Patients

The Admitting Department Hours:

• Monday – Friday | 5:00 a.m. – 10:00 p.m.
• Saturday | 6:00 a.m. – 2:30 p.m.
• Sunday | Closed

Direct Admits between 8:00 p.m. and 10:00 p.m. must enter through the Emergency Care Center.

The Admitting Department is located on the first floor of the hospital. Admissions are accepted 24 hours a day, 7 days a week through our Emergency Care Center. A nurse is available 24 hours a day to accept direct admissions. You or a family member will be requested to complete all necessary admission requirements.

If you are scheduled for a procedure or surgery in advance, you should receive a call at home a few days prior to your expected arrival at Beverly Hospital. Your personal and insurance information will be gathered in order to expedite the admissions process once you arrive at the facility.

To save time, you may complete, print and bring the Pre-Admission Form to make your admission process easier.

• Pre-Admission Form – English
• Pre-Admission Form – Spanish

In an effort to reduce the number of persons entering the hospital, Please fill out the Authorization to Release PHI below and email to ROI@beverly.org

• Authorization to Release PHI – English
• Authorization to Release PHI – Spanish

If you have questions concerning your admitting process, you may call (323) 725-4279.

You have the right to execute an Advance Directive. This is a written document that states your wishes for care and allows you to name another person as agent or proxy to make decisions about your medical care in the event that you are no longer able to make those decisions for yourself. In California, the legal form of Advance Directives is the “California Advance Healthcare Directives,” formerly known as the “Durable Power of Attorney for Healthcare.”

Upon admission to Adventist Health White Memorial Montebello, you will be given explanation of Advance Directives, asked if you have one, and given an opportunity to fill one out. For further information about Advance Directives, please request the “California Advance Healthcare Directives” booklet during admissions, speak to the nurse caring for you or contact Social Services at (323) 725-4321.

• Advanced Directives Form

Vending machines are available in the Cafe and outside of the Emergency Care Center, offering refrigerated items such as sandwiches, fruit, yogurt, desserts, muffins, and hot and cold beverages.

For your convenience, an ATM machine and public telephones are also available within the hospital building.

Privacy Policy

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical and dental records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper or orally, are kept properly confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse Protected Health Information (PHI).

This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

Uses and Disclosures of Protected Health Information
Your Protected Health Information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the practice, and any other use required by law.
Treatment: We will use and disclose your Protected Health Information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the health care professional has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for health care services. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, and conducting or arranging for other business activities. We may use or disclose, as needed, your protected health information to support the business activities of this practice. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. We may call your home and leave a message (either on an answering machine or with the person answering the phone) to remind you of an upcoming appointment, the need to schedule a new appointment or to call our office. We may also mail a postcard reminder to your home address. If you would prefer that we call or contact you at another telephone number or location, please let us know.
We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues required by law, Communicable Diseases: Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Workers’ Compensation: Inmates: Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of HIPAA.
Other Permitted and Required Uses and Disclosures Will Be Made Only With Your Consent, Authorization or Opportunity to Object unless required by law.
You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Your Rights
The Following is a statement of your rights with respect to your protected health information.
You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.
You have the right to request a restriction of your health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in you care or for notification purposes described in this Notice of Privacy Practices. Your request must state the specific restriction and to whom you want the restriction to apply.
Your physician is not required to agree to a restriction you may request. If your physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this Notice from us, upon request, even if you have agreed to accept this Notice alternatively (i.e. electronically).
You may have the right to have your physician amend your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.
We reserve the right to change the terms of this Notice and will inform you of any changes. You then have the right to object or withdraw as provided in this Notice.

Complaints
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy officer of your complaint at our office and main telephone number. We will not retaliate against you for filing a complaint.

This Notice was published and becomes effective on/or before [Date:now].

Beverly Hospital
309 West Beverly Boulevard
Montebello, CA 90640

Consistent with our mission and values, Beverly Hospital supports the assurance of patient rights to each patient. You have the right to file a complaint/grievance with the hospital. Your concerns as a patient are very important to us. Any member of the healthcare team can receive a grievance or complaint.

You may request information about the formal grievance process from the unit Director. The report will then be followed up by their director/manager or patient safety officer as appropriate. All issues will be handled in a timely manner. You may contact the Nursing Office at ext. 4216 or the Quality Department at ext. 5038. Our desire is to work together with you to resolve any issues regarding the care or service.

Issues that cannot be resolved through our suggested level may be forwarded to our Administrative Offices at (323) 725-4257 or (323) 725-4378 or mailed to:

Beverly Hospital
309 West Beverly Boulevard
Montebello, CA 90640
Attn: Administration

A patient who perceives that a right has been violated may submit a written or verbal grievance directly to the Department of Public Health Services, regardless of whether or not the patient uses the hospital’s grievance process. The County of Los Angeles, Department of Public Health Services can be contacted at:

The California Department of Public Health
Licensing and Certification
3400 Aerojet Avenue, Suite 323
El Monte, CA 91731
(800) 228-1019

Medical doctors are licensed and regulated by the Medical Board of California. To file a grievance about a physician, you may contact (800) 633-2322 or via the website:www.mbc.ca.gov.

For concerns regarding quality of care issues you may contact DNV HEALTHCARE INC. toll free at (866) 523-6842 or via email: hospitalcomplaint@dnv.com.

Your satisfaction is the optimal outcome in any measurement of the success and quality of our services given to you. All communication with you will be conducted in a caring, warm and compassionate manner, while supporting our patient’s dignity and justice. The ongoing or future care of any patient exercising the right to invoke the grievance procedure will not be compromised in any way. We thank you for giving us the opportunity to provide you with high quality healthcare.

We would also welcome and appreciate your compliments so that we may recognize and celebrate any of our employees who have exceeded your expectations. You may speak with a nurse or supervisor regarding staff or individuals who have done an outstanding job in meeting your needs. Please feel free to call or write us through our Administrative Office at(323) 725-4257 or (323) 725-4378, or mail to:

Beverly Hospital
309 West Beverly Boulevard
Montebello, CA 90640

Patients are responsible for the provision of accurate and complete information about their health state, compliance with instructions and asking questions when clarification is needed; his/her own actions if he/she should refuse treatment; assuring hospital related financial obligations are met; and adherence to all hospital rules and regulations including consideration for others.

Provision of Information: A patient has the responsibility to provide, to the best his/her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other matters related his/her health. He/she has the responsibility to report unexpected changes in his/her condition to the responsible practitioner. A patient is responsible for reporting whether he/she clearly comprehends a contemplated course of action and what is expected of him/her.

Instruction Compliance: A patient is responsible for following the treatment plan recommended by the practitioner primarily responsible for his/her care. This may include following the instructions of nurses and allied health personnel as they carry out the coordinated plan of care, implement the responsible practitioner’s orders and enforce the applicable hospital rules and regulations. The patient is responsible for keeping appointments and, when unable to do so for any reason, notifying the responsible practitioner or the hospital.

Refusal of Treatment: The patient is responsible for his/her actions if he/she refuses treatment or does not follow the practitioner’s instructions.

Hospital Charges: The patient is responsible for assuring the financial obligations of his/her healthcare are fulfilled as promptly as possible.

Hospital Rules and Regulations: The patient is responsible for following hospital rules and regulations affecting patient care and conduct.

Respect and Consideration: The patient is responsible for being considerate of the rights of other patients and hospital personnel and for assisting Beverly Hospital in the control of noise, observation of the hospital’s no smoking policy and the number of visitors. The patient is responsible for being respectful of property of other persons and that of the hospital.

Patient satisfaction is so important at Beverly Hospital that we actually measure it. A few weeks after discharge, patients may receive a mailed survey to rate their satisfaction level during their hospital stay. Our goal is to exceed our patients’ expectations and make their stay exceptional.

We also appreciate comments and suggestions. Please contact Administration at (323) 725-4257 or our Patient Liaison at (323) 725-4350.

You have the right to:

1. Considerate and respectful care, and to be made comfortable. You have the right to respect for your cultural, psychosocial, spiritual, and personal values, beliefs and preferences.
2. Have a family member (or other representative of your choosing) and your own physician notified promptly of your admission to the hospital.
3. 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 nonphysicians who will see you.
4. Receive information about your health status, diagnosis, prognosis, course of treatment, prospects for recovery and outcomes of care (including unanticipated outcomes) in terms you can understand. You have the right to access your medical records. You will receive a separate “Notice of Privacy Practices” that explains your rights to access your records. You have the right to effective communication and to participate in the development and implementation of your plan of care. You 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.
5. 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 nontreatment and the risks involved in each, and the name of the person who will carry out the procedure or treatment.
6. Request or refuse treatment, to the extent permitted by law. However, you do not have the right to demand inappropriate or medically unnecessary treatment or services. You have the right to leave the hospital even against the advice of members of the medical staff, to the extent permitted by law.
7. 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 experimentation affecting your care or treatment. You have the right to refuse to participate in such research projects.
8. Reasonable responses to any reasonable requests made for service.
9. Appropriate assessment and management of your pain, information about pain, pain relief measures and to participate in pain management decisions. You may request or reject the use of any or all modalities to relieve pain, including opiate medication, if you suffer 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.
10. Formulate advance directives. This includes designating a decision maker if you become incapable of understanding a proposed treatment or become unable to communicate your wishes regarding care. Hospital staff 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.
11. Have personal privacy respected. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. You have the right to be told the reason for the presence of any individual. You 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.
12. Confidential treatment of all communications and records pertaining to your care and stay in the hospital. You 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.
13. Receive care in a safe setting, free from mental, physical, sexual or verbal abuse and neglect, exploitation or harassment. You have the right to access protective and advocacy services including notifying government agencies of neglect or abuse.
14. Be free from restraints and seclusion of any form used as a means of coercion, discipline, convenience or retaliation by staff.
15. 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.
16. Be informed by the physician, or a delegate of the physician, of continuing health care requirements and options following discharge from the hospital. You 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.
17. Know which hospital rules and policies apply to your conduct while a patient.
18. Designate a support person as well as visitors of your choosing, if you have decision-making capacity, whether or not the visitor is related by blood, marriage, or registered domestic partner status, unless:
    • No visitors are allowed.
    • The facility reasonably determines that the presence of a particular visitor would endanger the health or safety of a patient, a member of the health facility staff, or other visitor to the health facility, or would significantly disrupt the operations of the facility.
    • You have told the health facility staff that you no longer want a particular person to visit.

However, a health facility may establish reasonable restrictions upon visitation, including 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 permitted to restrict, limit, or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability.

19. 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.
20. Examine and receive an explanation of the hospital’s bill regardless of the source of payment.
21. Exercise these rights without regard to, and be free of discrimination on the basis of, sex, economic status, educational background, 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.
22. File a grievance. If you want to file a grievance with this hospital, you may do so by writing or by calling Adventist Health White Memorial Montebello, 309 W Beverly Blvd, Montebello, CA 90640, (323) 307-8595. The Grievance Committee shall issue a final determination regarding resolution of the matter at the conclusion of the investigation. A written notice of the Hospital’s determination regarding the grievance shall be communicated to the patient or patient’s legal representative in a language and manner that the patient or patient’s legal representative understands. Concerns regarding quality of care or premature discharge will also be referred to the appropriate Utilization and Quality Control Peer Review Organization (PRO).
23. 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 are: California Department of Public Health Licensing and Certification L.A. County Acute & Ancillary Unit 3400 Aerojet Avenue, Suite 323, El Monte, CA 91731 (626) 312-1104.
24. If your concerns cannot be resolved through the organization, you may contact The Joint Commission directly at (800) 994- 6610, Fax: (630) 792- 5636, or www.jointcommission.org and follow the link for “Report a Patient Safety Event”. Mail: Office of Quality and Patient Safety, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181.
25. File a complaint with the Medical Board of California at www.mbc.ca.gov/consumers/complaints, 800-633-2322 or 2005 Evergreen St ., #1200, Sacramento, CA 95815.

We are pleased to provide the Cyracom System telephone translation service, allowing us to communicate with patients and family members in virtually any spoken language.

We also offer LIFESIGNS, Inc. and TDD telephone services for the hearing-impaired patients.

There is no charge for these services. Please ask your nurse for assistance in arranging for these services.

View our Language Assistance Policy

Adventist Health White Memorial Montebello is pleased to offer free transportation for area residents who need hospital based services. The van is available Monday – Friday, 8:30 am – 4 pm, except for holidays. Free taxi services for patients with scheduled hospital appointments are available seven days a week.

All transportation services must be previously coordinated through the security desk at the hospital or by phone at (323) 725-5088.

Due to demand, this service is provided on a first-come, first-served basis.

IN CASE OF EMERGENCY, DIAL 911