and herbal remedies. health care for our patients and their Tell your doctor and nurses if you families. We believe that everyone have any drug allergies. plays an important role in your safety, Your prescriptions are written by including you. Taking an active role in computer. Whenever a new your health care is important in medicine is ordered you will be keeping you safe. given an updated list of all your These are steps you can take to help medicines. you keep safe and improve your care. It is important to bring your VA card 1. Ask questions if you have any with you when you pick up your doubts or concerns. medicines. Proof of identification is Remember, it is okay to ask needed to make sure you receive questions. Your health is too the right medicine. important to worry about being Ask the pharmacist: embarrassed if you don’t  What is the medicine for? understand something you are told.  How am I suppose to take it Write down your questions you and for how long? have for your doctor so that you do  What are the common side not forget them. effects and what do I do if they If you think something is wrong, occur? speak up. You have the right to ask about your health care.

39  Is this medicine safe to take If you are place in isolation while in with over the counter medicines the hospital, please ask your family or dietary supplements? or friends to follow all instructions  What food, drink, or other posted on the room isolation sign. activities should I stay away 4. Get results of any test or from while taking these treatments. medicines? Ask when and how you will get  About any directions on the results of any test or treatments. medicine bottles you do not Do not think that no news is good understand. news. Ask your doctor or nurse for  For medicine information your results. sheets, pill cutters, pill boxes, Ask what the results mean for your and or medicine cups. care. Before you receive medicines, be 5. Understand what will happen if sure the nurse asks your name and you need surgery. checks your arm band. Ask your surgeon: 3. Help prevent the spread of  What exactly will he be doing to infection. you? Remind health care givers, family  About how long it will take? and friends to wash their hands or  What will happen after surgery? use an alcohol based hand product  And, how can I expect to feel before coming into contact with after my surgery? you. Hand washing is the most Make sure the surgeon explains important way to prevent the and you understand any possible spread of infection. problems. Ask providers if they washed their Tell all the doctors and nurses any hands before examining you. bad reactions you had to Discourage family or friends with anesthesia medicines. an active cough from visiting you. Before receiving any medicines or have test done, make sure the

40 nurse or technician asks your Police Notification Procedures name and checks your name band. Everyone is encouraged Make sure that your doctor has to notify the VA Police as clearly marked the body part to be soon as possible when they operated on you. are aware of an actual or 6. Know what to do after you are suspected criminal activity, suspicious discharged from the hospital. activity or emergency condition (i.e. Make sure you understand all theft, assault, disturbance, threat, etc.) discharge instructions and any Audie L. Murphy the police station is follow up appointments given to located in the main lobby (ext. 15911) your by your doctor and nurses. Kerrville the police station is adjacent Get a written copy of the to main lobby (ext 12911). instructions to take home with you. Review all medicines you are given Restraints with the nurse or pharmacist It is the policy of the South Texas including: Veterans Health Care System that  The name of the medicines; patients receive care free from the use  How much to take; of restraint devices except when  The reason you are taking it; necessary to protect the patient.  And how often to take them. What are restraints? Ask your doctor or nurse to provide Restraints are things that prevent or a phone number to call if you have limit movement of any part of the body. any questions following your Why restraints are used? discharge. Some medications or illnesses can Remember, you are an important part cause patients to be confused. of your health care team. Patient Restraints are used to help keep safety is everyone’s job. Speak up patients from hurting themselves. about any questions or concerns you We use restraints to help prevent: may have about your health care.

41 Behavior that posses immediate  Eat a healthy diet; risk to patient’s own safety or to  Get regular check-ups and others screenings; Removal of needed medical  Control your weight; equipment  Prevent accidents and injuries; Harm to wounds or bandages  Get immunizations. Immunizations Preventing Falls Keeping your immunizations up-to- The STVHCS wants to tell you some date is important to your health. We ways to help you remain safe while recommend: you are a patient. The risk for falls is a yearly flu shot; highest in your first few days in the a pneumococcal vaccine at age 65 hospital. Remember, (or sooner if you have chronic Call Don’t Fall. health problems); Tetanus shot every 10 years. Weight Management Screening Exams Screening exams are done to find out if you are at risk for specific health problems. It is important to have the If your weight keeps you from doing following screenings: what you want or feeling your best Blood Pressure Management please ask a about our weight All Adults reduction programs– we can help! Every visit Cholesterol Screening Staying Healthy Men older than 35 There are steps you Women older than 45 can take to stay healthy. Anyone with a history of heart  Avoid drinking alcohol and disease or diabetes or anyone that smoking; smokes Yearly

42 Mammogram Depression Screening All women All adults 40-80 years At least yearly Screening exam at age 35 and Pain Assessment annual mammogram every year All adults after 40 At every visit Pap Smear (to detect cervical Hepatitis C Screening cancer) All adults Women up to age 75 Yearly Yearly with history of STDs or multiple sex partners Every 3 years after 2 normal

annual exams

Stop after age 75 if other exams are normal Colorectal Cancer Screenings Everyone over age 50 Colonoscopy every 10 years or FOBT (fecal occult blood test) yearly. Prostate Exam Men between 50 -75 should discuss this test with their provider As recommended Tobacco Screening Anyone who has used tobacco At every visit Alcohol Screening Everyone who has used alcohol At every visit

43 Notice: The South Texas Veterans Health Care System and all of its programs and facilities in San Antonio, Kerrville and South Texas, are pleased to announce that the quality of services provided are of the highest caliber, as expressed by the 3-year accreditation decision of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), for the period 2005-2008. “Patients and their families, patient advocates and advocacy groups, members of the community for whom services are provided and staff members are able to communicate with JCAHO by writing or calling. The public may contact the Joint Commission’s Office of Quality Monitoring to report any concerns or register complaints about a Joint Commission– accredited health care organization by either calling (800) 994-6610 or emailing [email protected].