Running head: HEALTHCARE INTAKE PACKET1
HEALTHCARE INTAKE PACKET 9
Healthcare Intake Packet
Sharlene Salinas
Professor Bradshaw
Rasmussen College
HSA
August 15, 2019
Healthcare Intake Packet
New Patient Letter
Three Mountains Regional Hospital
5096, Detroit, MI 3963-1130,
US
____________, day of _______, 20____
Dear ________________________ (Patient’s Name),
RE: HEALTHCARE INTAKE PACKET INTRODUCTION
Greetings and it is an honor to have you at Three Mountains
Regional Hospital. We are dedicated to excellence within our
professional practice of promoting community, organizational,

family, and individual health. The following healthcare intake
packet includes the hospital’s code of ethics and a living will.
The code of ethics provides a structure and shape to the
hospital’s environment and ethical position. A living will is a
legal document with proper instructions which specifies the
type of treatment or medical care that you want or not want, in
the event, I am unable to make decisions for yourself.
Three Mountains Regional Hospital will handle your
information under HIPAA and its regulations to protect the
confidentiality of medical and personal information as permitted
and required by the law.
Save time before your appointment at the Three Mountains
Regional Hospital. It is recommended that you print and
complete your patient intake form before your appointment.
(This is not mandatory but offered as a convenience for
patients)
Sincerely,
________________________
Health Services Manager
Three Mountains Regional Hospital
Code of Ethics
· Uphold policies of the Three Mountains Regional Hospital.
· Protect the intellectual, physical, and electronic property of
the hospital.
· Promote a healthy, secure, and safe working environment.
· Promote the principles of accuracy and confidentiality in
billing processes.
· Uphold the principles of social networking by not transmitting
or placing online, individually identifiable patient information.
Protect and respect the confidentiality and privacy of all
individuals and information linked to the Three Mountains

Regional Hospital policies and relevant legislation such as
HIPAA.
· Treat both internal and external members of the community
with dignity, respect, and without discrimination.
· Promote the communication of information, rights, and
responsibilities to nurture informed decision making geared
towards offering the highest quality of care and safety.
· Offer patient care, support work, and research education with
professional competence, high ethical standards, and
intellectual honesty.
· Uphold the values of the Three Mountains Regional Hospital
· Individuals are encouraged to professionally engage in social-
political activities through transparency and honesty to the
healthcare profession.
Three Mountains Regional Hospital
Living Will Declaration
Advance Health Care Directive of:
_________________________
To my family, doctors, surgeons, medical care providers,
hospitals, and all others concerned with my care:
I, ______________________, residing at
_____________________, in the County of ____________, in
the State of _________________, in the zip code
_____________, and whose telephone number is
________________, being of rational thought and sound mind,
and acting willingly without duress, herein direct that this
declaration to be followed as a formal statement of my desires if
I become incapacitated or incompetent to communicating my
desires, preferences, and wishes. I voluntarily make this
designation with regards to my living will which makes these
directives and instructions to be binding to the fullest extent
permitted by the law.
Directions
1. In the event, there is no reasonable expectation of recovery; I
direct my attending primary care or physician to withdraw or

withhold life-sustaining treatment that only prolongs my dying.
2. I direct that treatment or medical care to be in limited
measures, which will only keep me comfortable by relieving
pain, which might occur by withdrawing or withholding the
above stated life-sustaining treatment or medical care.
3. In the event that I am in the condition described above in
item 1, I direct that I specifically do not want the following
forms of treatment or medical care:
a) _________________________________________
b) _________________________________________
c) _________________________________________
d) _________________________________________
e) _________________________________________
f) _________________________________________
g) _________________________________________
4. In the event that I am in the condition described above in
item 1, and I also have the conditions of
________________________________, I direct that I receive
the following treatment and medical care:
_____________________________________________________
________________
_____________________________________________________
________________
_____________________________________________________
________________
_____________________________________________________
________________
_____________________________________________________
________________
_____________________________________________________
________________
Declaration Statement and Signature
This living will declaration expresses my sole preferences,
desires, and wishes which are under a form specified by the law
of the State of _____________________, and I honorably
request that this will be honored in any state I may reside in.

By signing below, I certify that I understand entirely and fully
aware of the contents of this document and that I am in the state
of a sound mind and body.
I make this living will declaration on ____________, day of
_______, 20____.
Declarant’s Signature: __________________________
Declarant’s Address: ____________________________
Witness Statements
This living will was signed by ___________________________
(Declarant’s Name) in the presence of the following individuals,
who confirm through their signature below that
____________________ (Declarant’s Name) was, at the time
this document was signed, of sound mind, disposition, memory,
understanding, at least 18 years, and able to understand the
impact of this decision, and not under duress or improper
influence.
Witness’s 1 Name: __________________________________
Witness’s 1 Signature: _______________________________
Witness’s 1 Address: _________________________________
Date: _____________________________
Witness’s 2 Name: __________________________________
Witness’s 2 Signature: _______________________________
Witness’s 2 Address: _________________________________
Date: _____________________________
Notarization
State of _________________________, County of
___________________
Subscribed and sworn before on _________________ day of
_______, 20____.
Signature of Notary Public: _______________________
My commission expires: _________________________
Three Mountains Regional Hospital
Healthcare Intake Packet Acknowledgement
To warrant that you receive the best of care, kindly confirm the

receipt of the following documents of the hospital's healthcare
intake packet. Kindly acknowledge the receipt by signing the
declaration below.
Receipt Acknowledgement Statement
By signing below, I approve that I have received the following
documents:
i. Three Mountains Regional Hospital Code of Ethics
ii. Living Will
Patient’s Name: __________________________________
Patient’s Signature: __________________________________
Patient’s Address: __________________________________
____________, day of _______, 20____
Email to the CEO and Board of Directors
Subject: Purpose of the Health Intake Packet
Date: Wed, 15 Aug 2019 14:35:16
From: Sharlene Salinas <[email protected]>
To: Mary Smith <[email protected]>
Cc: Board of Directors
Greetings,
Just a reminder on the proposed patient intake packet which will
include the Three Mountains Regional Hospital’s Code of Ethics
and the patient’s living will.
The healthcare intake packet provides patients with the purpose
of each part in the packet. Through the hospital’s values and
code of ethics part, the patients will receive information about
HIPAA, informed consent, and the confidentiality of their
health reports.
This patient intake packet will help establish patient trust in
Three Mountains Regional Hospital and its employees.
Thank you,
Sharlene Salinas
Sharlene
Nice work on the letter, as you did a nice job addressing it to
the patient, but you need to develop the introduction more, as
this letter sets the tone throughout the document of the

importance of privacy and the intake packet. The opening letter
should be a full page length document . You needed more in
covering HIPPA and ethics, as you needed sections on each of
these issues and why they are important to the facility. You also
need to include your privacy p[ledge. You need to make sure to
have APA citations to show that you used your material in the
letter.
Your one page bullet point on ethics looks good. Your Living
Will and patient acknowledgement forms look really good.
Your email to the Board of Directors was good and had a good
overview and discussion how this new intake packet should
address the issues that the facility has previously experienced
and how this packet will build trust between the patients and the
facility and its staff.
Running head: IDENTIFYING ORGANIZATIONAL
LEARNING ISSUES 1
IDENTIFYING ORGANIZATIONAL LEARNING ISSUES
5
Identifying Organizational Learning Issues
HRM 562: Developing a Learning Organization
Dr. Allan Beck
Penny Williams
July 21, 2019
Identifying Organizational Learning Issues
The concept of organizational learning is complex as it lacks a
universal definition. In as much as various scholars define the

organizational learning differently, there is no denying that a
firm must understand the concept’s key aspects. An
understanding of the concept is essential for effective
transitioning of a firm from individual learning to
organizational learning. Some of the key aspects worth
understanding include, an organizations culture regarding
knowledge sharing, organizational learning mechanisms, and the
norms relating to organizational learning. Moreover, it is
important to understand disconnect between organizational
learning and culture based on mystifications of organizational
learning.
Organizational Culture and Learning
ABC Company’s (my employer) culture mirrors teamwork and
passion. Employers can freely share their opinion, ideas and
views to support the organization and inspire growth.
Management encourages generation of innovative ideas that can
propel the organization to greater heights and enhance its
competitiveness in the market. Moreover, the company’s culture
embraces formation of healthy relationships among employees
for the establishment of a knowledge sharing environment. At
ABC Company, inclusivity and respect for diversity is of
absolute importance. There is a policy that prohibits
discrimination of employees on the basis of race, ethnicity, age,
gender, sexual orientation, political affiliation, religion, and
disability. Hence, all employees can freely share their ideas
without fear of victimization. Nonetheless, departments fear
sharing knowledge with one another which hinders the
company’s culture of teamwork. The disconnection is due to
three mystifications organizational learning, namely-
anthropomorphism, multiple parochial disciplines, and double
loop learning concept.
According to Lipshitz, Friedman and Popper (2007),
anthropomorphism is the act of treating firms like human beings
by attributing human capacity of learning to an organization.
But whereas people have the ability to share knowledge as well
as learn from experiences, organizations cannot. At ABC

Company, the organization’s culture is grounded on the
assumption that organizational learning happens through
employee training. But this leads to disconnection between
organizational learning and organizational culture because
learning of individual employees does not imply organizational
learning.
Mystification of organizational learning is also attributed to
multiplicity of viewpoints regarding the concept. Studies on
organizational learning reflect lack of cumulative work, and
little consensus on the meaning of organizational learning.
Despite growing number of literatures, the concept of
organizational learning lacks a theoretical integration on the
meaning of the term (Antal, Meusburger & Suarsana, 2013). In
essence, the more researches about organizational learning, the
more obscure the term has become. For instance, ABC
Company’s culture considers organizational learning as a
community. In other words, the organization is a collection of
individuals who cannot only learn, but develop as well. Hence,
the organization’s culture relating to organizational learning is
anchored on one of the various definitions of the term.
The organizational learning field has also introduced new
terminologies such as system’s thinking, organizational
memory, double loop learning, competency trap, tacit
knowledge, mental models, and defensive routines (Lipshitz,
Friedman & Popper, 2007). The jargons are appealing as well as
easy to adopt but difficult to understand and apply in
appropriate ways. The double loop learning concept, for
instance, describes a rare type of learning founded on a specific
theoretical framework (Kantamara & Ractham, 2014). ABC
Company has adopted the double loop learning concept to refer
to all types of organizational changes within the organization
despite the fact that it is only applicable to specific types of
learning in specific contexts.
Organizational Learning Mechanisms
The concept of organizational learning mechanisms highlights
the similarities plus differences between individual and

organizational learning. The other contribution of
organizational learning mechanisms is that they provide non-
metaphorical means of showing how firms learn thereby
demystify organizational learning (Cirella, Canterino, Guerci &
Shani, 2016). Nonetheless, organizational learning mechanisms
such as organizational culture, organizational system and
structure, as well as leadership can also hinder organizational
learning. Cook and Yanow (2011) posit that culture involves
shared knowledge, values, plus assumptions about
organizational learning. However, ABC Company lacks a
uniform culture since each department has its own culture which
hampers organizational learning. In addition, the organization’s
leaders do not motivate and encourage sharing of knowledge
between departments. An employee training program introduced
by the company to educate workers on importance of
communication has been ineffective because majority of
employees lack effective communication skills. This can be
attributed to poor leadership and non-collaboration between
departments.
Solution
The off-line/external organizational learning mechanism is the
most appropriate organizational learning mechanism to solve
the problems hindering organizational learning at ABC
Company. According to Lipshitz, Friedman and Popper (2007)
learning is performed by experts in off-line/external
organizational learning mechanism. Normally, experts are
assigned the task on full time basic because they possess

specialized analytical skills. The experts operate from
centralized units that act as companywide repositories of
knowledge as well as knowledge dissemination centers. The
three best practice organizational learning mechanisms that fall
under off-line/ external include U.S. Army Center for Army
Lessons Learned, British Petroleum’s Post-Project Assessment
Unit, and Shell’s Strategic Scenario Planning Unit. Hiring
experts to handle ABC Company’s organization learning
process on full time would enable the company handle all
aspects relating to the concept.
Norms in ABC Company’s Organizational Learning
Organizational learning is grounded on norms, shared
experiences, as well as understanding, which foster appropriate
behavior and learning techniques. Norms of an organization’s
learning culture can affect productive learning when they are
not in congruence with the concept of organizational learning
(Lipshitz, Friedman & Popper, 2007). ABC Company must re-
evaluate its inquiry and transparency norms. Currently, the
company lacks an inquiry norm, which explain the decision
making and innovation problems experienced at ABC. Lipshitz,
Friedman and Popper (2007) indicate that a firm can foster its
inquiry norm by adopting an inquisitive culture which can
enhance learning and knowledge sharing processes. Apart from
inquiry norm, ABC Company lacks an effective transparency
norm. For instance, various departments are willing to share

their knowledge among one another. As a result, ABC Company
is lagging behind the industry in as far as creativity and
innovation is concerned. The organization must foster a
companywide norm of transparency to enhance organizational
learning.
References
Antal, A. B., Meusburger, P., & Suarsana, L. (Eds.).
(2013). Learning organizations: Extending the field (Vol. 6).
Berlin/Heidelberg, Germany: Springer Science & Business
Media.
Cirella, S., Canterino, F., Guerci, M., & Shani, A. B. (2016).
Organizational learning mechanisms and creative climate:
Insights from an Italian fashion design company. Creativity and
Innovation Management, 25(2), 211-222.
Cook, S. N., & Yanow, D. (2011). Culture and organizational
learning. Journal of Management Inquiry, 20(4), 362-379.
Kantamara, P., & Ractham, V. (2014). Single-loop vs. double-
loop learning: An obstacle or a success factor for organizational
learning. International Journal of Education and Research, 2(7),
55-62.
Lipshitz, R., Friedman, V. J., Popper, M. (2007). Demystifying
organizational learning. Thousand Oaks, CA: Sage Publications,
Inc.

8/7/2019
https://blackboard.strayer.edu/bbcswebdav/institution/HRM/562
/1152/Week6/Week 6 Supporting Document 2 Rubrics.html
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/1152/Week6/Week 6 Supporting Document 2 Rubrics.html 1/2
Grading for this assignment will be based on answer quality,
logic / organization of the paper, and language and writing
skills, using
the following rubric.
Points: 100 Supporting Document 2: Resistance Risk Mitigation
Intervention Table
Criteria
Unacceptable
Below 70% F
Fair

70-79% C
Proficient
80-89% B
Exemplary
90-100% A
1. Determine one (1) challenge
in the culture that may cause a
major resistance to the
transition from individual
learning to organizational
learning. Next, recommend one
(1) mitigation intervention to
downgrade the identified
resistance in your table.
Provide a rationale for your
selected mitigation intervention.
Weight: 17%
Did not submit or
incompletely determined
one (1) challenge in the

culture that may cause a
major resistance to the
transition from individual
learning to organizational
learning. Did not submit
or incompletely
recommended one (1)
mitigation intervention to
downgrade the identified
resistance in your table.
Did not submit or
incompletely provided a
rationale for your
selected mitigation
intervention.
Partially determined one
(1) challenge in the
culture that may cause a
major resistance to the
transition from individual
learning to organizational
learning. Partially
recommended one (1)
mitigation intervention to

downgrade the identified
resistance in your table.
Partially provided a
rationale for your
selected mitigation
intervention.
Satisfactorily determined
one (1) challenge in the
culture that may cause a
major resistance to the
transition from individual
learning to organizational
learning. Satisfactorily
recommended one (1)
mitigation intervention to
downgrade the identified
resistance in your table.
Satisfactorily provided a
rationale for your
selected mitigation
intervention.
Thoroughly determined
one (1) challenge in the

culture that may cause a
major resistance to the
transition from individual
learning to organizational
learning. Thoroughly
recommended one (1)
mitigation intervention to
downgrade the identified
resistance in your table.
Thoroughly provided a
rationale for your selected
mitigation intervention.
2. Predict one (1) psychological
learning threat that may result
from the transition and then
provide one (1) mitigation
intervention to downgrade the
identified resistance in your
table. Provide a rationale for
your selected mitigation
intervention.
Weight: 17%
Did not submit or

incompletely predicted
one (1) psychological
learning threat that may
result from the transition
and did not submit or
incompletely provided
one (1) mitigation
intervention to
downgrade the identified
resistance in your table.
Did not submit or
incompletely provided a
rationale for your
selected mitigation
intervention.
Partially predicted one (1)
psychological learning
threat that may result
from the transition and
partially provided one (1)
mitigation intervention to
downgrade the identified
resistance in your table.
Partially provided a

rationale for your
selected mitigation
intervention.
Satisfactorily predicted
one (1) psychological
learning threat that may
result from the transition
and satisfactorily
provided one (1)
mitigation intervention to
downgrade the identified
resistance in your table.
Satisfactorily provided a
rationale for your
selected mitigation
intervention.
Thoroughly predicted one
(1) psychological learning
threat that may result
from the transition and
thoroughly provided one
(1) mitigation intervention
to downgrade the

identified resistance in
your table. Thoroughly
provided a rationale for
your selected mitigation
intervention.
3. Assess the current
organization structure as it
relates to the free flow of
knowledge then specify one (1)
issue that may cause a major
resistance to the transition.
Provide one (1) mitigation
intervention to downgrade the
identified resistance in your
table. Provide a rationale for
your selected mitigation
intervention.
Weight: 17%
Did not submit or
incompletely assessed
the current organization
structure as it relates to
the free flow of

knowledge then specify
one (1) issue that may
cause a major resistance
to the transition. Did not
submit or incompletely
provided one (1)
mitigation intervention to
downgrade the identified
resistance in your table.
Did not submit or
incompletely provided a
rationale for your
selected mitigation
intervention.
Partially assessed the
current organization
structure as it relates to
the free flow of
knowledge then specify
one (1) issue that may
cause a major resistance
to the transition. Partially
provided one (1)
mitigation intervention to

downgrade the identified
resistance in your table.
Partially provided a
rationale for your
selected mitigation
intervention.
Satisfactorily assessed
the current organization
structure as it relates to
the free flow of
knowledge then specify
one (1) issue that may
cause a major resistance
to the transition.
Satisfactorily provided
one (1) mitigation
intervention to
downgrade the identified
resistance in your table.
Satisfactorily provided a
rationale for your
selected mitigation
intervention.

Thoroughly assessed the
current organization
structure as it relates to
the free flow of
knowledge then specify
one (1) issue that may
cause a major resistance
to the transition.
Thoroughly provided one
(1) mitigation intervention
to downgrade the
identified resistance in
your table. Thoroughly
provided a rationale for
your selected mitigation
intervention.
4. Critique the workforce
commitment to this transition
and predict one (1) major
resistance you may encounter.
Next, provide a mitigation
intervention to downgrade the
identified resistance in your
table. Provide a rationale for

your selected mitigation
intervention.
Weight: 17%
Did not submit or
incompletely critiqued the
workforce commitment to
this transition and predict
one (1) major resistance
you may encounter. Did
not submit or
incompletely provided a
mitigation intervention to
downgrade the identified
resistance in your table.
Did not submit or
incompletely provided a
rationale for your
Partially critiqued the
workforce commitment to
this transition and predict
one (1) major resistance
you may encounter.
Partially provided a

mitigation intervention to
downgrade the identified
resistance in your table.
Partially provided a
rationale for your
selected mitigation
intervention.
Satisfactorily critiqued the
workforce commitment to
this transition and predict
one (1) major resistance
you may encounter.
Satisfactorily provided a
mitigation intervention to
downgrade the identified
resistance in your table.
Satisfactorily provided a
rationale for your
selected mitigation
intervention.
Thoroughly critiqued the
workforce commitment to
this transition and predict

one (1) major resistance
you may encounter.
Thoroughly provided a
mitigation intervention to
downgrade the identified
resistance in your table.
Thoroughly provided a
rationale for your selected
mitigation intervention.
8/7/2019
https://blackboard.strayer.edu/bbcswebdav/institution/HRM/562
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selected mitigation
intervention.
5. Propose one (1)
dissemination of knowledge
issue with the recipients’ ability

to absorb the knowledge and
comprehend it into action (i.e.,
motivating the recipient to
share knowledge). Next,
provide one (1) mitigation
intervention to downgrade the
identified resistance in your
table. Provide a rationale for
your selected mitigation
intervention.
Weight: 17%
Did not submit or
incompletely proposed
one (1) dissemination of
knowledge issue with the
recipients’ ability to
absorb the knowledge
and comprehend it into
action (i.e., motivating the
recipient to share
knowledge). Did not
submit or incompletely
provided one (1)
mitigation intervention to

downgrade the identified
resistance in your table.
Did not submit or
incompletely provided a
rationale for your
selected mitigation
intervention.
Partially proposed one (1)
dissemination of
knowledge issue with the
recipients’ ability to
absorb the knowledge
and comprehend it into
action (i.e., motivating the
recipient to share
knowledge). Partially
provided one (1)
mitigation intervention to
downgrade the identified
resistance in your table.
Partially provided a
rationale for your
selected mitigation
intervention.

Satisfactorily proposed
one (1) dissemination of
knowledge issue with the
recipients’ ability to
absorb the knowledge
and comprehend it into
action (i.e., motivating the
recipient to share
knowledge). Satisfactorily
provided one (1)
mitigation intervention to
downgrade the identified
resistance in your table.
Satisfactorily provided a
rationale for your
selected mitigation
intervention.
Thoroughly proposed one
(1) dissemination of
knowledge issue with the
recipients’ ability to
absorb the knowledge
and comprehend it into

action (i.e., motivating the
recipient to share
knowledge). Thoroughly
provided one (1)
mitigation intervention to
downgrade the identified
resistance in your table.
Thoroughly provided a
rationale for your selected
mitigation intervention.
6. Writing Mechanics,
Grammar, and Table
Formatting
Weight: 10%
Serious and persistent
errors in grammar,
spelling, punctuation, or
table formatting.
Partially free of errors in
grammar, spelling,
punctuation, or table
formatting.

Mostly free of errors in
grammar, spelling,
punctuation, or table
formatting.
Error free or almost error
free grammar, spelling,
punctuation, or table
formatting.
7. Clarity and Coherence of
Writing
Weight: 5%
Information is confusing
to the reader and fails to
include reasons and
evidence that logically
support ideas.
Information is partially
clear with minimal
reasons and evidence
that logically support

ideas.
Information is mostly
clear and generally
supported with reasons
and evidence that
logically support ideas.
Information is provided in
a clear, coherent, and
consistent manner with
reasons and evidence
that logically support
ideas.
The Healthcare Intake Packet
Sharlene
Rasmussen College

Code of Ethics
Healthcare developments call for ethical conduct
Three Mountains Regional Hospital:
Dedicated to excellence
Led by shared professional values
Care under the best possible conduct
Progressive developments in science and technology in the 20th
century contributed to advances in healthcare and medicine that
have helped many lives. Healthcare professionals are
increasingly being confronted with ethical dilemmas and moral
questions as the context in which healthcare is provided keeps
on changing. Healthcare specialists, at Three Mountains
Regional Hospital, are required to be dedicated to excellence
within their professional practice of promoting community,
organizational, family, and individual health. The hospital’s
Code of Ethics will cover both staff and patients under shared
professional values. It is the responsibility of the hospital’s

healthcare specialists to reach the best possible standards of
conduct and to encourage these ethical practices to those with
whom they work together.
2
Key Values of the Hospital
Autonomy of patients
Justice for patients
Beneficence
Non-maleficence
Three Mountains Regional Hospital requires patients to have
independence of their thoughts, intention, and action when
making their healthcare decisions. Patient engagement will
uphold the spirit of the existing medical laws and being fair to
all parties involved. All procedures provided to patients will be
based on the intent of doing well for the patient involved.
Through non-maleficence, the hospital will not engage in
procedures which can harm patients and others in society.
3

Ideals of the Code of Ethics
Virtues – caring, compassion, and empathy among others
Conscientiousness – Responsible practice, learning, and full
dedication (Savulescu & Sahakian, 2016).
Collegiality – Communal development
Three Mountains Regional Hospital strives to develop and
practice virtues such as caring, compassion, and empathy,
among others. Through conscientiousness, staff will be required
to practice responsibly by learning from experience through a
dedication to self-improvement and lifelong learning. Hospital’s
staff are required to be generous with their time to answer
questions from patients, patients’ family members and friends,
and from trainees.
4
Purpose of the Intake Packet
Offer better preparation for the appointment
Improve follow up the appointment process
Improve patient experience (Holt & Hope, 2019)

The healthcare intake packet offers patients an opportunity to
understand Three Mountains Regional Hospital and the process
they will be going through. While filling in the form, patients
will engage with their family, friends, and caregivers to prepare
for the care process. The intake packet will develop a
relationship between each patient and the hospital. This
relationship will help improve any required follow up
appointment process. At the end of it all, this will improve the
patient experience in the hospital because their needs will be
clearly captured and addressed.
5
Purpose of the Intake
Packet (cont’d)
Pre-validate patient information (Pedersen & Sanders, 2018)
Save time and money for patients
Improve staff productivity
Accurate patient information is key to good healthcare services
provision. The healthcare intake packet offers patients an
opportunity to fill and validate key information with healthcare
providers. This process will help save the much-needed time for

patients seeking medical care. The process will also help
hospital staff improve their level of productivity which
consequently benefits all stakeholders including patients.
6
Privacy Policy
Patient rights
Three Mountains Regional Hospital’s privacy policy covers
patient rights in regards to any information collected or
processed about them.
Notice of privacy practices
Three Mountains Regional Hospital’s patients have the right to
receive a notice explaining how the hospital will use or disclose
their information.
Protect and respect the confidentiality and privacy of all
individuals and information linked to the Three Mountains
Regional Hospital policies and relevant legislation. Promote the
communication of information, rights, and responsibilities to
nurture informed decision making geared towards offering the
highest quality of care and safety
7

HIPAA
Three Mountains Regional Hospital is under the HIPAA
compliance and regulations (McKnight & Franko, 2016).
Protected health information is appropriately secured
Patients should understand that HIPAA is legislation ensures
patients are protected from healthcare fraud and their
information is secured and under restricted access. Three
Mountains Regional Hospital ensures it maintains the required
HIPAA standards on healthcare data protection. This process
involves compliance with a number of data protection laws.
8
Purpose of HIPAA
Hospital has multiple safeguards to protect patient information
Controls in place to limit who has access to health data
Patients are given control over their information (McKnight &
Franko, 2016).

Through the HIPPA compliance, the Three Mountains Regional
Hospital’s patients will benefit from several safeguards which
will ensure their healthcare information is protected. The
patients need to also understand the hospital maintains different
levels of controls on who accesses healthcare data. Patients are
allowed to maintain an active role in their healthcare and this is
ensured by giving them control over their information.
9
Benefits of Acknowledging Receipt
Understanding of the hospital’s Code of Ethics
Accurate information (Holt & Hope, 2019)
Improve experience
By acknowledging receipt of the healthcare intake packet, the
patient will get an opportunity to understand the values and
code of ethics of the hospital. Receipt of the intake packet will
also improve the accuracy of information which will improve
the medical care processes of the patient.
10

Call for Acknowledging
Receipt
Kindly acknowledge receipt of the healthcare intake packet to
help improve your medical care experience.
Three Mountains Regional Hospital is committed to offering the
best of care for your and the community.
Three Mountains Regional Hospital
5096, Detroit, MI 3963-1130,
US
11
References
Holt, N. R., & Hope, D. A. (2019). First impressions online:
The inclusion of transgender and gender nonconforming
identities and services in mental healthcare providers' online
materials in the USA. International Journal of Transgenderism,
20(1), 49-62.
McKnight, R., & Franko, O. (2016). HIPAA compliance with
mobile devices among ACGME programs. Journal of medical

systems, 40(5), 129.
Pedersen, S., & Sanders, V. (2018). A New and Inclusive Intake
Form for Diagnostic Imaging Departments. Journal of medical
imaging and radiation sciences, 49(4), 371-375.
Savulescu, J., & Sahakian, B. J. (2016). Facilitating the ethical
use of health data for the benefit of society: electronic health
records, consent and the duty of easy rescue. Philosophical
Transactions of the Royal Society A: Mathematical, Physical
and Engineering Sciences, 374(2083), 20160130.
REVIEW
The power point presentation looks good in that it covers a lot
of the material that is included in the intake packet. Nice
overview on each slide with more description and overview of
each slide in the notes section that provided additional details
and information. You needed to show how you supported your
material with APA citations. You did a good job discussing the
need for the intake packet and the purpose that it would be
serving for the facility. You had a good overview of HIPPA and
the facility’s privacy policy and how this policy would protect
the patient and ensure their information is always protected.
You had a good overview of the acknowledgement form and

good encouragement to the patients to sign the form and
demonstrate that they are agreeable to all parts of the intake
packet. Review APA format and ensure all your citations are
correct.
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Grading Rubric
Project Criteria
F
F
C
B
A
0
1
2
3
4
Not Submitted

No Pass
Competence
Proficiency
Mastery
Business letter to the patient explaining the importance of
ethics to the facility and the patient, why each part of the packet
is included, and how the packet is to be used.
Not Submitted
Letter does not fully address the importance of ethics to the
facility and the patient, why each part of the packet is included,
and how the packet is to be used. Major issues with the
formatting of the letter, and is underdeveloped.
Letter addresses the importance of ethics to the facility and the
patient, why each part of the packet is included, and how the
packet is to be used. Lacks supporting evidence and has minor
issues with the formatting.
In-depth letter addresses the importance of ethics to the facility
and the patient, why each part of the packet is included, and
how the packet is to be used. Lacks supporting evidence and has
minor issues with the formatting.
In-depth letter that fully addresses the importance of ethics to
the facility and the patient, why each part of the packet is
included, and how the packet is to be used. Provides proper
formatting and supporting details throughout.
Create a one-page bulleted Code of Ethics.

Not Submitted
Code of Ethics is undeveloped and lacks the requisite elements.
Major issues with the code.
Code of Ethics is present; however, it lacks detail and is flawed
in design. Missing components.
Code of Ethics contains applicable tenets, but they are missing
the details to make them fully applicable to the organization.
Code of Ethics is an in-depth, 1-page bulleted list that is
applicable to the organization.
A sample Living Will template, revised based on previous
feedback.
Not Submitted
Document attempts to provide a sample, living will template
with formatting, but with major errors. Missing parts of the
required pieces. Makes minimal attempt to incorporate feedback
from module assessment.
Document includes a formatted living will; however, it is
lacking detail and depth. Missing revisions based on feedback.
Document includes a detailed living will with minor errors or
missing pieces. Attempts revisions based on feedback.
Document includes an in-depth living will with all of the
requisite pieces and details. Supporting evidence provided. Any
necessary revisions made based on previous feedback.
Create a new form for the patient to sign, acknowledging receipt
of the above documents.

Not Submitted
Patient acknowledgment form is underdeveloped, lacks detail
and formatting.
Patient acknowledgment form submission is basic, missing
minimal elements.
Patient acknowledgment form contains the relevant pieces with
minor errors and issues.
Patient acknowledgment form is complete and contains all of
the requisite pieces.
Craft an email to the CEO and the Board of Directors,
explaining the purpose of the Intake Packet and all its elements.
Not Submitted
Email is underdeveloped in tone and message. Major issues with
formatting.
Provides a basic email that does not fully contain the purpose of
the packet. Minor issues with formatting and tone.
Email provides an in-depth message about the purpose of the
packet. Contains minor issues in formatting or professional
tone.
Email contains proper email formatting (including subject line
description) and contains language appropriate to the receiver.
The message is in-depth and conveys the purpose of the packet.
Create and record a Power Point presentation.
Not Submitted
No formal style in presentation, lacks significant information

and detail.
Formal style is apparent in some parts of recorded presentation
but not maintained throughout. Slides are lacking supporting
evidence.
Formal style is reflected in the majority of the recording. Minor
errors with supporting evidence.
Formal style in presentation throughout with in-depth and
detailed slides. Clear narration.
APA Formatting, Grammar, Spelling, and Mechanics.
Not Submitted
The Reference list is not set up per APA rules, using correct
formatting for margins, font, spacing and is not in alphabetical
order as required. Major issues with grammar, spelling, and
mechanics.
The Reference list set up demonstrates some of the APA rules
of formatting, but omits margins, font, and indentation
formatting, along with an omitting alphabetical listing of
entries. Minor issues with grammar, spelling, and mechanics.
The Reference List set up demonstrates the majority of APA
rules of formatting correctly, follows margin and fonts rule, and
alphabetical entries are mostly correct, but omits double spacing
and hanging indent for second lines as required. Minimal issues
with grammar, spelling, and mechanics.
The Reference list set up exhibits excellent attention to
formatting with fonts, margins, spacing, and alphabetical entry

correctly applied per APA formatting standards.
Grading Criteria
0 No Pass
0points
F 1 No Pass
1points
C 2 Competence
2points
B 3 Proficiency
3points
A 4 Mastery
4points