• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • About KVH
  • Pay My Bill
  • Contact Us
  • Events & Education
  • Careers
  • Foundation
  • Show Search

KV Healthcare

MENUMENU
  • Clinics & Specialties
        • KVH Cardiology
        • KVH Dermatology
        • KVH ENT & Allergy
        • KVH Family Medicine – Cle Elum
          • Addiction Medicine
          • Anticoagulation Clinic
        • KVH Family Medicine – Ellensburg
          • Addiction Medicine
          • Anticoagulation Clinic
        • KVH General Surgery
        • KVH Geriatric Nurse Practitioners
        • KVH Home Health
          • Home Infusion Services
        • KVH Hospice
        • KVH Internal Medicine
          • Anticoagulation Clinic
        • KVH Neurology
        • KVH Occupational Medicine
        • KVH Occupational Therapy
        • KVH Orthopedics
        • KVH Pediatrics
        • KVH Physical Therapy
          • Aquatic Therapy
        • KVH Speech Therapy
        • KVH Urgent Care
        • KVH Vascular Surgery
        • KVH Women’s Health
        • KVH Workplace Health
        • KVH Wound Care
  • Hospital Services
    • Cardiopulmonary Services
      • Diagnostic Testing
    • Emergency Department
      • What to expect upon arrival
      • Ouchless ER
      • Sexual Assault Nurse Examiners
    • Family Birthing Place
      • What to Expect
      • Birth & Family Education
      • Lactation Services
      • 4th Trimester Resource Center
      • Pregnancy & Infant Loss
    • Imaging Services
      • Bone Densitometry
      • Computerized Tomography (CT)
      • Digital Fluoroscopy
      • Echocardiography
      • Magnetic Resonance Imaging (MRI)
      • Digital Mammography
      • Radiography (X-ray)
      • Ultrasound
    • Laboratory Services
      • Standing Orders
      • Sample Collection
    • Nutrition Services
      • Nutrition Consultation
      • Diabetes Self-Management
      • Nutrition Classes
      • Diabetes Support Club
      • Nutrition Resources
    • Pharmacy Services
    • Surgical Services
      • Preparation for Surgery
      • Children & Surgery
  • Patients & Visitors
    • Checking In
      • Patient Policies
      • Patient Safety & Security
    • Visiting
    • Billing
      • Online Bill Payment
      • Price Transparency Tool
      • Bills from Other Providers
      • Insurance plans accepted at KVH
      • Insurance vs. Self Pay
      • Washington Health Plan Finder
    • Medical Records
    • DAISY Award Program
    • Patient Stories
    • Patient Portal
    • Quality of Care
    • Retail Pharmacy
  • Find a Provider
  • KVH News
  • Pay My Bill
  • MyPatientPortal
Hide Search

Consent for Treatment

All patients receiving care at KVH Hospital are asked to sign a Consent for Treatment form at each visit.

The undersigned hereby consents to diagnostic procedures, anesthesia, medical-surgical treatment or hospital services that may be rendered, as ordered by a healthcare professional. I understand that my care is under the control of my attending provider, his or her assistants or designees, and that the hospital is not liable for any act of omission of treatment when following the instructions of that physician.

Release of Healthcare Information

I permit the healthcare organization and the physicians or other health professionals involved in the inpatient or outpatient care to release my healthcare information for purposes of treatment, payment or healthcare operations. Healthcare information may be released to any person or entity liable for payment on the patient’s behalf in order to verify coverage or payment questions or for any purpose related to benefit payment.

Financial Agreement

I hereby assign and authorize payment directly to Kittitas Valley Healthcare for all hospital and medical insurance benefits otherwise payable to me, in an amount not to exceed the hospital’s charges for its services. I understand I am financially responsible to KVH for any charges not paid under this assignment. Should legal action become necessary to collect this bill, I understand that I will be held responsible for collection expenses.

Other Acknowledgements

I hereby consent to the release of my name, my presence in the hospital, and my condition as part of the general hospital directory, available to those who ask for me by name.

I authorize my healthcare information to be disclosed for purposes of communicating results, findings, and care decisions to my family members and others responsible for my care or designated by me.

I understand and agree that personal property such as money and jewelry should not be brought into the hospital and understand and agree that KVH shall not be liable for loss or damage any personal property.

Sub: PV: Check In: Policies

Patient Policies

Patient Policies

  • Consent for Treatment
  • Death with Dignity
  • Financial Assistance & Charity Care
  • Patient Rights and Responsibilities
  • No Surprise Act
  • Privacy Notice
  • Public Disclosure Requests
  • Reproductive Health Services
  • Tortious Claims, Presentment and Filing (PDF)
  • Website Disclaimer & Privacy Policy

Agreements

Agreements

  • PHD Interlocal (PDF)
  • WRHC Interlocal (PDF)

Checking In

Checking In

  • Patient Policies
  • Patient Safety & Security

For Patients & Visitors

Patients & Visitors

  • Checking In
  • Visiting
  • Price Transparency and Billing Services
  • Medical Records
  • DAISY Award Program
  • Patient Stories
  • Patient Portal
  • Quality of Care
  • Retail Pharmacy

Footer Top 1

HRSA National Health Service Corps Site

Footer Top 2

603 S. Chestnut Street - Ellensburg, WA 98926
509.962.9841

  • Facebook
  • Instagram
  • LinkedIn
  • Twitter
  • YouTube

Footer Top 3

Footer Bottom 1

Download the MyPatient Portal App
Apple Store Google Play Store

Footer Bottom 2

  • About KVH
  • Careers
  • Board of Commissioners
  • Contact Us
  • Foundation

Footer Bottom 3

  • Our Locations
  • Hospital Services
  • Clinics & Specialty Services
  • Patients & Visitors
  • Events & Education
  • Press Releases
  • KVH Legal Information

Footer Bottom 4

Google Translate