Hospital Patient Notices & Forms

As a patient at Hoag Orthopedic Institute hospital, you have certain rights and responsibilities that are inherent in your health care. To receive the best possible care, it is important that you play an active role in your medical treatment. It is the responsibility of your health care team at Hoag Orthopedic Institute to include you in that process.

Patient Rights & Responsibilities

Please select the English or Spanish translation of the Patient Rights & Responsibilities document below:

• English - Patient Rights and Responsibilities
• Spanish - Patient Rights and Responsibilities

Patient Information Booklet

The following content is included in the Patient Information Booklet. In addition to the English Booklet, we also offer translated booklets linked below:

• English - Patient Information Packet
• Spanish - Patient Information Booklet
• Farsi - Patient Information Booklet
• Chinese - Patient Information Booklet
• Korean - Patient Information Booklet
• Vietnamese - Patient Information Booklet

Pre-Admission Screening Form

• Pre-Admission Screening (PAS) Form

Conditions of Admission Form

In order to care for our patient, all patients must sign Hoag Orthopedic Institutes Condition of Admission during the registration process. For your convenience, the Conditions of Admission is linked below for your review.

• Conditions of Admission Form (English) - Required
• 9611-A Conditions of Admission - Arabic
• 9611-C Conditions of Admission - Chinese
• 9611-F Conditions of Admission - Farsi
• 9611-K Conditions of Admission - Korean
• 9611-S Conditions of Admission - Spanish
• 9611-V Conditions of Admission - Vietnamese

Advance Health Care Directive

• Advance Health Care Directive - English
• Advance Health Care Directive - Spanish

Language Assistance Services

• Section 504 Notice of Program
• Notice of Nondiscrimination and Accessibility Rights

Notice to Consumers - Medical Board

• Notice to Consumers - Medical Board - English
• Notice to Consumers - Medical Board - Spanish
• Notice to Consumers - Medical Board - Farsi
• Notice to Consumers - Medical Board - Chinese
• Notice to Consumers - Medical Board - Korean

Notice to Consumers - Physician Assistant Board

• Notice to Consumers - PA - English
• Notice to Consumers - PA - Spanish

Notice to Consumers - Physical Therapy Board

• Notice to Consumers - PT - English
• Notice to Consumers - PT - Spanish

Communication with Persons with Limited English Proficiency Policies

Please select the appropriate PDF below.

• English
• Español
• Korean
• Chinese
• Farsi

Auxiliary Aids and Services for Persons with Disabilities Policies

Please select the appropriate PDF below.

• English
• Español
• Korean
• Chinese
• Farsi

Patient Grievances

If you have questions or concerns about your care, a patient relations specialist is available to help you better understand the health care environment, resolve problems, provide information and address ethical concerns. You can contact Patient Relations at (949) 727-5151.

Contact DNV Healthcare

ATTN: Healthcare Complaints
DNV Healthcare USA Inc
1400 Ravello Dr
Katy, TX 77449
ONLINE COMPLAINT FORM: www.dnvhealthcare.com
(COMPLAINTS HYPERLINK): https://www.dnvhealthcareportal.com/patient-complaint-report)
COMPLAINTS E-MAIL: hospitalcomplaint@dnv.com
COMPLAINTS VOICEMAIL: 866-496-9647COMPLAINTS FAX: 281-870-4818

Contact the California Department of Public Health

You may file a complaint with the California Department of Public Health regardless of whether you use the hospital's grievance process.

By mail: California Department of Public Health
681 South Parker Street, Suite 200
Orange, CA 92868

By phone: (714) 567-2906
Toll Free: (800) 228-5234