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Physician Directory

Forms

Patient Forms

Thousand Oaks Surgical Hospital (TOSH) is committed to providing our patients with as much information as possible prior to their scheduled procedure or stay. Below are several informational forms for your use.

1. Patient Information Guide provides you with general information about TOSH including Services and Amenities, Patient Safety, Your Stay and Financial Services. To view this guide click here.


2. You Are Having Surgery Form provides you with information about preparing for your procedure, important phone numbers and directions to our hospital. To view this form click here.


3. Pre-Operative Instructions provide you with information about preparing for your procedure. A Pre-Assessment Nurse will go over this form with you prior to your procedure and review any variances or additional instructions based on your specific procedure. To view this form click here.

Physician Office Forms

The following physician forms have been made to guide you and your office through the ease of scheduling surgical cases or other services at TOSH.
You will find three (3) areas of focus in our physician forms:

1. Surgery Scheduling (both inpatient and outpatient)
2. Direct Admissions, Post-Anesthesia
3. Medical Admissions

Surgery Scheduling

1. The information in our Surgery Scheduling Sheet is needed. To schedule a surgery, please utilize this form, fax it to the surgery scheduling desk (fax: 805-418-1387), and phone the scheduling office (805-418-1300) to arrange for the surgery date and time.
2. Pre-Op Physician Orders (click on your specialty below to download the form):
1. ENT/Head & Neck Pre-Operative Physician Orders click here.
2. Epidural Block Pre and Post-Op Physician Orders click here.
3. General Surgery Pre-Operative Physician Orders click here.
4. Gynecology Pre-Operative Physician Orders click here.
5. Orthopedic/Podiatry Pre-Operative Physician Orders click here.
6. Spine/Neurological Pre-Operative Physician Orders click here.
7. Urology/Genitourinary Pre-Operative Physician Orders click here.
• Important Information provides you with key TOSH contacts that you may need as well as phone numbers for various departments.  To view this form, click here.

Direct Admissions, Post-Anesthesia

A "Direct Admission, Post-Anesthesia" is defined as any patient who is admitted to TOSH for overnight care following a surgical procedure completed at another facility. A Direct Admission, Post-Anesthesia from a physician will be dependent upon medical appropriateness for TOSH, the availability of inpatient staffing/census and insurance verification (if applicable). Approval from the Medical Director may also be required.
In order to admit a patient under this classification, the following steps must be taken:

1. Call TOSH at (805) 777-7750 Monday through Friday, from 8:00am-6:00pm and ask to speak to someone in the Business Office. The Business Office will verify the patient's insurance as well as initiate communication with Inpatient Services for bed availability. When contacting the Business Office, we require an admitting diagnosis and basic clinical information. This is needed for pre-certification. After hours, we ask that you call Inpatient Services at (805) 418-1281, and ask to speak to a Manager or Charge Nurse.
   *In the event your patient is a self-pay/cash patient, payment will be due at the time of the admission. Your office will be given an estimated cost and we ask that you provide that information to your patient prior to their admission.
2. We will call you back to confirm whether the patient can be admitted. 
3. The following forms must be completed by the admitting physician and faxed to Inpatient Services (fax number is indicated on the forms) prior to directing the patient to TOSH.
1. Direct Post-Op Surgical Admit Assessment Form click here
2. Direct Admit Patients Medical/Surgical Orders click here
3. Patient’s Own Medication Form click here
4. History and Physical click here
4. Unless medically contraindicated, the patient will be instructed to stop at the TOSH Registration Desk when he/she arrives to sign his/her admission papers and make any payments necessary (co-pay, co-insurance, self pay/cash fees).

Medical Admissions

A “Medical Admission" is defined as an admission to Inpatient Services at TOSH related to clinical necessity that cannot be provided in a less acute setting, such as management of severe pain.  A Medical Admission from a physician will be dependent upon medical appropriateness for TOSH, the availability of inpatient staffing/census and insurance verification (if applicable). Approval from the Medical Director may also be required.
In order to admit a patient under this classification, the following steps must be taken:

1. Call TOSH at (805) 777-7750 Monday through Friday, from 8:00am-6:00pm and ask to speak to someone in the Business Office.  The Business Office will verify the patient’s insurance as well as initiate communication with Inpatient Services for bed availability.  When contacting the Business Office, we require an admitting diagnosis and basic clinical information.  This is needed for pre-certification.  After hours, we ask that you call Inpatient Services at (805) 418-1281, and ask to speak to a Manager or Charge Nurse.
   *In the event your patient is a self-pay/cash patient, payment will be due at the time of the admission. Your office will be given an estimated cost and we ask that you provide that information to your patient prior to their admission.
2. We will call you back to confirm whether the patient can be admitted.
3. The following forms must be completed by the admitting physician and faxed to Inpatient Services (fax number is indicated on the forms) prior to directing the patient to TOSH.
1. Direct Admit Patients Medical/Surgical Orders click here
2. Patient’s Own Medication Form click here
3. History and Physical click here
4. Unless medically contraindicated, the patient will be instructed to stop at the TOSH Registration Desk when he/she arrives to sign his/her admission papers and make any payments necessary (co-pay, co-insurance, self pay/cash fees).