Patient Forms

The following forms are for patients of Overlake Surgery Center. For your convenience, some forms may be completed online, while others are available to download and print. Just be sure to bring any printed forms with you to your appointment.

Durable Power of Attorney and Healthcare Directives

Advance health care directives, also known as advance directives or living will, are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity. If you have an advance directive, please bring it with you to the surgery center. Based on organization conscience, in the event of a patient emergency we will do everything possible to attempt life saving measures including resuscitation. We will then transfer you to a hospital for continuation of care. Should this occur, a copy of your advance directives forms will accompany you. We have Advance Directive forms and information available at the surgery center if you are interested. A health care directive, commonly referred to as a ‘living will’, is a legal document specifying your wishes regarding the care you receive at the end of life, should you become unable to communicate them. In Washington State, the directive is used only if you have a terminal condition where life-sustaining treatment would only artificially prolong the process of dying; or if you are in an irreversible coma and there is no reasonable hope of recovery. Health care directives may also be called a directive to a physician, declaration or medical directive. They can also be accessed via the following website:

›› Download Form (41.38kb PDF, revised 10/19/2011)

Medical Records Release Form

According to the Federal HIPAA Privacy Rule, your medical records are considered private and confidential. No one can see them without your express permission. In order to release your medical records, we require that you complete this form, sign and either fax or mail it to our office.

›› Download Form (52.09kb PDF, revised 10/19/2011)

Update Patient Information

Update your information on file at Overlake Surgery center using this form. You may also use our convenient online form.

›› Download Form (160.98kb PDF, revised 10/19/2011)

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