ContractTerms and Conditions of Service • September 9th, 2020
TERMS AND CONDITIONS OF SERVICE: ADMISSION, MEDICAL SERVICES,AND FINANCIAL AGREEMENT (Page 1 of 3) UNIT NUMBER PT. NAME BIRTHDATE: DATE OF SERVICE: 1. UCSF MEDICAL CENTER: is part of the University of California and is comprised of its hospital(s) (UCSF Medical Center, UCSF Medical Center at Mt. Zion, and UCSF Benioff Children’s Hospital), its hospital-based clinics, its Primary Care Network clinics, and the UCSF School of Medicine.2. MEDICAL CONSENT: I consent to medical treatments or procedures, X-ray examinations, drawing blood for tests, medications, injections, taking of treatment related photographs, videotaping, laboratory procedures, and hospital services rendered to me under the general and special instructions of the physicians or other health care professionals assisting in my care. To facilitate my care, I consent to evaluation and examination by a physician or other health team professionals who may be physically distant from me via telehealth technologies, including b