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47 Cards in this Set
- Front
- Back
- 3rd side (hint)
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The health care provider (the PERSON) |
EL profesional de la salud |
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The health care provider (the COMPANY) |
El prestador de servicios médicos |
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Give this form to your provider |
Dé este formulario a su profesional de la salud |
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I hereby... |
Mediante LA presente... |
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...give my consent and authorization voluntarily... |
...yo doy mi consentimiento y autorización voluntaria... |
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...and release Park Health Services from any claims... |
...y libero a Park Health Services de cualquier RECLAMO... |
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...that I have or may have in the future with this treatment... |
...que tengA o puedA tener en el futuro con este tratamiento... |
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...regardless of result |
...sin importar el resultado |
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I may refuse to... |
Puede que me niegue a... |
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...and my refusal will not affect my treatment |
...y mi negativa no afectará a este tratamiento |
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To disclose |
Divulgar |
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A disclosure of my health information |
Una divulgación de LA información sobre mi salud |
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A family member |
Un FAMILIAR |
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To name a family member (as guardian, etc.) |
Nombrar a un FAMILIAR |
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Parent or legal guardian |
El padre o tutor legal |
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I may revoke this authorization at any time |
Puedo revocar esta autorización en cualquier momento |
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____ is effective upon... |
____ entra en rigor al... |
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The revocation is effective upon receipt of this document |
La revocación entra en rigor al recibir este documento |
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The discharge instructions |
Las instrucciones DEL ALTA |
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Let's go over... |
Vamos a revisar... |
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Let's go over the instructions... |
Vamos a revisar las instrucciones... |
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...for when you're released |
...para cuando le demos de alta |
"We release you" |
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A release |
Una autorización para tratamiento médico |
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At the top of the page |
Al principio de la página |
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At the bottom of the page |
Al final de la página |
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Have you ever had...? |
¿Alguna vez ha tenido...? |
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...any of the following conditions? |
...alguna de las siguientes afecciones? |
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How would you rate your pain? |
¿Cómo clasificaría su dolor? |
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Please provide... |
Por favor PROPORCIONE... |
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Please provide a signed form |
Por favor PROPORCIONE un formulario firmado |
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An advanced directive |
Las instrucciones por adelantado |
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Make sure that... |
Asegúrese de que... |
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Make sure they understand your wishes |
Asegúrese de que entiendan sus instrucciones |
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Agrees as follows |
Conviene lo siguiente |
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In the appropriate box |
La casilla co-rre-spon-di-en-te |
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Mark the appropriate box |
Ponga una equis en la casilla co-rre-spon-di-en-te |
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Preauthorization |
La autorización previa |
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Compensation |
La compensación |
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Under duress |
Bajo coacción |
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I am of sound mind |
Estoy en pleno USO de mis facultades |
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Medical insurance |
El seguro médico |
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Your medical insurance plan |
Su plan de seguro médico |
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(Insurance) coverage |
CObertura |
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It's not covered by that plan |
No es cubierto por ese plan |
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Your social security number |
Su número se seguro social |
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Do you have your social security number? |
¿Trae su número de seguro médico? |
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Your living will |
Su documento vital |
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