![](media/image1.jpeg){width="5.965277777777778in"
height="11.556944444444444in"}Veteran

![](media/image1.jpeg){width="4.079166666666667in"
height="5.826388888888889in"}Information

Packet

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**Home Address:**

**Home Telephone:**

**Other Important Information:**

### Emergency Contact -- Name:

### 

### Telephone:

### 

### Relationship:

### 

### 

### 

### 

### My Prime Care Team is:

### 

### Telephone (713) 794-

**My Prime Care Physician is:**

**My Prime Care Nurse is:**

To ensure patient safety at the Michael E. DeBakey VA Medical Center,
you will be asked to state your full name and full social security
number before treatments and/or invasive procedures are done. Always
bring your VA card with you.

## **Table of Contents**

WELCOME TO THE MICHAEL E. DEBAKEY VA MEDICAL CENTER 5

ELIGIBILITY 5

Am I eligible for the VA Medical Benefits Package? .........\...5

What are the VA Priority Groups? .........\...6

Combat Veteran Eligibility .........\...7

ENROLLMENT 8

Do I have to enroll to receive health care? .........\...8

How do I get a copy of my DD 214? .........\...8

Once enrolled, do I need to enroll each year? .........\...8

BENEFITS & SERVICES 9

What is the Medical Benefits
Package?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
9

What does it
cover?\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
10

QUESTIONS ABOUT BENEFITS & SERVICES 12

What about other VA benefits? .........\...12

How do I begin to receive VA medical benefits and services?
.........\...12

PATIENT
TRAVEL.......................................................................................................13

EMERGENCY ROOM
PROCEDURES....................................................... 18

EMERGENCY CARE IN NON-VA FACILITIES 18

How do I qualify? .........\...19

Should I cancel my current insurance? .........\...19

What type of emergency services will VA cover? .........\...19

Do I need to get approval before going to the emergency room?
.........\...20

What documents are required by VA to process my claim? .........\...22

CHARGES & CO-PAYMENTS 23

If I am enrolled, what cost will there be for me? .........\...23

Will I have out-of-pocket expenses? .........\...23

How are the co-payments calculated? .........\...23

What are the medical expense deductions? .........\...24

How is the co-payment for prescription drugs calculated? .........\...24

What is the co-payment for prescriptions? .........\...24

Who pays for my hearing aids and eyeglasses? .........\...25

PRIMARY CARE 25

What is my Prime Care Provider responsible for? .........\...25

How do I find out who my Prime Care Team is? .........\...26

Can I walk in and see my Prime Care Team anytime? .........\...26

Who do I call if I have a problem after hours? .........\...27

VA NETWORK TELECARE
CENTER........................................................................\........27

What is the purpose of the VA Network Telecare Center? ............27

Should I call if it's a life-threatening emergency? ...........27

I have a complaint. Should I call the Telecare Center? ...........27

MAKE, CHANGE OR CANCEL AN APPOINTMENT .........\...28

URGENT CARE 29

PRESCRIPTIONS 29

PRESCRIPTION REFILLS 32

DENTAL CARE 33

CO-MANAGED CARE: VA AND PRIVATE PHYSICIANS 34

Can I receive care from both a VA and local community health provider?
.........\...34

How do I participate in Co-Managed Care? .........\...34

Can I get my prescriptions filled at the VA and not see a VA doctor?
.........\...34

VA Co-Management Check List .........\...36

Co-Managed Care Letter to Community Health Care Provider .........\...37

TRANSPORTATION 38

INFORMED CONSENT 38

Can I refuse medical treatment? .........\...38

How do consent forms work? .........\...38

ADVANCE DIRECTIVES 39

ORGAN DONATION 42

ALLOWANCE FOR HOUSEBOUND 42

CHAMPVA 43

PARTICIPATE IN YOUR CARE .........\...44

ADMISSION PROCEDURES 44

Where do I go for admission processing? .........\...44

Do I get an ID bracelet? .........\...45

Do I bring my medications with me? .........\...45

YOUR HOSPITAL STAY .........\...45

Patient Safety .........\...45

Calling Your Nurse .........\...46

Restrictions .........\...46

Face Mask .........\...46

Conduct and Behavior .........\...46

Smoking .........\...46

Noise .........\...46

Meals .........\...46

Fire/Disaster Drills .........\...47

Patient Day Rooms .........\...47

Televisions .........\...47

Hearing Impaired Patients .........\...47

Telephones........................................................................................................47

Passes ............47

FISHER HOUSE & COURTESY
QUARTERS\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
............48

FACILITIES & SERVICES INSIDE THE HOSPITAL 48

Canteen Services .........\...48

Barber Shop .........\...49

Information Desk .........\...49

Lost & Found .........\...49

Patient Mail .........\...49

Parking .........\...49

Release of Medical Information .........\...50

Religious Services .........\...50

Social Workers .........\...50

Veterans Benefits Counselors .........\...50

Voluntary Services .........\...50

Escort Service .........\...51

Recreation Therapy .........\...51

VISITING HOURS & GUIDELINES 51

PATIENT PRIVACY 52

QUALITY & SATISFACTION 53

How can I be sure that I am getting high quality care? .........\...53

Who do I talk to if I have a complaint? .........\...53

CARE CHOICES 54

PAIN MANAGEMENT 54

PATIENT RIGHTS & RESPONSIBILITES 55

PATIENT EDUCATION RESOURCE CENTER (PERC) 53

DISCHARGE FROM THE HOSPITAL 57

MENTAL HEALTH SERVICES 58

LEGAL
CLINIC.......................................................................................................\...\...59

SUPPORT GROUPS .........\...60

IMPORTANT HOUSTON VA TELEPHONE
NUMBERS\...\...\...\...\...\...\...\...\...\...\...\...\...\... 62

Updated January 2008 by Michael E. DeBakey VA Medical Center Public
Affairs, (713) 794-7349

**Welcome to the Michael E. DeBakey VA Medical Center**

The Michael E. DeBakey VA Medical Center (MEDVAMC) serves as primary
health care provider for more than 120,000 veterans in Southeast Texas.
In fiscal year 2007, there were 733,628 outpatient visits at the Houston
facility, 60,540 outpatient visits at the Beaumont Outpatient Clinic,
45,489 outpatient visits at the Charles Wilson Outpatient Clinic in
Lufkin, 35,025 outpatient visits at the Galveston and Texas City
Community Based Outpatient Clinics and 11,447 outpatient visits at the
Conroe Outpatient Clinic. During the same period, 13,275 veterans were
admitted as inpatients and 243 were admitted to the Transitional Care
Center.

Veterans from around the country are referred to the MEDVAMC for
specialized diagnostic care, radiation therapy, surgery, and medical
treatment including cardiovascular surgery, gastrointestinal endoscopy,
nuclear medicine, ophthalmology, and treatment of spinal cord injury and
diseases. The MEDVAMC is home to a Post Traumatic Stress Disorder
Clinic; a Network Polytrauma Center; an award-winning Cardiac and
General Surgery Program; a Liver Transplant Center; and one of the VA's
six Parkinson's Disease Research, Education, and Clinical Centers.

Many MEDVAMC programs have received national awards and honors including
accreditation from Joint Commission for hospital, long-term care,
behavioral health care, and substance abuse. In 2005, the MEDVAMC was
awarded three-year Commission on Accreditation of Rehabilitation
Facilities (CARF) accreditations for its Mental Health Care Line's
Vocational Rehabilitation and Health Care for Homeless Veterans
Programs. A year later, the MEDVAMC was awarded a three-year CARF
accreditation for its Comprehensive Integrated Inpatient Rehabilitation
Program and Spinal Cord Injury Care Line. In 2007, the MEDVAMC received
praise from the VA Continuous Improvement in Cardiac Surgery Program for
decreasing its already exceptionally low cardiac surgery mortality rate
despite increased patient load caused by the 2005 hurricanes and from
the VA Inpatient Evaluation Center for having a significantly low
standardized mortality rate in its Surgical Intensive Care unit for
fiscal years 2005 and 2006. The same year, the MEDVAMC medical
laboratory was awarded re-accreditation by the Commission on Laboratory
Accreditation of the College of American Pathologists and the cancer
program was granted a three-year approval award by the Commission on
Cancer of the American College of Surgeons.

**Notice to Veterans**

The Veterans Health Administration (VHA) is pleased you have selected us
to provide your health care. We want to improve your health and
well-being. We will make your visit or stay as pleasant for you as
possible. As part of our service to you, to other veterans and to the
nation, we are committed to improving health care quality. We also train
future health care professionals, conduct research, and support our
country in times of national emergency. In all of these activities, our
employees will respect and support your rights as a patient.

**Eligibility**

**Am I eligible for the VA Medical Benefits Package?**

When a veteran calls the Eligibility Office, (713) 794-7288, at the
MEDVAMC, the first question the veteran is asked is, "When were you in
the military?" If the veteran enlisted after September 7, 1980, the next
questions are, "Did you complete 24 months of continuous active duty
service? If not, were you discharged because of a disability or a
hardship? Does your DD214 state this? What branch of service did you
serve in?" If the veteran completed 24 months of continuous active duty
service and served in the regular branch of the armed forces, he or she
is eligible for VA medical care. If the veteran was in the Reserves, he
or she is not eligible unless called up to active military by an
executive order issued by the President of the United States and served
the period of duty required on the orders.

Merchant Marines are only eligible if they served during World War II
and have a copy of their DD214 showing this service.

National Guardsmen are not eligible unless they are called up to active
military by an executive order issued by the President of the United
States and served the period of duty required on the orders.

Once eligibility is established, veterans are advised they may apply for
health care benefits in person, by mail, or on the Internet at
*www.va.gov*.

Once the application is processed, a veteran is notified by mail and
given information on his or her priority group. Priority groups
distinguish between veterans with service-connected disabilities, former
Prisoners of War, Purple Heart recipients, World War I veterans,
veterans with disabilities associated with exposure to toxic substances,
and so forth.

Priority groups also determine applicable co-payments for medical care.

After registration, veterans are assigned a primary health care provider
who has responsibility for all of their health care needs.

**What are the Priority Groups?**

Once you apply for enrollment, your eligibility will be verified. Based
on your specific eligibility status, you will be assigned a priority
group. The priority groups are as follows, ranging from 1-8 with 1 being
the highest priority for enrollment. Under the Medical Benefits Package,
the same services are generally available to all enrolled veterans.

As of January 17, 2003, VA is not accepting new Priority Group 8
veterans for enrollment (veterans falling into Priority Groups 8e and
8g). It is important to note that Priority Group 8 veterans already
enrolled will be "grandfathered" and allowed to continue in VA's health
care system.

Priority Group 1:

-   Veterans with service-connected disabilities rated 50% or more
    disabling

-   Veterans determined by VA to be unemployable due to
    service-connected conditions

# 

# Priority Group 2:

-   Veterans with service-connected disabilities rated 30% or 40%
    disabling

Priority Group 3:

-   Veterans who are former POWs

-   Veterans awarded a Purple Heart medal

-   Veterans whose discharge was for a disability that was incurred or
    aggravated in the line of duty

-   Veterans with service-connected disabilities rated 10% or 20%
    disabling

-   Veterans awarded special eligibility classification under Title 38,
    U.S.C., Section 1151, \"benefits for individuals disabled by
    treatment or vocational rehabilitation\"

Priority Group 4:

-   Veterans who are receiving aid and attendance or housebound benefits

-   Veterans who have been determined by VA to be catastrophically
    disabled

Priority Group 5:

-   Nonservice-connected veterans and noncompensable service-connected
    veterans rated 0% disabled whose annual income and net worth are
    below the established VA Means Test thresholds

-   Veterans receiving VA pension benefits

-   Veterans eligible for Medicaid benefits

-   

Priority Group 6:

-   Compensable 0% service-connected veterans

-   World War I veterans

-   Mexican Border War veterans

-   Veterans solely seeking care for disorders associated with exposure
    to herbicides while serving in Vietnam, exposure to ionizing
    radiation during atmospheric testing or during the occupation of
    Hiroshima and Nagasaki, for disorders associated with service in the
    Gulf War, or for any illness associated with service in combat in a
    war after the Gulf War or during a period of hostility after
    November 11, 1998.

Priority Group 7:

-   Veterans who agree to pay specified co-payments with income and/or
    net worth above the VA Means Test threshold and income below the HUD
    geographic index

-   Subpriority a: Noncompensable 0% service-connected veterans who were
    enrolled in the VA Health Care System on a specified date and who
    have remained enrolled since that date

-   Subpriority c: Nonservice-connected veterans who were enrolled in
    the VA Health Care System on a specified date and who have remained
    enrolled since that date

-   Subpriority e: Noncompensable 0% service-connected veterans not
    included in Subpriority a above

-   Subpriority g: Nonservice-connected veterans not included in
    Subpriority c above

Priority Group 8:

-   Veterans who agree to pay specified co-payments with income and/or
    net worth above the VA Means Test threshold and the HUD geographic
    index

-   Subpriority a: Noncompensable 0% service-connected veterans enrolled
    as of January 16, 2003 and who have remained enrolled since that
    date

-   Subpriority c: Nonservice-connected veterans enrolled as of January
    16, 2003 and who have remained enrolled since that date

-   Subpriority e: Noncompensable 0% service-connected veterans applying
    for enrollment after January 16, 2003

-   Subpriority g: Nonservice-connected veterans applying for enrollment
    after January 16, 2003

### 

**What about Combat Veteran Eligibility?**

Veterans who served in combat during a period of war after the Gulf War
or against a hostile force during a period of hostilities after November
11, 1998, qualify, and are eligible for hospital care, medical services,
and nursing home care for 5 years after discharge from the military for
any illness.

Co-payments may be charged for those conditions which the Veterans
Health Administration (VHA) finds resulted from a cause *other* than
such combat service.

National Guard and Reserve personnel who were activated and who served
in combat support or direct combat operations, may also be eligible for
the combat related health care benefits. Certain requirements, which
essentially satisfy the definition of "veteran" must be met to qualify.

There is an OEF/OIF Team available to help facilitate your progress
through the VA medical care process.  Questions may be directed to Fern
A. Taylor, Iraqi Veteran Coordinator, at (713) 794-7034; Toni Brown,
Program Manager, at (713) 794-7928; and Vickie Toliver, Transition
Patient Advocate, at (713) 794-8825.

**Who do I call if I have more questions?**

For additional information or to get your eligibility questions
answered, please call the MEDVAMC VA Eligibility and Enrollment Office
at (713) 794-7288, Monday through Friday, 8 a.m. to 4:30 p.m.

**Enrollment**

### 

To receive health care, most veterans must be enrolled first.  As of
January 17, 2003, VA is not accepting new Priority Group 8 veterans for
enrollment (veterans falling into Priority Groups 8e and 8g.)

**Do I have to enroll to receive health care?* ***

You are *NOT *required to apply for enrollment if you fall into one of
the following categories: 

-   VA has rated you as 50% or more service-connected;

-   Less than one year has passed since you were discharged from
    military service for a disability that the military determined was
    incurred or aggravated in the line of duty, but VA has not yet
    rated; or

-   You are seeking care from VA for a service-connected disability only
    (even if the rating is only 0%).

**How do I apply?**

You can apply for enrollment at any VA health care facility, VA Regional
Office, or Veterans Service Office, or you may apply via the Internet at
*[www.va.gov/elig](http://www.va.gov/elig).*

You can apply for VA health care by completing VA form 10-10EZ. The
10-10EZ form may be obtained by visiting, calling, or writing any VA
health care facility or veterans\' benefits office. You can also call
toll-free 1-877-222-VETS (1-877-222-8387) or access the form on the
Internet at *<http://www.va.gov/1010ez.htm>.* Completed applications
must be signed and dated.

We will need a copy of your DD214 or Military Discharge Certificate to
verify your eligibility. After applying, you will receive a letter
confirming your enrollment from the Department of Veterans Affairs that
identifies your Priority Group**.**

**How do I get a copy of my DD214?**

The Department of Veterans Affairs does not maintain records of
veteran's military service, except as are necessary for providing
benefits. For information about obtaining your military record, please
visit the Military Personnel Records Center in St. Louis, which is part
of the National Archives and Records Administration, on the Internet at
[www.nara.gov/regional/mpr.html](http://www.nara.gov/regional/mpr.html)
or call 1-866-272-7272. The VA Regional Office, at 1-800-827-1000, can
also send you the necessary request form.

**What else do I need to know?**

Enrollment is an ongoing process. You can apply for enrollment at any VA
health care facility.  An important aspect of enrollment is for you to
identify which VA health care facility you choose as your preferred
facility. 

The preferred facility is where you receive your primary care. If for
any reason a selected facility is unable to provide the health care
needed by an enrolled veteran, then that facility will make arrangements
for referral to another VA health care facility or to one of VA's
private sector affiliates to provide the required care.

### Once enrolled, do I need to enroll each year?

Enrollments are renewed annually and many veterans will stay enrolled
each year without any action on their part. Veterans who are not
receiving monthly compensation or pension checks from VA; however, may
be required to complete an annual financial statement known as a Means
Test. Completing a Means Test allows the VA to place you in the correct
Priority Group for determination of co-payments. It also ensures that
your local VA receives reimbursement from our headquarters office for
the health care we provide to you. Veterans from the Gulf Coast area
affected by Hurricanes Katrina and/or Rita will have their changed
circumstances taken into account for eligibility purposes. We would be
glad to help you with the forms.

Contact the MEDVAMC Enrollment Office at (713) 794-7288 if you have
questions.

### How does enrolling in the VA Health Benefits Package affect my Medicare and/or private insurance?

If you have health insurance, or eligibility for other programs such as
Medicare, Medicaid, or CHAMPUS, you may continue to use services under
those programs. You are not required to use VA as your exclusive health
care provider.

Veterans with private insurance, Medicare, or Medicaid, may find VA
enrollment to be a complement to their other coverage. VA encourages
veterans to maintain their Medicare and/or private insurance coverage to
provide options and flexibility in the future.

Whether or not you have insurance does not affect your eligibility for
VA health care benefits. But if you do have insurance coverage, we would
like to know for three reasons. Two of the reasons benefit you. First,
the law requires us to bill private health insurance companies for all
care provided for veteran's non-service connected disabilities. Keep in
mind that you will not be responsible for any unpaid balance that the
insurance company does not pay, except for VA co-payments.

Second, many insurance companies will apply VA health care charges
toward the satisfaction of your annual deductible. Finally, and most
importantly, the Michael E. DeBakey VA Medical Center's medical care
budget is supplemented by the amount we are able to collect from private
health insurance carriers. This means the money we collect here in
Houston is used to pay our doctor and nurse salaries, buy medications
for our pharmacy, and deliver medical services to the veterans we serve
in Southeast Texas. Your assistance in assuring that the insurance
information we have for you is current and accurate helps us meet the
requirements of the law, and more importantly, helps us to provide
health care services to all the veterans we serve.

**If I cannot be enrolled, will I still be eligible for VA hospital and
outpatient care?**

> A veteran who is not enrolled will still be eligible for hospital and
> outpatient care for conditions related to military sexual trauma, head
> or neck cancer related to nose or throat radium treatment while in the
> military, readjustment counseling services, and treatment related to
> service-connected conditions.
>
> If you need more information, please contact the MEDVAMC Enrollment
> Office at (713) 794-7288.

**Benefits & Services**

**What is the Medical Benefits Package?**

In October 1996, Congress passed Public Law 104-262, the *Veterans\'
Health Care Eligibility Reform Act of 1996*. This legislation paved the
way for the creation of a Medical Benefits Package - a standard enhanced
health benefits plan generally available to all enrolled veterans. Like
other standard health care plans, the Medical Benefits Package
emphasizes preventive and primary care, offering a full range of
outpatient and inpatient services.

VA places a priority on improved veteran satisfaction. Our goal is to
ensure the quality of care and service you receive is consistently
excellent, in every location, in every program.

**What does it cover?**

The Medical Benefits Package will generally be provided to all enrolled
veterans regardless of your priority group.

Public Law 104-262 calls for VA to provide you hospital care and
outpatient care services that are defined as \"needed.\" VA defines
\"needed\" as care or service that will promote, preserve, and restore
health. This includes treatment, procedures, supplies, or services. This
decision of need will be based on the judgment of your health care
provider and in accordance with generally accepted standards of clinical
practice.

The following three categories contain a list of health care services
that are provided under the Medical Benefits Package, a list of some
that are not covered by VA, and a list of other services that are
provided under special authority.

**Category 1: Services Covered Under the Medical Benefits Package   **

**Basic care** 

-   Outpatient medical, surgical, and mental health care including care
    for substance abuse.

-   Inpatient hospital, medical, surgical, and mental health care
    including care for substance abuse.       

-   Prescription drugs including over-the-counter drugs and medical and
    surgical supplies available under the VA national formulary
    system.       

-   Emergency care in VA facilities.       

-   Bereavement counseling.       

-   Comprehensive rehabilitative services other than vocational
    services.       

-   Consultation, professional counseling, training, and mental health
    services for the members of the immediate family or legal guardian
    of the veteran.       

-   Durable medical equipment and prosthetic and orthotic devices
    including eyeglasses and hearing aids.       

-   Home health services.       

-   Reconstructive (plastic) surgery required as a result of a disease
    or trauma but not including cosmetic surgery that is not medically
    necessary.       

-   Respite, hospice, and palliative care.       

-   Emergency care in non-VA facilities in certain conditions: This
    benefit is a safety net for veterans requiring emergency care for a
    service connected disability or enrolled veterans who have no other
    means of paying a private facility emergency bill. If another health
    insurance provider pays all or part of a bill, VA cannot provide any
    reimbursement.

> To qualify for payment or reimbursement for non-VA emergency care
> service for a **service-connected** disability, you must meet all of
> the following criteria:   

-   It must be for a Medical Emergency.   

-   Department of Veterans Affairs or other Federal facilities are not
    feasibly available at time of emergency event.   

-   The emergency was for a service-connected disability. 

> To qualify for payment or reimbursement for non-VA emergency care
> services for a **nonservice-connected** condition, you must meet all
> of the following criteria:   

-   You are enrolled in the VA Health Care System.   

-   You have been provided care by a VA clinician or provider within the
    last 24 months.  

-   You were provided care in a hospital emergency department or similar
    facility providing emergency care.  

-   You have no other form of health insurance.  

-   You do not have coverage under Medicare, Medicaid, or a state
    program.  

-   You do not have coverage under any other VA programs.  

-   Department of Veterans Affairs or other Federal facilities are not
    feasibly available at time of emergency event.  

-   A reasonable layperson would judge that any delay in medical
    attention would endanger your health or life.  

-   You are financially liable to the provider of the emergency
    treatment for that treatment.  

-   You have no other contractual or legal recourse against a third
    party that will pay all or part of the bill. 

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-   Payment of and travel expenses for eligible veterans:   

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-   A veteran or other person traveling in connection with treatment for
    a service-connected disability (irrespective of percent of
    disability).   

-   A veteran with a service-connected disability rated at 30 percent or
    more, for treatment of any condition.   

-   A veteran receiving VA pension benefits.   

-   A veteran whose annual income does not exceed the maximum annual
    rate of pension, which would be payable if the veteran were eligible
    for pension, or who is unable to defray the expenses of travel. 

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-   Pregnancy and delivery service, to the extent authorized by
    law.       

-   Completion of forms. This coverage includes completion of forms such
    as Family Medical Leave forms, life insurance applications,
    Department of Education forms for loan repayment exemptions based on
    disability, and non-VA disability program forms by health care
    professionals based on an examination or knowledge of the veteran\'s
    condition. This does not include the completion of forms for
    examinations if a third party customarily will pay health care
    practitioners for the examination but will not pay VA.

### Preventive care 

-   Periodic medical exams.       

-   Health education, including nutrition education.       

-   Maintenance of drug-use profiles, drug monitoring, and drug use
    education.       

-   Mental health and substance abuse preventive services.

**Category 2: Services Not Covered Under the Medical Benefits
Package   **

-   Abortions and abortion counseling.         

-   In vitro fertilization.         

-   Drugs, biologicals, and medical devices not approved by the Food and
    Drug Administration unless the treating medical facility is
    conducting formal clinical trials under an Investigational Device
    Exemption (IDE) or an Investigational New Drug (IND) application, or
    the drugs, biologicals, or medical devices are prescribed under a
    compassionate use exemption.         

-   Gender alterations.         

-   Hospital and outpatient care for a veteran who is either a patient
    or inmate in an institution of another government agency if that
    agency has a duty to give the care or services.         

-   Membership in spas and health clubs.

**Category 3: Services with Limited Coverage**

-   Commonwealth Army veterans and new Philippine Scouts may receive
    hospital and outpatient care provided for in the Medical Benefits
    Package.       

-   A veteran may receive certain types of VA hospital and outpatient
    care not included in the Medical Benefits Package such as
    humanitarian emergency care for which the individual will be billed,
    compensation and pension examinations, dental care, readjustment
    counseling, care as part of a VA-approved research project,
    seeing-eye or guide dogs, sexual trauma counseling and treatment,
    special registry examinations.       

-   A veteran may receive an examination to determine whether the
    veteran is catastrophically disabled; and therefore, eligible for
    inclusion in priority group 4.

-   Non-enrolled veterans

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-   A veteran rated for service-connected disabilities at 50 percent or
    greater will receive VA hospital and outpatient care.       

-   A veteran who has a service-connected disability will receive VA
    hospital care for that service-connected disability.       

-   A veteran who was discharged or released from active military
    service for a disability incurred or aggravated in the line of duty
    will receive VA hospital and outpatient care for that disability for
    the 12-month period following discharge or release.       

-   When there is a compelling medical need to complete a course of VA
    treatment started when the veteran was enrolled in the VA health
    care system, a veteran will receive that treatment.       

-   A veteran participating in VA\'s vocational rehabilitation will
    receive VA hospital and outpatient care.       

-   A veteran may receive VA hospital and outpatient care based on
    factors other than veteran status e.g., a veteran who is a
    private-hospital patient and is referred to VA for a diagnostic test
    by that hospital under a sharing contract; a veteran who is a VA
    employee and is examined to determine physical or mental fitness to
    perform official duties; a Department of Defense retiree under a
    sharing agreement.       

-   A veteran may receive VA hospital and outpatient care outside the
    United States, without regard to the veteran\'s citizenship, if
    necessary for treatment of a service-connected disability, or any
    disability associated with and held to be aggravating a
    service-connected disability or if the care is furnished to a
    veteran participating in a VA rehabilitation program.

**Questions about Benefits & Services**

### What about other VA benefits?

For all non-medical related VA Benefits, such as filing for
service-connection or pension, educational benefits, burial benefits,
home loans, or vocational rehabilitation contact the VA Regional Office
at **1-800-827-1000**.

**How do I begin to receive VA medical benefits and medical services?**

When you enroll for the VA Medical Benefits Package, you will be asked
if you are interested in receiving care through the VA Prime Care
Program. The full range of the VA Medical Benefits Package is delivered
through our comprehensive Prime Care Program. If you are interested in
receiving your primary medical care through the VA, call the VA Network
Telecare Center at (713) 794-8985 or toll free 1 (800) 639-5137 to have
a Prime Care Provider assigned to you and to arrange an initial
appointment.

At your first appointment, your VA Prime Care provider will conduct a
thorough physical examination, obtain a complete medical history, review
your current medications, and arrange for any laboratory or diagnostic
tests required. This appointment is very important. To make the most of
it, we request that you bring copies of your medical records from your
private provider.

### What if the closest VA facility does not have services I need?

If you are enrolled in the VA Medical Benefits package and wish to
receive VA health care, we are responsible for providing you with a full
range of services. These services will generally be provided through
your Prime Care Provider at the MEDVAMC or the outpatient clinics in
Lufkin, Beaumont, Conroe, Texas City or Galveston. Other services will
be provided at the nearest VA facility that can provide the care you
need. By law, the VA has to provide care within the VA system. If the VA
cannot provide the medical care you need, a VA provider will arrange for
you to receive care in a private facility or clinic at VA\'s expense.

### Are there limits on days of care or number of outpatient visits VA will provide?

No. Your treating physician or Prime Care Provider will determine what
is appropriate and necessary based on your individual needs and will
provide care consistent with current medical practice.

### Can I choose to get care outside the VA system at VA cost?

Generally, no. By law, the VA has to provide care within the VA system.
If you meet certain eligibility criteria, VA may be able to pay for
routine care you receive in your local community. This is called Fee
Basis care. We may authorize you to receive Fee Basis care if we can\'t
provide the medical services you need or if we find that you aren\'t
physically able to travel to our facilities because of your health or
the distance you must travel. To learn more about Fee Basis care and
whether or not you are eligible, contact the MEDVAMC Fee Basis staff at
(713) 794-7282.

### 

### Are there any special benefits for recently discharged combat veterans?

Yes, recently discharged veterans who served in combat locations can
receive health care for conditions potentially related to their service
for two years after their release from service. Call the Eligibility and
Enrollment Office at (713) 794-7288 for information.

### How do I get care in an emergency?

In any serious emergency, call 911 immediately. For urgent, but not
life-threatening, health care needs, contact your Prime Care Provider.
His or her name and telephone number is on the inside front of this
booklet. If taking the time to contact your Prime Care Provider might
endanger your life, call 911 or go directly to the closest emergency
room.

Please remember, the VA does not automatically cover non-VA provided
emergency care or ambulance transports.

**Who pays for emergency services at non-VA facilities?**

Please turn to the "Emergency Care in Non-VA Facilities" section of this
booklet.

**Who do I call if I have more questions?**

For more information on the Uniform Benefits Package, priority groups,
or the application process, call toll-free 1-877-222-VETS
(1-877-222-8387) or access information on the Internet at
*www.va.gov/elig*. At the Michael E. DeBakey VA Medical Center, call the
Eligibility and Enrollment Office at (713) 794-7288.

**Patient Travel**

This section is designed to provide you helpful information under which
transportation at Government expense may be furnished to beneficiaries
traveling to or from VA facilities, or other places of examination,
treatment or care. Questions regarding patient travel should be directed
to Patient Travel/Funds office located in Room 1B-306, Main Hospital
Building**.** Hours of Operation: Monday thru Friday (excluding
holidays) 8:00 am - 4:30 pm (Travel); 8:00 am - 3:30 pm (Funds).

**What travel can the Department of Veterans Affairs (VA) provide?**

VA has authority to provide eligible beneficiaries reimbursement for
mileage, special mode transportation (when medically justified by a VA
health care provider), and in certain circumstances, taxi or hired car.

**What are current mileage rates for travel? Why are rates different for
veterans and VA employees?**

VA currently reimburses 28.5 cents per mile for ALL veteran travel,
including C&P exams. When VA has determined that a deficiency exists in
relation to a C&P exam (need to repeat a lab test, x-ray, or through no
fault of the veteran not all exams in relation to the C&P were
completed) reimbursement is 28.5 cents per mile. This is travel for the
\"Convenience of the Government\". Mileage rates for veterans and VA
employees are determined under separate authorities and take different
criteria under account. Title 38 United States Code (U.S.C.) 111 and 38
Code of Federal Regulations (CFR) 17.143-145 are authorities for
Beneficiary Travel. 41 CFR Chapter 301 provides guidance for employee
travel.

**How is it determined that a veteran requires \"Special Mode\"
transportation? What eligibility requirements must be met?**

-   Special mode transportation includes ambulance, ambulette, air
    ambulance, wheelchair van, and other modes which are specially
    designed to transport certain disabled individuals. Special mode
    DOES NOT include bus, subway, train, airplane, or privately owned
    conveyance.

-   In order to be eligible for special mode transportation two criteria
    must be met. The veteran first has to be administratively eligible
    for transport at VA expense. Unless this basic criterion is met the
    veteran is not eligible for special mode transportation.

-   Once administrative eligibility is established, a VA clinician must
    then determine that a special mode of transportation is clinically
    required to transport the veteran for VA health care. Unless one of
    the forms of special mode transportation is required and documented
    as such, this method of transportation is inappropriate. Should it
    be clinically determined at one VA facility that such transportation
    is required, this should be accepted at all VA facilities, unless
    there is reason to think a veteran's condition may have changed.
    Local procedures should be established to determine special mode
    requirements, as well as communication guidelines to other VA
    facilities when it is necessary to send veterans with this
    requirement to Tertiary Care, other VA facilities, or non-VA
    providers for treatment.

**How much discretion does a facility have if a veteran does not meet
eligibility standards and extenuating circumstances exist?**

There is no authority to provide transportation at VA expense for
veterans who do not meet eligibility requirements, except in the case of
Organ Transplants (VHA Directive 2001-027).

**Is there anything we can do to obtain travel for ineligible
beneficiaries?**

-   When a veteran does not meet eligibility for Beneficiary Travel,
    other sources, including the DAV network, family and community
    should be aggressively pursued.

-   VA Form 3068, \"Reduced Rate transportation\" is also available for
    field use. This form can be presented to transportation carriers for
    possible reduced rates for veterans needing to travel in relation to
    VA health care. It is mainly used for bus transportation; however
    acceptance by other carriers, including airlines is being explored.

-   In addition, VA facilities should be pro-active in assisting the
    veteran explore possible VA options that would give him/her
    eligibility for Beneficiary Travel. These include:

    -   Service Connection: Is the veteran potentially eligible? Refer
        to Service organization, VBA representative, Regional Office, VA
        Web site

    -   Housebound/A+A: For veterans not receiving these benefits is
        their income at or below the income thresholds for these
        benefits? VHA Directive 2004-026, \"Income Thresholds Used in
        Identifying Veterans Exempt from Extended Care Service and
        Outpatient Medication Co-payment and in Determining Eligibility
        for Beneficiary Travel\" provides details how veterans not
        receiving A&A, housebound may still be determined eligible for
        Beneficiary Travel.

    -   \"Hardship\" review: -Is veteran unable to defray the cost of
        transportation? Has veteran lost job? Does it appear future
        income will be less?

**Does VA have authority to provide transportation for FEE Basis or
visits when an eligible veteran chooses to use his other insurance to
pay for care (such as dialysis)?**

VA has authority to pay transportation to eligible veterans traveling to
non-VA health care authorized at VA expense. Therefore, VA can provide
travel to eligible veterans sent for FEE Basis care. If VA is not paying
for the care travel at VA expense should not be provided.

**What if a veteran chooses to go to his \"preferred\" facility instead
of the closest VA facility that can provide the care?**

Veterans have the choice to go to any VA facility they choose for care.
However, travel can only be authorized to the nearest facility that can
provide the needed care. Therefore, should a veteran choose to go to
another facility than that closest to his home, he or she is responsible
for any costs beyond that for transportation to the closer facility.
This includes mileage and special mode transportation.

**How do we determine mileage for reimbursement purposes?**

VA has not established use of a single reference. Mileage should be
determined using authoritative guidance such as Rand McNally or Map
Quest or Yahoo Maps. Most references are available on line.   However, a
new VA website is being used which calculates the mileage from the
residence zip code of the veteran to the zip code of the VA facility. 
This site is not available to veterans or the public.

**What if a veteran has a P.O. BOX and physically lives elsewhere?**

Beneficiary Travel is intended to assist veterans with transportation
from their place of residence to the VA health care facility that can
provide the needed care. Because of required implementation of the
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
veterans now have the option of having their official mail sent to any
place they choose. However, this does not imply that Travel should be
paid from that point. Similarly, a veteran's home address could be in
another state but he or she is currently staying in the area. Therefore,
Travel should not necessarily be paid from the distant address. In order
to determine appropriate travel reimbursement it is necessary that a
veteran establish a current place of residence. If there is any question
as to this, a veteran can be asked to provide a bill, or some document
establishing his or her address. Should a veteran refuse to provide this
information, remember you are only authorized to provide travel to the
closest VA facility that can provide the required care, not necessarily
where the veteran chooses to seek care or treatment. In those cases
should another VA facility be closer to the veteran's \"Home\" address
and that VA facility can provide the care then Travel reimbursement
should only be to that point.

**Is the \$46.62 per month deductible for each facility or does it
pertain to travel to all VA facilities for health care? Who is required
to pay the deductible?**

The \$46.62 is the total monthly deductible amount for travel to all VA
facilities. Therefore, should a veteran be going to multiple VA
facilities, and the veteran notes this when applying for Travel
reimbursement, it is incumbent upon the facility providing the care and
travel to contact any other VA facilities to determine if the deductible
has been met.

The only exemptions to the deductible are:

-   Veterans traveling in conjunction with a C+P examination,

-   Non veteran donors,

-   Veterans requiring special mode transportation, and

-   When it is determined that the imposition of the deductible would
    cause a severe financial hardship

-   All other eligible veterans, including those receiving care for SC
    conditions, are required to have the deductible applied.

**Which facility is responsible for travel when a veteran is referred to
a Tertiary Care facility, or another facility that can provide the
needed care on an outpatient basis? For inpatient treatment? What about
veterans who do not meet eligibility criteria?**

-   For outpatient treatment the VA facility that is providing the care,
    or in the case of non-VA care the facility that authorizes the care,
    is responsible for arranging and providing travel to eligible
    veterans. Therefore, should a VA facility refer/consult a veteran to
    another VA facility for care, the second facility is responsible for
    providing travel, as they will be providing the care (as well as
    authorizing it). For non-VA (FEE Basis) care the VA facility that
    authorizes and pays for the treatment is responsible for travel. In
    the case of all outpatient care, including referral to another VA
    facility, the veteran has to meet eligibility requirements in order
    to receive travel at VA expense. Should a veteran not meet travel
    eligibility requirements, other sources such as the DAV network,
    inter-facility VA transportation networks, family and community
    resources should be explored.

-   When it is necessary to transport an inpatient between VA facilities
    (Inter-facility Travel) the releasing/sending VA facility is
    responsible for travel. Therefore, the initial transportation will
    be the responsibility of the first facility, and return transport is
    the responsibility of second facility. The only exceptions to these
    rules are for certain VA Special programs such as transplant. Some
    of these programs require that the sending VA facility provide round
    trip transportation, both for inpatient and outpatient treatment.

**Who is responsible for transport of veterans in a community nursing
home in emergent situations?**

For veterans in a CNH at VA expense the placing VA facility is
responsible for travel. Should a CNH veteran be placed in another VA
(VISN or facility) Clinic of Jurisdiction (COJ) the initial placing
facility will be responsible for travel (and CNH payment) for the first
90 days. After that time, the receiving COJ will be responsible for
costs incurred, including travel for VA placement of the veteran.
Veterans in a CNH at private expense must meet eligibility requirements
for VA payment of non-VA emergency care as well as Beneficiary Travel in
order to receive transport at VA expense.

**What authority does VA have to transport veterans in emergency
situations?**

VA can provide transportation of veterans in emergency situations only
in certain circumstances. Should a veteran develop an emergency while in
a VA facility and the facility cannot provide the care, it can transport
the veteran both ways regardless of eligibility. In cases of
unauthorized care, it depends on whether the care is authorized for
payment and under what authority payment is made. In any situation VA
only has authority to pay for transportation when the non-VA emergency
care is paid for by VA. When a veterans unauthorized care meets the
payment criteria of 38 U.S.C. 1728, \"Reimbursement of certain medical
expenses\" (original unauthorized care legislation) travel to the point
of emergency care, and in the case of veterans transferred to a VA
facility, can be authorized. Similarly, when emergency care is
authorized under 38 U.S.C. 1725, \"Reimbursement for emergency
treatment\" (Mill Bill) VA has authority to pay for transportation from
the point of emergency to the initial treating non-VA facility. Should a
\"Mill Bill\" veteran require further transport, including to a VA
facility, for continued care, the veteran must meet Beneficiary Travel
eligibility criteria in order to receive travel at VA expense.

**Can VA pay for transport of an attendant, donor or other
non-veteran?**

-   VA has authority to pay for transportation and associated incidental
    costs (lodging, food, etc.) at VA expense of certain non-veterans.

-   When it is clinically determined by a VA provider that due to the
    veterans mental or physical condition that an attendant is required
    when transporting the veteran.

-   When the non-veteran is the donor or potential donor of tissue,
    organ, or parts to a veteran receiving VA, or VA authorized non-VA
    health care.

**Is VA required to pay for lodging, tolls etc. as part of authorized
travel?**

VA may provide reimbursement for meals, lodging, tolls, and other
incidental costs when appropriate. The need for such additional costs
should be determined on a case-by-case basis, and based upon the
veteran's medical condition, distance required to travel, and any other
extenuating circumstances. Reimbursement should not be provided solely
because the veteran chooses to stop or take a less direct route to the
VA facility.

**Does VA have authority to transfer veterans to where they \"grew up\",
or where their family resides?**

VA has limited authority to provide travel for such requests. Only
veterans receiving inpatient care at a VA facility, or non-VA facility
at VA expense, in a terminal condition (estimated less than 6-months to
live) can be transferred to a suitable health care facility in area
other than where they lived upon entering the VA facility. In addition
such transfer can occur only from one VA facility to another, or when VA
is paying for care at a non-VA facility, and future care will be at VA
expense. Veterans receiving care on an outpatient basis are not eligible
for such transportation.

**How should Beneficiary Travel at CBOC's be handled when there isn't a
Travel Office or agent cashier agent cashier on station?**

Each \"parent\" facility must develop local guidelines in order to
provide Beneficiary Travel benefits to eligible veterans at remote
facilities under their jurisdiction. These must include procedures to
capture appropriate documents and signatures in order to meet the
requirements of the Program as well as those of other involved Services
such as Fiscal.

**How long do veterans have to claim travel?**

In accordance with Section II b of VA Form 3542, \"Authorization to
Report -- Voucher for Mileage Allowance\" claims for reimbursement for
travel expenses must be received within 30 days of completion of travel
or be forfeit. However, veterans can always submit an \"unauthorized
claim\" for travel in accordance with 38 CFR 17.120. In these cases the
veteran can submit a claim within the time frames noted in 38CFR 17.126,
\"Timely filing.\"

**What are the VA authorities for Beneficiary Travel, and where can
copies be found?**

The following are current legislative, regulatory and VHA Manual
guidelines for VA Beneficiary Travel and can be located at the web sites
indicated:

-   38 United States Code (U.S.C.) 111, \"Payments or allowances for
    beneficiary travel\",

-   <http://www.gpoaccess.gov/> \*

-   38 Code of Federal Regulations (CFR) 17.143, \"Transportation of
    claimants and beneficiaries\"; 17.144, \"Limitations\"; 17.145,
    \"Approval of unauthorized travel of claimants and beneficiaries\";
    and 17.1003, \"Emergency transportation\" (Mill Bill)

-   VHA Manual M-1, Part 1, Chapter 25, \"Beneficiary Travel\"

-   <http://vaww.va.gov/publ/direc/health/publications.asp?publ=manual&order=Issue&dir=desc>

**Emergency Room Procedures**

### 

The MEDVAMC Emergency Room (ER) functions under an Emergent Care Triage
Protocol System. This means **critical cases** such as cardiac
emergencies, pneumonia, and difficulty breathing are seen before
non-critical ones -- no matter when a patient came in. This may result
in **very long waits** for patients with non-life threatening illnesses
such as colds, ingrown toenails, rashes, minor cuts, prescription
refills, or minor illness that have been present for several days.

The ER is not designed to serve as a primary care provider for patients.
Patients are assigned a Primary Care Team at the MEDVAMC to ensure
continuity of care. Prime care providers are supported by a team of
nurses, clerks, social workers, dietitians, pharmacists, and other
skilled professionals to assure patients receive well-coordinated
medical care. If you have not been assigned a Primary Care Team, call
the **VA Network Telecare Center** at **(713) 794-8985** or toll-free
**1 (800) 639-5137.**

If you have a medical problem after hours and cannot wait until your
next appointment, call the **VA Network Telecare Center** at **(713)
794-8985** or toll-free **1 (800) 639-5137**. Professionally trained,
registered nurses are ready to help answer health care questions 24
hours a day, 7 days a week.

The VA Network Telecare can also put you in touch with your Primary Care
Team.

**If you are at home and have a life-threatening medical emergency,
immediately call 911.**

**Emergency Care in Non-VA Facilities**

In 2001, the U.S. Congress provided VA with authorization (called the
Mill Bill) to pay for emergency care in non-VA facilities for veterans
enrolled in the VA health care system.  The benefit will pay for
emergency care rendered for non-service-connected conditions for
enrolled veterans who have no other source of payment for the care. 
However, VA will only pay to the point of medical stability. There are
very strict guidelines concerning these types of claims.  Veterans and
their non-VA providers should be aware that these claims must be filed
with the VA within 90 days from the last day of the emergent care. 

### How do I qualify?

This benefit is a safety net for enrolled veterans who have no other
means of paying a private facility emergency bill. If another health
insurance provider pays all or part of a bill, VA cannot provide any
reimbursement. Veterans who retired from the U.S. military are covered
by TRICARE/CHAMPUS insurance and cannot file a Mill Bill claim.  To
qualify, you must meet all of these criteria:

         You were provided care in a hospital emergency department or
similar facility providing emergency care.

         You are enrolled in the VA Health Care System.

         You have been provided care by a VA health care provider within
the last 24 months (excludes C & P, Agent Orange, Ionized Radiation and
Persian Gulf exams).

         You are financially liable to the provider of the emergency
treatment for that treatment.

         You have no other form of health care insurance.

        You do not have coverage under Medicare, Medicaid, or a state
program.

        You do not have coverage under any other VA programs.

         You have no other contractual or legal recourse against a third
party (such as a Workman\'s Comp Claim or a Motor Vehicle Accident) that
will pay all or part of the bill.

        VA or other Federal facilities were not feasibly available at
time of the emergency.

         The care must have been rendered in a medical emergency of such
nature that a prudent layperson would have reasonably expected that
delay in seeking immediate medical attention would have been hazardous
to life or health.    

                

**Should I cancel my current insurance to meet these requirements?**

VA encourages you to keep all current health insurance coverage. If you
cancel your current insurance, your spouse may not retain health
insurance coverage and spouses of veterans generally do not qualify for
VA health care. Cancellation of current insurance coverage could result
in you being disqualified for reinstatement based upon any pre-existing
illnesses. If you are covered by Medicare Part B and you cancel it, it
cannot be reinstated until January of the next year. If you are covered
by a program or plan that would pay for the emergency care received, you
would not qualify for this benefit.

### 

### What is the timeline to file?

Veterans have a responsibility to ensure that the VA Transfer Center is
notified immediately upon any hospital admission. The MEDVAMC Transfer
Center Coordinator can be reached during regular business hours at (713)
794-7109.  If you are calling after hours, dial (713) 791-1414, ext.
3808 and ask to speak to the Medical Administrative Assistant on duty.
Claims must be filed with the nearest VA Medical facility to where the
services were rendered within 90 days of the discharge date of medical
service; otherwise, the claim will be denied because it was not filed in
a timely manner.

**What type of emergency services will VA cover?**

VA will reimburse health care providers for all medical services
necessary to stabilize your condition up to the point you can be
transferred to an approved VA health care facility or other federal
facility.

**What about pharmacy items?** 

The VA\'s authority for reimbursement of pharmacy items to veterans from
non-VA providers follows a strict set of guidelines.  The veteran must
be actively enrolled in a Fee Basis Program; the pharmacy item must be
considered as urgent or emergent by the initiating physician; the
pharmacy item cannot be reimbursed past a ten day supply; and the
prescription and receipts must be turned in to the Fee Basis Unit. The
reimbursement is based upon the U.S. Government\'s Red Book cost and no
taxes can be reimbursed. 

**Do I need to get approval before going to the emergency room?**

No. If you are an eligible veteran, and a VA facility is not feasibly
available when you believe your health or life is in immediate danger,
report directly to the closest emergency room. If hospitalization is
required, you, your representative, or the treating facility should
contact the nearest VA within 24 hours to arrange a transfer to VA care
by calling the VA Transfer Center at (713) 794-7109.

**How long will I stay in the private hospital?**

If you are hospitalized, and the VA is notified, the VA will be in
regular contact with your physician at the private hospital. As soon as
your condition stabilizes, the VA will assist the private facility with
arrangements to transport you to a VA, or VA-designated facility.

**What if I do not wish to leave the private facility?**

VA will pay for your emergency care services only until your condition
is stabilized. If you stay beyond that point, you will assume full
responsibility for the payment of costs associated with treatment.

**Will I have to pay for my ambulance bill to the non-VA facility?**

If the VA accepts responsibility for the emergency room visit and/or
admission, the ambulance will be paid from the scene of the incident to
the first non-VA facility providing necessary care.

**Will I have to pay for an ambulance from the non-VA facility to a VA
facility?**

Yes. The VA is only authorized to pay for an ambulance to go from the
scene of the incident to the first non-VA facility providing necessary
care.  Ambulance bills are considered unauthorized claims, and must be
submitted to the VA in a timely manner.

### What if the private hospital bills me for services?

If you are billed for emergency care services **on or after May 15,
2007**, contact the VISN 16 Consolidated Fee Unit at 601-933-7700. **For
care provided prior to May 15, 2007,** contact the Fee Basis Mill Bill
office at (713) 791-1414, ext. 3883, 3880, 4047, or 4057 and a
representative will assist you in resolving the issue.  Under the law,
payment from the VA is considered as "payment in full" for the dates
authorized.

### What if I am the victim of a crime?

If you are a victim of a crime in Texas, the claim must be filed with
your local municipality because the state of Texas has various victim
relief funds available.  These claims cannot be supplemented by a
payment from the VA.

**What documents are required by VA to process claims for emergency care
in non-VA facilities?**

The following page contains a list of documents necessary for the VA to
process claims for emergency care in non-VA facilities.  Remember, there
is a **90-day deadline** to file a Mill Bill Claim once you have been
discharged from the Emergency Room/Hospital. Please submit all of the
documents as a packet to the MEDVAMC Fee Basis Mill Bill Office for
**claims dated on or after May 15, 2007**.  The mailing address is: 
VISN 16, Consolidated Fee Unit,  P.O. Box 320164,  Flowood, MS  39232. 
If using a shipper such as FedEx, UPS, etc., the physical address is:
VISN 16 Consolidated Fee Unit, 100 Spring Lake Cove, Pearl, MS  39208. 
Their telephone number is 601-933-7700.  For **claims for service dated
before May 15, 2007**, the mailing address is: MEDVAMC, 2002 Holcombe
Blvd, ATTN: 04FRM (Mill Bill), Houston, TX 77030-4298.

### Who do I call for more information?

For more information about emergency care in non-VA facilities, call the
MEDVAMC Fee Basis Mill Bill office at (713) 791-1414, ext. 3883 or the
Fee Basis Office at (713) 794-7282. Or go to: 
[*http://www.houston.med.va.gov*](http://www.houston.med.va.gov/).

**Documents Required by VA to Process Claims for**

Emergency Care in Non-VA Facilities (Mill Bill)

(Non-Service Connected Care)

NAME: (Last, First, Mi)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SSN: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

#### DATE OF ADMISSION / ER VISIT: From \_\_\_\_\_\_\_\_\_\_\_\_\_\_ Through \_\_\_\_\_\_\_\_\_\_\_\_\_

##### Non-VA Emergency Room Visit And/Or Hospitalization

#####  

-   **HCFA Form UB-92** **or other Approved Medicare Form (OCR)** (pink
    > and white Medicare Billing Form) from the Hospital Business
    > Finance Office

-   **Itemized Billing Statement** from the Hospital Business Office

## A complete copy of **All Medical Records** pertaining to the admission through the date of discharge for this ER Visit/Hospitalization 

## **Ambulance Provider HCFA Form 1500 or other Approved Medicare Form (OCR)** (pink and white Medicare billing form) 

###### Ambulance Trip Ticket/Run Report 

###### ALL OTHER Provider/Physician Medicare HCFA Form 1500 or other Approved Medicare Form (OCR) 

***Remember, there is a 90-day deadline to file a Mill Bill Claim once
you have been discharged from the Emergency Room/Hospital.***

Please submit **ALL OF THE ABOVE ITEMS** as directed above in: What
documents are required by VA to process claims for emergency care in
non-VA facilities?

For more information about emergency care in non-VA facilities, visit
our Web site at:

[http://www.houston.med.va.gov](http://www.houston.med.va.gov/) (Mill
Bill: Emergency Care in Non-VA Facilities)

**Charges & Co-Payments**

**What are the types of co-payments?**

There are four basic types of charges:

-   Medication -- Prescription co-payment charges are established by the
    U.S. Congress. The charge is \$8 for each 30 day or less supply of
    medications provided on an outpatient basis
    for nonservice-connected conditions.

-   Outpatient -- The co-payments will be based on primary care visits
    (\$15) and specialty care visits (\$50). 

-   Inpatient -- Congress determined the appropriate inpatient
    co-payment should be the current inpatient Medicare Deductible Rate
    (\$992 in 2007) for the first 90 days that you remain in the
    hospital plus a \$10 per diem charge.

-   Long Term Care -- VA charges for Long Term Care Services vary by
    type of service provided and the individual veteran's ability to
    pay.

### 

### If I am enrolled, what cost will there be for me?

There is no monthly premium required to use VA care. Most
nonservice-connected veterans and noncompensable 0% service-connected
veterans are required to complete an annual Means Test or to agree to
pay VA the applicable co-payment. The means test is based on their
family's income and net worth and medical out-of-pocket expenses for the
previous year.

Some veterans are required to make co-payments for their care and
medications. Veterans are requested to provide health insurance
information. In 1985, the U.S. Congress passed Public Law 99-272
(Medical Care Cost Recovery Act) authorizing the Department of Veterans
Affairs to bill third party health insurance carriers for medical care
provided to veterans for treatment of their non-service connected
disabilities.

VA is required to submit claims to insurance carriers for treatment of
all nonservice-connected conditions. Reimbursement received from
insurance carriers is retained at the Michael E. DeBakey VA Medical
Center. These funds are used to provide additional health care services
to veterans here.

### Will I have out-of-pocket expenses?

You may be responsible for making co-payments in some cases. Co-payments
are determined according to the eight VA priority groups (see the
"Eligibility" section of this booklet). The dollar amounts of
co-payments are updated annually and are set by Congress.

**How are the co-payments calculated?**

Veterans with no service-connected disability or veterans with
non-compensated 0% service­-connected disability may be required to make
co-payments for care received at the VA if he or she has a combined
family income above the levels specified below. Some health insurance
plans may pay for care received at the VA.

The following income levels are used to determine co-payment for
outpatient or inpatient services, not including prescription drugs:

-   Veterans with no dependents and have an income of \$27,790 and above
    will require a co-payment.

-   Veterans with one (1) dependent and have an income of \$33,350 and
    above will require a co-payment.

-   Add \$1,866 income levels for each additional dependent.

**What is the three-tier co-payment system for outpatient services?**

On December 6, 2001, VA implemented a three-tier co-payment system for
outpatient services. This primarily affects Priority 7 and 8 enrollees.

-   The first tier covers preventative care and will cost veterans
    nothing. Care includes flu shots, lab tests, some radiology
    services, hepatitis C screening and other preventative services.

-   The second tier covers primary care outpatient visits and requires a
    \$15 co-payment per day regardless of the number of primary care
    visits on a given day.

-   The third tier includes specialty outpatient surgery, audiology, and
    optometry. This care requires a referral from a primary care
    provider and will cost \$50 per day. Many times medical consults to
    such specialty clinics as dermatology, cardiology, etc. also have a
    co-payment attached. Contact the MEDVAMC Enrollment Office at (713)
    794-7288 if you have questions about your situation.

Veterans with income, below VA national income threshold, and assets,
which exceed \$80,000, may be required to make a co­-payment. For
example, if you have income of \$20,000 and savings of \$65,000, the
total would be \$85,000; which may require a co-payment. Medical
deductions, which you have paid, may reduce your income amounts. Be sure
to complete the Medical Deductions section on the enrollment
application.

**What are the medical expense deductions?**

Medical expense deductions (veteran, spouse and minor children) are
subtracted from income. Medical expense deductions are those expenses
not covered by insurance and which you had to pay from your personal
funds.

Medical expenses include doctor or hospital bills, payments for
prescription medicines, dental and eye expenses, travel to and from
medical facilities, health insurance premiums, and other health related
expenses. If you have had family medical expenses during the previous
calendar year, be sure to specify the amounts on the enrollment
application. All medical expenses are subject to a deductible (based on
number of dependents), which will be deducted from the Non-reimbursed
Medical Expenses you claim.

**How is the co-payment for prescription drugs calculated?**

The following income levels are used to determine co-payment for
prescription drugs:

-   Veterans with no dependents and an income of \$10,929 or above will
    require a co-payment.

-   Veterans with one (1) dependent and an income of \$14,313 or above
    will require a co-payment.

**Are there exceptions for the prescription drug co-payment?**

If you are a POW, a veteran with a 50% or greater service connected
disability, or are receiving a VA NSC pension, there will be no charge
for medications. If you have a service-connected disability rated at up
to 40%, there will be no charge for prescriptions for your
service-connected condition. However, there may be a co-payment for
those prescriptions not related to your service-connected condition.

**What is the co-payment for prescriptions?**

Effective January 1, 2007, co-payments are presently at the rate of \$8
per prescription for each 30-day (or less) supply. Pharmacy will
dispense a 90-day supply of some medications, and the co-pay charge for
these drugs will be \$24 for a 90-day supply. However, there is a \$960
yearly cap for veterans enrolled in Priority Groups 2 through 6. There
is no annual cap for veterans enrolled in Priority Group 7 or 8.

**Who pays for my hearing aids and eyeglasses?**

Hearing aids and eyeglasses generally require a service-connected
disability rating of 10% or more. Nonservice-connected veterans with a
pension, housebound veterans, and aid & attendance veterans are also
eligible. Hearing aids and eyeglasses are usually not provided to
nonservice-connected veterans for generally occurring hearing or vision
loss.

**What about dental care?**

Please see the Dental Care section in this booklet.

**What about co-payments for Long Term Care?**

For information about Long Term Care co-payments, contact the MEDVAMC
Enrollment Office at (713) 794-7288.

**Do enrolled veterans have to pay the deductibles that their insurance
carrier requires when treated at VA?**

No. VA does not require veterans to pay those charges. In fact, many
insurance companies will apply VA co-payment charges toward satisfaction
of their annual deductible.

### I can\'t afford to make co-payments. What should I do?

There are options. The first option is to set up a repayment plan. The
second option is to request a waiver for paying the co-payments you
currently owe. If you request a waiver, you must submit proof that you
can\'t financially afford to make payment to the VA. This process could
take several months. Please contact the MEDVAMC Medical Care Cost
Recovery Coordinator at (713) 794-7796 for more information.

The third option is to request a hardship determination. If you request
a hardship, you are asking VA to change your Priority Group status. You
will need to submit current financial information, along with
documentation and a decision will be made based on the information you
provide.

**Who do I call for more information?**

For the current co-payment rates and to have your specific co-payment
questions answered, contact the MEDVAMC Enrollment Office at (713)
794-7288. If you are looking for general information, visit
[*http://www.va.gov/revenue/overview.cfm*](http://www.va.gov/revenue/overview.cfm)
on the Internet.

### Primary Care

Primary Care, known at the MEDVAMC as Prime Care, means having one
provider in charge of your health care. Prime Care Providers are Family
Practice or Internal Medicine Physicians, Nurse Practitioners, and
Physician Assistants. The Prime Care Provider is supported by a team of
nurses, clerks, social workers, dietitians, pharmacists, and other
skilled professionals who assure you receive well-coordinated high
quality care.

The Michael E. DeBakey VA Medical Center operates an active Prime Care
Clinic that logs nearly 753,000 visits each year. Satellite outpatient
clinics in Lufkin, Beaumont, Conroe, Galveston and Texas City provide
care to veterans outside of Houston.

**What is my Prime Care Provider responsible for?**

-   Managing any acute and chronic health problems you may have

-   Health promotion and prevention services

-   Immunizations

-   Coordination of your health care

-   Women\'s health services (you may elect to receive care at the
    Women\'s Health Clinic)

-   Referrals for VA specialty care and services such as Audiology,
    Optometry, Urology, Orthopedics, etc.

-   Management of your medications

-   Office visits for acute and chronic medical illnesses and periodic
    physical exams

### How do I get the most out of my VA health care?

To get the most from your visit with your Prime Care Provider, bring a
list of medications and vitamins you are taking; tell your health care
provider everything you think or feel about your diagnosis and treatment
plan; ask questions about your tests, medications, side effects, or
symptoms; and know your personal and family medical history.

**Do I have to check in when I have a Prime Care appointment? Do I have
to stay in the clinic area during my wait?**

You are asked to check in at your assigned station in the Prime Care
Clinic and remain there until called for your appointment. When you
leave the waiting area and are not available when called, you may be
skipped and the next patient on the list called. You then may face a
longer wait time because you must be worked into the schedule later in
the day.

**What kind of privacy do I have when I talk with my Prime Care
Provider?**

In order to protect the privacy of all veterans, please do not enter the
examination area unless you are escorted by a Prime Care staff member.
You are strongly discouraged from walking into the exam areas to find a
provider, social worker, or nurse. If you need assistance, check in at
the clerks' station and the clerks will contact the staff member you are
looking for. Because of the limited space in the exam rooms, only one
family member should accompany the patient in to see his or her health
care provider. All other family members are asked to wait in the waiting
area.

**How do I find out who my Prime Care Team is?**

If you have already registered with the MEDVAMC, you can find out your
Prime Care Team by calling the VA Network Telecare Center at (713)
794-8985 or toll-free 1 (800) 639-5137. If you are at the Medical
Center, stop by the Information Desk and they can help you. If you are
not registered with the MEDVAMC, you must first register at the
Admissions/Registration Office located near the Emergency Room on the
first floor. You may also apply via the Internet at *www.va.gov/elig*.
The form you will complete to apply for enrollment is called the 10-10
EZ.

If you are HIV infected, you are automatically assigned to the
Infectious Diseases Prime Care Team. Once you are registered, you can
call (713) 794-7943 directly for an appointment.

### Can I walk in and see my Prime Care Team anytime?

### Just like any private doctor's office, the MEDVAMC Prime Care Teams are designed to see patients by appointment. When you are enrolled in Prime Care, the staff is available to answer your health care questions and concerns by telephone. The name and telephone number of your Prime Care Team is on the inside, front cover of this booklet. 

###  Please call your assigned team rather than walking into the clinic to ask questions. It's important to make sure the Prime Care Team has your most current telephone number and address. When leaving a message, give all information that is pertinent to your present problem or concern. Please give your name, full social security number, and a telephone number where you can be reached. Allow 24 hours for a response.

### Who do I call if I have a problem after hours?

### If you have medical problems after hours and cannot wait until your next appointment, you can talk with registered nurses and administrative clerks at our VA Network Telecare Center by calling (713) 794-8985 or toll-free 1 (800) 639-5137. 

### VA Network Telecare Center 

Help is just a telephone call away. Professionally trained registered
nurses at the VA Network Telecare Center are ready to help answer your
health care questions 24/7. That's right - 24 hours a day, seven days a
week. If you have medical questions or concerns, and cannot wait until
your next appointment, call the VA Network Telecare Center at (713)
794-8985 or toll-free 1 (800) 639-5137.

The South Central VA Health Care Network created its Telecare Center as
part of its on-going efforts to provide veterans with timely health care
information. All telephone calls are answered by a staff of
professionals who are experienced in telephone assessment of medical
situations and crisis intervention. To help veterans who call, nurses
use their training and experience as well as other readily available
resources.

Telecare nurses provide both medical and emotional support. They are
trained to provide symptom analysis, instruct on first aid procedures,
help with stress and anxiety, answer medication questions, explain lab
test results, educate patients about specific diseases, and check
appointments.

### What is the purpose of the VA Network Telecare Center?

The purpose of this service is to provide veterans with timely access to
information concerning your health care. A call to the Telecare Center
might also help a veteran avoid a long emergency room wait.

The VA Network Telecare Center is very beneficial to veterans who are
already enrolled in the system because the nurses can review patient
records and document care for veterans in the system. Non-enrolled
veterans or anonymous callers may receive emergency assistance, and they
will be referred to community resources after being given enrollment
information.

**Should I call if it is a life-threatening emergency?**

No. The VA Network Telecare Center is not for life-threatening
emergencies. If you have a life-threatening emergency, immediately call
911.

**What information will I need when I call?**

You will be asked for your name, Social Security Number, the VA medical
center you usually visit, and the reason for your call. You might also
be asked some additional identifying information in accordance with the
new Privacy Act regulations.

**I have a complaint. Should I call the Telecare Center?**

No. The VA Network Telecare Center is not a complaint line. Please limit
your calls to questions about your health.

**Who should I call if I have a health care complaint?**

Contact your local VA medical center and ask to speak with a patient
advocate. In Houston, the telephone number is (713) 794-7884. In
Beaumont, please call (409) 981-8550, ext. 113, and in Lufkin, the
telephone number is (936) 633-2753. In Galveston and Texas City, the
telephone number is (713) 794-7884. In Conroe, the telephone number is
(936) 522-4000.

### Make, Change or Cancel an Appointment

If you are already enrolled in the VA system and you need an appointment
at the Michael E. DeBakey VA Medical Center, call the VA Network
Telecare Center at (713) 794-8985 or toll free 1 (800) 639-5137.

**It is very important for you to keep your scheduled appointments. If
you cannot use the slotted time, another veteran might be able to do
so.** **Keeping your scheduled VA health care appointments ensures your
continued access to care and medications from the MEDVAMC. Failure to
keep appointments may result in your removal from your primary care
provider's panel of patients and cancellation of specialty care
consultations. If you are taking certain medications requiring
continuous medical monitoring, missing appointments may force your
health care provider to cancel your refills. If, for some reason, you
cannot keep your appointment, please immediately call the VA Network
Telecare Center at (713) 794-8985 or toll free 1 (800) 639-5137 and
reschedule or cancel. Please cancel at least 24 hours in advance so we
can offer your appointment to another veteran.**

Several departments at the MEDVAMC schedule their own appointments.
Please call these clinics directly to make an appointment.

**Behavioral Medicine** (713) 794-7101

**Cardiology** (713) 794-7300

**Compensation & Pension** (713) 794-7091

**Comprehensive Mental Health** (713) 794-8709

**Dermatology Clinic** (713) 791-1414, ext. 3452

**Dental Clinic** (713) 794-7187

**ENT Clinic** (713) 794-7180

**EEG/EMG** (713) 794-8835

**Eye Clinic** (713) 794-7450

**GI Clinic** (713) 794-7274

**MRI** (713) 794-7807

**Neuro CDC Initial** (713) 794-7460 or 8090

**Neuro Initial** (713) 794-7460 or 8090

**Neuro Initial OB** (713) 794-7460 or 8090

**Neuro Procedure** (713) 794-7460 or 8090

**Neuropsychology** (713) 794-7201

**Neuro Seizure Initial** (713) 794-7460 or 8090

**Neuro STOP Stroke Clinics** (713) 794-7460 or 8090

**Ostomy Clinic** (713) 794-7501

**Oncology Clinic** (713) 794-7454

**Pacemaker** (713) 794-7300

**PADRECC** (713) 794-7481

**Spinal Cord Injury Clinic** (713) 794-7057

**Stroke Post d/c Follow-up** (713) 794-7460 or 8090

**Substance Dependence** (713) 794-8700

**Trauma Recovery Program** (713) 794-8700

**Urology Clinic** (713) 791-1414, ext. 6424

**X-ray** (713) 791-1414, ext. 4516 or 4514

**How do I change or cancel an appointment at one of the Outpatient
Clinics?**

Patients at the **Charles Wilson VA Outpatient Clinic in Lufkin** should
call (936) 633-2758 to cancel or change an appointment.

Patients at the **Beaumont VA Outpatient Clinic** should call (409)
981-8550 to cancel or change an appointment.

Patients at the **Galveston CBOC** should call (409) 741-0256 to cancel
or change an appointment.

Patients may also call the VA Telecare Center at (713) 794-8985.

Patients at the **Texas City CBOC** should call (409) 986-1129 to cancel
or change an appointment.

Patients at the **Conroe VA Outpatient Clinic** should call (936)
522-4000.

Patients may also call the VA Telecare Center at (713) 794-8985.

# Urgent Care

In any serious emergency, call 911 immediately.

**What if I have an urgent, but not threatening health care need?**

For urgent, but not life-threatening, health care needs, contact your
Prime Care Provider. His or her name and telephone number are on the
front, inside cover of this booklet.

Except for medical emergencies, all VA health care is provided through
scheduled appointments. If you need to be seen prior to your next
scheduled visit, call your Prime Care Team. An appointment will be
scheduled appropriate to the urgency of your medical issues. Remember,
the first person you speak to needs to have as much information \"up
front\" in order to direct you to the right person in the timeliest
manner and to prioritize correctly.

Professionally trained registered nurses at the VA Network Telecare
Center are ready to help answer your non-emergency, health care
questions 24 hours per day, 7 days a week. In Southeast Texas, dial
(713) 794-8985 or toll free 1 (800) 639-5137.

# Prescriptions

### 

### Can VA fill my prescriptions from a private provider?

The VA will provide medications that are prescribed by VA providers in
conjunction with VA medical care. VA will **not** fill or rewrite
prescriptions prescribed by your private physician.

**What should I know about my medications?**

To take medications safely and effectively, ask yourself if you can
answer these questions about your medications:

-   What is the name of the medication?

-   What is it supposed to do?

-   How do I take the medication?

-   Should I expect any side effects?

-   Have I told my health care provider about my allergies to foods or
    medications?

-   Should I avoid alcohol or certain foods?

-   What about my other medications?

-   How do I get prescription refills?

Before taking any medication, always check to see that each prescription
bottle has YOUR name on it, and it is not another family member's
medication.

### What should I do if I have side effects? 

If you have side effects, call the VA Network Telecare Center at (713)
794-8985 or *toll free* 1 (800) 639-5137. Or call your Prime Care Team
at the telephone number you have written down on the inside cover of
this booklet.

### How should I store my medications?

Medications should be stored in a cool, dry place unless the bottle says
to refrigerate.

**Why won't the VA fill my prescriptions from a private provider?**

Medications are an important part of your health care. Managing
medications is **serious** business. Medications need to be monitored
and some require ongoing laboratory tests. Multiple medications taken
together can cause dangerous side effects or become ineffective because
of the combination of drugs. Some medications can cause side effects
even without other medications being involved. Because of these risks,
your VA provider cannot prescribe medications without managing your
health care.

**What is a drug formulary?**

Medications are selected by your VA provider from a list of approved
drugs (the VA \"formulary\"). A drug formulary is a list of medications
that are readily available for use within our facility. The formulary
helps to prevent duplication in the same medication class, reduces
health care costs, and provides the best possible care to you. Drugs
that are not on the VA formulary are generally not available; but in
most cases, there is a drug on our formulary that can be substituted
safely.

######### What if the drug I am currently taking is not on the VA formulary?

If the drug you take is not on the VA formulary, there is at least one
similar product already there. Most of the time our providers can change
you to our alternative formulary product without a major change in your
condition. Our alternative formulary products are equally effective to
non-formulary medications.

**If my outside doctor prescribes a medication that is not on the VA
formulary, can I obtain the drug through the VA pharmacy?**

The VA does not have a \"medication-only program." In order to receive
medication from the VA pharmacy, you will need to be followed regularly
in the VA Prime Care Clinic. If you wish to continue taking the
medication prescribed by your private physician, you will be expected to
purchase this medication through an outside pharmacy.

Patient safety is our utmost concern. Specific documentation must be
provided by your community provider in order for you to obtain a
non-formulary medication from the VA. This documentation must include
past medical history, medication history and recent laboratory results.

**What do I do if I am running out of my medication?**

Your provider will make sure that you have enough refills to last until
your next appointment. If you find that you are running out of
medication and have no refills left, please contact your Prime Care Team
at least two weeks before you will run out.

To avoid the risk of running out of medicine, it is recommended that you
order your refills the same day you receive them.

**How do I get my prescriptions?**

When your health care provider orders a new prescription, Pharmacy
Service will mail it to you. If you wish to wait and pick up your new
prescription at the pharmacy, you must report to the pharmacy check-in
window and inform a pharmacy staff member that you wish to wait to pick
up your prescriptions. Refills are always sent by mail except for items
requiring constant refrigeration.

### What do I do about expired prescriptions?

When a prescription has no refills remaining or has expired (over a year
old), please contact your Prime Care provider to have the prescription
reordered. The name and telephone number of your Prime Care Team is
located on the front, inside cover of this booklet.

If you cannot locate that information, contact the VA Network Telecare
Center at (713) 794-8985 or toll-free 1 (800) 639-5137.

**Who do I talk to if I have questions about my medications?**

If you have any questions about how to take your medication, the
possible side effects, or any precautions you should take, please ask
your Prime Care provider or a pharmacist.

### How does Medicare Part D affect me?

The Department of Veterans Affairs (VA) administers the nation's largest
health care system. Many of the veterans enrolled in the VA health care
system are also eligible for coverage by Medicare. With the advent of
Medicare's new prescription drug program (Medicare Part D), VA offers
the following information about this new program and its impact on
veterans.

Starting January 1, 2006, prescription drug coverage will be available
to everyone with Medicare through Medicare prescription drug plans. All
Medicare prescription drug plans will provide at least a standard level
of coverage set by Medicare. Some plans might also offer more coverage
for a higher monthly premium.

VA has determined that its prescription drug coverage for veterans
enrolled in the VA health care program is at least as good as the
standard Medicare prescription drug coverage benefit, meaning that
enrollment in VA health care provides veterans with "creditable
coverage" for Medicare Part D purposes.

Veterans with Medicare can enroll in a Medicare prescription drug plan
from November 15, 2005 through May 15, 2006. After that an annual
enrollment period will be available each year, beginning in 2006, from
November 15 through December 31.

Although some people who choose to enroll later may be subject to a
penalty, veterans enrolled in the VA health care system can be assured
that they can choose to delay enrolling in Medicare Part D until later
enrollment periods without penalty because VA enrollment provides
"creditable coverage."

Veterans should remember that in addition to prescription drugs, VA's
Medical Benefits Package provides a full range of health care benefits.
Veterans will still be eligible to receive all current health and
prescription drug benefits if they choose to enroll in a Medicare
prescription drug plan.

Veterans do not have to choose between VA coverage and a Medicare
prescription drug plan; they may participate in either or both. However,
if a veteran decides to enroll in a Medicare prescription drug plan and
disenroll from VA, he or she may not be able to re-enroll later if VA is
not enrolling all priority groups.

If VA takes some action that causes a veteran to lose VA coverage (e.g.,
VA makes an enrollment decision that would further restrict access to
certain Priority Groups), affected veterans can enroll in a Medicare
prescription drug plan, without penalty, within 62 days of the end of VA
coverage. Enrollment in the Medicare Part D program must be applied for
within the 62 day time limit to avoid the penalty.

In addition, a veteran who is or who becomes a patient or inmate in an
institution of another government agency (for example, a state veterans
home or a corrections facility), may not have creditable coverage from
VA while in that institution. Veterans who are unsure whether this may
apply to them should contact the institution where they reside or the VA
Health Benefits Service Center at 1 877-222-VETS (8387).

Individuals with limited income and resources may be eligible for extra
help paying for a Medicare prescription drug plan. Information about
this extra help is available from the Social Security Administration at
[[www.socialsecurity.gov]{.underline}](../www.socialsecurity.gov) or by
calling them at 1-800-772-1213.

For information on how the Medicare prescription drug program may affect
survivors and dependents of veterans eligible for benefits under the
Civilian Health and Medical Program of the Department of Veterans
Affairs (CHAMPVA), call 1-800-733-8387 or visit
[[www.va.gov/hac/forbeneficiaries/forbeneficiaries.asp]{.underline}](../www.va.gov/hac/forbeneficiaries/forbeneficiaries.asp).

Additional information about the new Medicare Prescription Drug Plan can
be found by calling 1-877-222-8387 or visiting the VA's comprehensive
Web site,
[[www.va.gov/healtheligibility/home/hecmain.asp]{.underline}](../www.va.gov/healtheligibility/home/hecmain.asp);
Medicare, [[www.medicare.gov]{.underline}](../www.medicare.gov); or the
Social Security Administration,
[[www.socialsecurity.gov]{.underline}](../www.socialsecurity.gov).

# Prescription Refills

When your health care provider orders a new prescription, Pharmacy
Service will mail it to you. **Refills are always sent by mail** except
for items requiring constant refrigeration. To avoid the risk of running
out of medicine, it is recommended that you order your refills the same
day you receive them so that you receive them in the mail at least 2
weeks before you need them.

**When your health care provider orders a new prescription, the pharmacy
will automatically mail it to you.  If you wish to pick up your new
prescription at the pharmacy, you will need to check in at the pharmacy
and let pharmacy staff know you will be waiting to pick up your
medication(s).  This will require that you meet with the outpatient
pharmacy greeter, take a ticket and wait for your number to be called to
speak with a pharmacist.  **

There are several easy and fast ways to receive your medications from
the Michael E. DeBakey VA Medical Center:

### Automated Telephone Refill System -- Fastest Easiest Way!

The MEDVAMC Pharmacy's Automated Telephone Prescription Refill System is
available seven days a week, 24 hours a day. The telephone number is
(713) 794-7648 or toll-free 1 (800) 454-1062. You will need a touch-tone
phone, your social security number, and your prescription number. Your
prescription number is located on the top left corner of your
prescription container. Please note that not all phones are touch-tone
compatible. If you attempt to access the automated telephone refill
system and have trouble, please check your telephone for touch tones.

**By Internet Access**

My Health*[e]{.underline}*Vet is a web-based application designed
specifically for veterans and their families. It will help veterans work
better with healthcare providers to achieve the best possible health.
You must register to use the new features on My
Health*[e]{.underline}*Vet. You may receive assistance with the Web site
by contacting the MEDVAMC Library located on the 4^th^ Floor or at (713)
794-7856. A Registration Wizard will guide you through the seven step
registration process. Since November 11, 2003, veterans have had
one-stop shopping for VA benefits, health information and service as
well as health assessment tools.

**By Mail**

You may mail in the refill request forms that you received with your
prescriptions when they were filled by Pharmacy. This method takes
longer to process and receive your prescription refills because of
postal delivery processing time.

### By Mail when Refill Slips Are Not Available

To request refills when you do not have the computerized refill slip,
just mail us your request in the form of a letter. This letter should
contain your complete name, social security number, and the prescription
number or name of medication. Mail your request to MEDVAMC 580/119, 2002
Holcombe Blvd., Houston, TX 77030-4298.

**By Drop-Off Box**

For those patients who just need to drop their refill requests off and
do not need to speak with the pharmacy staff, three (3) drop boxes are
available throughout the hospital. One drop box is located to the right
of the rotating doors as you enter the hospital. A second drop box is
located in front of Prime Care Clinic #3 (Space Team Room CIA-300). The
third drop box is located at the Greeter's desk located in the
Outpatient Pharmacy waiting room.

### Hours of Operation

The MEDVAMC Outpatient Pharmacy is open Monday through Friday, 8 a.m. to
8 p.m. On Saturdays, the hours of operation are 8 a.m. to 4 p.m. The
pharmacy is closed on Sundays and most federal holidays.

**Pharmacy Telephone Helpline (The helpline is NOT a refill line)**

If you are having trouble using the automated refill line, the MEDVAMC
Pharmacy Telephone Helpline is available Monday through Friday from 8
a.m. to 4 p.m. by dialing (713) 791-1414, extension 2421 or (713)
794-7653. Pharmacy staff is available to answer any questions you have
concerning how to order your refills and any questions concerning your
medications.

#### Dental Care

Outpatient dental benefits are provided by the Department of Veterans
Affairs according to law. In some instances, the dental care may be
extensive, while in other cases treatment may be limited. This section
describes the outpatient dental eligibility criteria and contains
information veterans should know in order to understand eligibility for
VA dental care.

##### Who is eligible?

Veterans are eligible for outpatient dental treatment if they are
determined by VA to meet one of the following criteria:

-   Those having a service-connected compensable dental disability or
    condition are eligible for any needed dental care.

-   Those who were prisoners of war and those whose service-connected
    disabilities have been rated at 100 percent, or who are receiving
    the 100 percent rate by reason of individual unemployability are
    eligible for any needed dental care. (Includes veterans with
    temporary ratings of 100 percent for duration of that rating or
    waiting for unemployability classification.)

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-   Those who are participating in a VA rehabilitation program are
    eligible for limited dental care necessary to complete their
    program.

-   Those having a service-connected noncompensable dental condition or
    disability may receive one-time treatment if it can be shown to have
    existed at the time of discharge or release from active duty of at
    least 90 days and application is made within 180 days of separation
    from active duty.

-   Those having a service-connected noncompensable dental condition or
    disability resulting from combat wounds or service trauma and those
    having a service-connected noncompensable dental condition or
    disability are eligible for repeat care for the service-connected
    condition(s).

-   Those having a dental condition clinically determined by VA to be
    currently aggravating a service-connected medical condition are
    eligible for limited dental care to resolve the problem.

-   Those with nonservice-connected dental conditions or disabilities
    for which treatment was begun while in a VA medical center, when it
    is clinically determined to be necessary to complete such dental
    treatment on an outpatient basis.

-   Those receiving outpatient care or scheduled for inpatient care may
    receive dental care if the dental condition is clinically determined
    to be complicating a medical condition currently under treatment.

##### Are there exceptions? 

Veterans may receive one-time dental treatment if the dental condition
can be shown to

have existed at discharge or release from active duty of at least 90
days.

### Co-Managed Care: VA and Private Physicians

**Can I receive care from both a VA and local community health care
provider?**

Yes, but if you do, you will want to participate in VA's Co-managed
Care. Co-managed Care is when you and your VA health care provider team
up with your community health care provider and agree to work together
and share information about your health care. This ensures that any
treatments, medications, or supplies VA provides are what you need and
are safe for you. VA will not reimburse you for medications you purchase
at a community pharmacy.

**How do I participate in Co-Managed Care?**

To participate in Co-managed Care, you should ask to be assigned to a VA
Prime Care Team who will monitor, diagnose, and treat your medical
problems and change your treatment, if needed. You must give the VA the
name, address, and telephone number of your community health care
provider. Ask your community health care provider for a copy of your
medical information and reports and bring them with you to your first VA
appointment. The information will help your VA health care provider
understand the status of your health care.

**Can I get my prescriptions filled at the VA and not see VA doctors?**

Please remember the VA **cannot** be used only as your pharmacy. VA
health care providers need to review and follow your care before
prescribing medications and supplies. Your VA provider is responsible
for prescribing medications that are safe and effective. Sometimes, it
is necessary to have blood tests done or to visit the clinic more
frequently to make sure your medications are working well and not
causing you any problems. In most cases, this kind of monitoring must be
done at a VA facility. If a medication prescribed by your community
health care provider is not available through the VA pharmacy, you must
purchase this medication at your own expense.

**Can I get a form to give to my community doctor about my VA
prescriptions?**

The next page of this booklet contains a letter you should ask your
community health care provider to fill out.

### What should I bring to bring to my first appointment with a VA health care provider?

A Check List of the documents you should bring with you from your
community health care providers to your first appointment with a VA
health care provider is provided on the page after next in this booklet.

**Michael E. DeBakey VA Medical Center**

**Co-Management Check List**

*The VA will notify you, either by telephone or mail,*

*about the date of your first VA appointment.*

*Bring these documents with you to your first appointment*

*with your VA health care provider.*

-   Problem List From All Your Providers

-   Medication Bottles Or Prescriptions

> Including Over-The-Counter
>
> (Not More Than 1 Year Old)
>
> From All Your Providers

-   Most Recent Physical

-   Most Recent ECG

-   Most Recent Lab Procedure Reports

-   Endoscopy And Stress Tests

-   Discharge Summaries From Hospitalizations

(During The Last 2 Years)

-   Dates Of Immunizations

-   Most Recent Progress Notes

> From All Your Providers

**Michael E. DeBakey VA Medical Center**

**Department of Veterans Affairs**

**2002 Holcombe Blvd.**

**Houston, TX 77030**

Date: In Reply Refer to: 580

Subject: Non-formulary/Restricted Medication Alternatives

Dear Community Health Care Provider:

Your patient, , has established primary care services at the Michael E.
DeBakey VA Medical Center and would like to begin receiving prescription
medication benefits through the VA Pharmacy. One or more of the
medications that you have prescribed for this patient is not on the VA
formulary (or their use is restricted). We have several therapeutic
alternatives available in most cases. Please refer to the chart below
and [circle]{.underline} the formulary alternative(s) that is (are) best
for your patient. If you feel that your patient is not a candidate for a
formulary alternative(s), the VA Pharmacy will need certain
documentation in order to approve the drug(s) for your patient. Please
note the documentation that is necessary for each medication. Please
return THIS form, along with any supporting medical documentation to
justify the need for a non-formulary/restricted drug(s).

TO THE PATIENT: The patient should bring this information with him/her
to the next scheduled VA Prime Care appointment.

+----------------+-----------------+-----------------------------------+
| **Requested**  | **VA            | **Documentation necessary to      |
|                | formulary**     | justify use of non-formulary      |
| **Medication** |                 | medication**                      |
|                | **A             |                                   |
|                | lternative(s)** |                                   |
+----------------+-----------------+-----------------------------------+
| Atorvastatin   | Lovastatin      | 1.  Failure to meet cholesterol   |
| Cerivastatin   |                 |     goal while on 80mg            |
|                | Simvastatin\*   |     simvastatin or equivalent for |
| Pravastatin    |                 |     6 weeks                       |
|                |                 |                                   |
|                |                 | 2.  Side effects from formulary   |
|                |                 |     agents                        |
|                |                 |                                   |
|                |                 | 3.  Pravastatin is available to   |
|                |                 |     our patients taking protease  |
|                |                 |     inhibitors                    |
+----------------+-----------------+-----------------------------------+
| Celecoxib,     | Acetaminophen   | 1.  Ulcer on formulary agents     |
| Rofecoxib      |                 |                                   |
|                | Naprosyn        | 2.  Concurrent use of high dose   |
|                |                 |     steroids                      |
|                | Etodolac        |                                   |
|                |                 | 3.  Concurrent use of warfarin    |
|                |                 |                                   |
|                |                 | 4.  Failure of scheduled doses of |
|                |                 |     acetaminophen (4 grams/day)   |
+----------------+-----------------+-----------------------------------+
| Clopidogrel    | Aspirin         | 1.  Aspirin allergy               |
|                |                 |                                   |
|                |                 | 2.  Stroke while taking aspirin   |
|                |                 |                                   |
|                |                 | 3.  30 day use after stent        |
|                |                 |     procedure                     |
+----------------+-----------------+-----------------------------------+
| Rosiglitazone  | Glyburide with  | 1.  Failure of maximum doses of   |
|                | or              |     formulary agents (side        |
| Pioglitazone   |                 |     effects or HgbA1 C \> 8.5)    |
|                | without         |                                   |
|                | metformin       | 2.  Contraindication to metformin |
|                |                 |                                   |
|                | Glipizide with  |                                   |
|                | or              |                                   |
|                |                 |                                   |
|                | without         |                                   |
|                | metformin       |                                   |
+----------------+-----------------+-----------------------------------+
| Tamsulosin     | Terazosin       | 1.  Side effects (low blood       |
|                |                 |     pressure, dizziness, or near  |
|                |                 |     fainting spells) while on     |
|                |                 |     formulary agent               |
+----------------+-----------------+-----------------------------------+
| Tramadol       | Acetaminophen   | 1.  Allergy to codeine or         |
|                | with codeine    |     derivatives                   |
|                |                 |                                   |
|                | Acetaminophen   | 2.  Side effects from codeine or  |
|                | with oxycodone  |     derivatives                   |
+----------------+-----------------+-----------------------------------+
| Zolpidem       | Trazodone       | 1.  PTSD history                  |
|                |                 |                                   |
|                | Lorazepam       | 2.  Substance abuse program       |
|                |                 |     completion                    |
|                | Temazepam       |                                   |
|                |                 | 3.  Side effects to or failure of |
|                |                 |     formulary agents              |
+----------------+-----------------+-----------------------------------+

\* These drugs are available as second-line alternatives (failure of
first-line agents is required).

Sincerely,

Michael E. DeBakey VA Medical Center Provider

# Transportation

# 

Transportation to and from the Michael E. DeBakey VA Medical Center from
outlying areas is available by way of vans operated by various veteran
service organizations. Call the telephone numbers listed below for
availability, pick-up point, and schedule information. It is a good idea
to call the day before your appointment to arrange your ride.

Bay City Van, (979) 323-9235 Voice Mail, leave message

Beaumont Vans, (409) 981-8550 Beaumont Clinic, Main number

Brazoria County Van, (979) 864-1289 Voice Mail, leave message

Conroe Van, (936) 756-7614 VFW, Voice Mail not available

El Campo Van, (979) 578-8387 DAV, 24 hour answering service

Harris County Precinct #2 Van, (281) 452-6071 Informational Recording,
no voice mail available

Harris County Social Services (713) 696-1985 Appointment Desk

Lufkin Bus, (936) 633-2750 Lufkin Clinic, Jeff Davis, voice mail when
he\'s not available

Montgomery County Vans (936) 756-5828 Voice Mail, leave message

Willis Van, (936) 856-5224 American Legion, no voice mail, 7:30 a.m. -
midnight

Woodville/Tyler County Van, (409) 283-2493 Voice Mail available

**To and from the Texas City Outpatient Clinic:**

Baytown, Channelview, Deer Park & Pasadena Van    (281) 452-6071

# Informed Consent

**Can I refuse medical treatment?**

Every veteran has the right to accept or refuse treatment based on
informed participation in decisions involving his or her health care.
This process of informed consent requires a practitioner to carefully
describe a procedure or treatment such that the patient, or the
patient\'s surrogate decision-maker:

-   Understands the nature of the treatment or procedure.

-   Understands the benefits and risks of the treatment.

-   Understands the alternatives to the proposed treatment or procedure.

-   Understands the expected outcome if the treatment or procedure is
    declined.

-   Is offered the opportunity to ask questions.

and

-   Is allowed to make a decision freely without coercion or duress.

**How do consent forms work?**

Consents are valid for up to 30 days providing there is no change in the
patient's condition that might alter the treatment decision, the effect
on the patient, or may constitute an increased risk. Signature consent
is not required for administration of most drugs or the performance of
minor procedures. However, the practitioner must discuss these
treatments or procedures with the patient and should document the
discussion in a progress note.

**What happens when there is a loss of decision-making capacity?**

The patient's right to accept or refuse treatment is not diminished by a
loss of decision-making capacity that may be due to physical or mental
impairment, disease, influence of medications, intoxicants or
unconsciousness.

A surrogate decision-maker must be identified who will assume this
responsibility using substituted judgment. If feasible, the proposed
treatment or procedure should be explained to the patient even when the
surrogate decision-maker has given consent.

**How is a surrogate decision-maker selected?**

The surrogate decision-maker is selected based on the following
priority:

-   Health care agent as named in a Durable Power-of-Attorney for Health
    Care (DPAHC) executed by a patient when s/he possessed
    decision-making capacity.

-   Court-appointed (legal) guardian of person or for medical
    decision-making.

-   Spouse.

-   Consensus of children who must be 18 years of age or older.

-   Parent.

-   Consensus of siblings who must be 18 years of age or older.

-   Grandparent.

-   Grandchild who must be 18 years of age or older.

-   Close friend or relative not listed above who must be 18 years of
    age or older and familiar with patient's activities, health,
    religious beliefs and values. A close friend must present a signed
    written statement to be filed in the medical record that describes
    (with specific examples) that person's relationship to and
    familiarity with the patient which must be concurred with in the
    medical record by Social Work Service.

-   If none of the above surrogate decision-makers are available, then
    the attending physician and the MEDVAMC Chief of Staff or designee
    can authorize consent for a treatment or procedure except for
    consent to withhold or withdraw life-sustaining treatment that
    requires review by the Ethics Committee and the Chief of Staff.
    Consideration is given to whether the appropriate court should be
    petitioned to appoint a guardian.

**What happens in a medical emergency?**

In medical emergencies, the patient's consent is implied by law. The
practitioner may provide necessary medical care in an emergency
situation if immediate medical care is necessary to preserve life or
prevent serious impairment when the patient is unable to consent to the
treatment or procedure, and the patient has no surrogate or the
practitioner determines that the waiting time to obtain consent from the
patient's surrogate would increase the hazard to life or health of the
patient or others.

#### Advance Directives 

#### 

#### Taking care of yourself and your family means making decisions about medical care while your health allows you to do so.

Although death comes to everyone, many of us tend to fear its approach
and may avoid confronting the issues surrounding the end of life.
Nevertheless, it is important for each person to document his or her
wishes in writing prior to serious illness or physical or mental
disability. Otherwise, those wishes may not be known and cannot be
honored, thus creating an unnecessary burden for loved ones.

### What are advance directives?

Advance directives are written instructions in the form of a living will
and/or durable power of attorney for health care. Advance directives do
not go into effect until the signer loses decision-making capacity.

### What is a living will?

A living will (health care treatment directive) is a legal document that
communicates a person\'s desire concerning withholding and/or
withdrawing medical treatment in the event that he or she suffers from
an incurable and terminal condition. Living wills outline in advance,
the treatment choices and instructions to be followed by caregivers if
the signer cannot take part in making health care decisions. It is
called a \"living will\" because it must be signed with the same type of
formality as a regular will, but the provisions take effect before
death.

### What does a living will do?

It may spell out specific measures that the person wishes, or does not
wish, to have taken to extend life when he or she is clearly dying. It
may specify the use or non-use of breathing machines, feeding tubes,
oxygen, intravenous fluids, blood products or other medications. It may
list specific illnesses or conditions (persistent vegetative state,
coma, terminal illness with no hope of recovery or cure, end-stage
dementia) under which the provisions of the living will are to go into
effect.

A living will must be witnessed to be legal; therefore, a person must be
competent when he or she signs it. Requirements vary from state to
state, but usually the witnesses must be unrelated to the patient,
cannot be creditors or heirs to the patient\'s estate, and cannot be the
patient\'s doctor. It is wise to prepare a living will at a time when
you are healthy, not when you have been seriously ill or are in the
hospital.

Most states have laws that recognize advance directives. Not all states
do; however, and living wills may not always be binding. Some states do
not recognize living wills that have been drafted in other states. You
need to be familiar with the laws in your state.

**What is a durable power-of-attorney for health care?**

A durable power-of-attorney for health care (DPAHC) designates a family
member or friend to follow the person\'s wishes and to make medical
decisions on his or her behalf should the signer lose decision-making
capacity. It is more flexible and comprehensive than the living will,
and is regarded by some as preferable. A durable power-of-attorney can
be incorporated into a living will.

### What about the legality?

For this document to be legal, the person must be competent at the time
he or she signs it. Anyone with a progressive brain disorder such as
Parkinson\'s disease or Alzheimer's may wish to draw up the DPAHC papers
early in the illness. The duty of an agent in the durable power of
attorney for health care is to follow the signer's wishes. In states
that recognize such documents, families and physicians generally cannot
override a living will or the agent of a DPAHC.

### Who should have a copy?

Once signed, these legal documents should be kept in a safe place, but
not in a safe deposit box where they may not be accessible when they are
needed. It is a good idea to discuss your wishes with your friends,
family members, and your physician. Providing these individuals copies
of your living will or DPAHC also is advisable. Making sure the MEDVAMC
has a copy of the documents is very important. In that case, should you
become incapacitated, others will have access to the documents that
express your wishes.

### Where do I get more information?

The VA has advance directive forms that include both the Living Will and
Durable Power of Attorney for Health Care directives that are honored in
any VA setting. The physician, nurse, or social worker caring for you
can answer many of the questions that you have. Information can also be
obtained by calling: Chaplain Service at ext. 7125; Consumer Affairs at
ext. 7883 or 7884; or the Chairman of the Ethics Committee at ext. 7011.

The VA forms are not honored in community (non-VA) hospitals or clinics,
which require that an advance directive be executed under state law.
Recent changes in VA policy allow patients to execute an Out-of-Hospital
DNR order based on Texas state law. This document will be recognized in
Texas communities as well as the VA and indicate your wishes regarding
withholding of resuscitation in the event of a cardiopulmonary event.
Since the "rules" vary from state-to-state, the Choice in Dying
organization will provide a copy of state-specific advance directives
free to anyone who contacts them. Their address is Choice in Dying, 200
Varick Street, New York, NY 10014. Their telephone number is
1-800-989-WILL. Your state health department, local hospitals, or state
bar also may be able to provide you with state specific advance
directives. You may wish to consult your lawyer about advance directives
and drawing up a durable power of attorney for health care or a living
will and a regular will that conform to the laws in your state.

**What happens if I am already incompetent or physically unable to
manage my own financial and medical affairs?**

Some older people are unable to manage their own affairs due to medical
illness or a mental impairment. The central issue is whether that person
can understand and make decisions involving medical and financial
choices. A person can be confused about time and place; nonetheless, may
be able to understand his or her choices if they are carefully
explained. It is also possible for an older person to be capable of
making decisions about his or her health but not about finances.
Physicians are often asked to evaluate the competency of a patient, but
a doctor can only make a medical determination about someone\'s
decision-making ability. A court must make any legal determination about
competency.

### What is a guardianship?

All states allow the courts to establish limited guardianships (also
called conservator-ships) and unlimited guardianships.

A limited guardianship allows the appointed guardian to make decisions
for someone in areas where the court has determined that the person
lacks the ability to function. This type of arrangement is often made
for managing finances. Someone judged incompetent for financial purposes
is still able to make decisions regarding his or her health.

An unlimited guardianship removes all rights of the individual to vote,
to decide where to live, and to manage his or her money and health. That
person is said to be incompetent for all purposes and receives the
protections generally given to a child.

### What is the meaning of \"resuscitate\" and \"do not resuscitate (DNR)?\"

If you are in a clinic, hospital, or nursing home, you may be asked
about code status. This term indicates to the staff what measures, if
any, you want taken should you be found not breathing and without a
heartbeat. Code status may be changed at any time.

### What about CPR?

Cardiopulmonary resuscitation (CPR) was developed in the 1960s as a way
to prevent sudden and unexpected death. When administered quickly, it is
generally effective for heart attacks, drownings, drug overdoses, and
similar acute situations. However, CPR is not generally as effective for
people with chronic and severe illnesses or where death is expected to
occur soon.

### What is a full code?

A full code means that you want everything possible to be done to revive
you. This includes administering chest compressions, electrical shocks,
medication (to start your heart) and putting^-^ you on a ventilator (a
machine to keep you breathing). This type of CPR has the most success
but is still less successful for people with chronic medical conditions.
Some people request a limited code, which usually excludes being put on
a ventilator and is much less often successful.

When CPR is medically futile, your doctor should explain why. In those
cases, a no code order (DNR for Do Not Resuscitate) may be written. It
is important to recognize that a DNR order only pertains to not having
CPR and does not limit other types of treatment. A person should receive
all indicated medical and nursing care, even when CPR would be of no
benefit or not wanted by the patient. A discussion with your doctor
about CPR is an excellent opportunity to review your overall medical
condition and treatment plan.

# Organ Donation

######### Does the MEDVAMC participate in organ donation?

The MEDVAMC is affiliated with the LifeGift Organ Donation Center.

######### Do I have to sign a consent form?

If an inpatient or their next of kin has consented to release their name
and telephone number to the LifeGift Organ Donation Center; LifeGift
will be notified of his or her death, or when he or she has been placed
on a ventilator due to a severe brain injury.

The LifeGift Organ Donation Center will assess the medical suitability
for donation of organs or tissues based on the patient's clinical
history and diagnosis. The LifeGift Organ Donation Center will contact
the next-of-kin to discuss organ and tissue donation and to ask for
consent if the potential donor is determined to be medically suitable.

It is MEDVAMC's policy that families of potential donors be treated with
the utmost respect and compassion, exercising discretion and sensitivity
to their circumstances, religious and cultural beliefs, and desires
during all of these discussions.

######### Where do I get more information?

For more information about the LifeGift Organ Donation Center, visit
*www.lifegift.org* on the Internet or call (713) 798-4930.

# Allowance for Housebound

**What is housebound allowance?**

The VA's Housebound Allowance is an additional amount available to
eligible veterans and dependents that are entitled to VA pension or VA
compensation. For more information, call toll-free 1-800-827-1000.

**Who is eligible for the housebound allowance?**

A veteran, dependent spouse or surviving spouse who because of their
physical limitations is unable to walk or travel beyond their home. This
allowance may be granted for those unable to meet the requirements of
the greater aid and attendance allowance. If their disabilities are
severe enough to confine them to their immediate premises for the
foreseeable future, they may be entitled to higher income limitations or
additional benefits, depending on the type of benefit received.

**How do I apply?**

You should furnish a medical statement covering the findings, diagnosis
and prognosis of any recent medical treatment or examination. The
doctor\'s statement or medical report should describe how your ability
to perform the personal functions of daily living, such as dressing,
feeding, bathing, and attending to the needs of nature, is limited by
your medical condition. It should also include the number of hours you
spend in bed and describe your posture and general appearance. You may
also furnish any other information indicating that you are unable to
care for yourself or walk or travel beyond your home because of your
condition.

Note: You are not required to incur the expense of the physical
examination by a private physician in order to receive consideration. If
the detailed medical information about your ability to care for yourself
is not available from the doctor\'s or hospital\'s current records, VA
may arrange for a physical examination.

**Does this help me with medication expenses?**

Veterans who have been adjudicated through the VA Regional Office for
Aid and Attendance Compensation Pension, Allowance for Housebound or
approved by the MEDVAMC for Fee Basis are entitled to receive
medications through VA Pharmacy without being assigned to a Primary Care
Provider. The medication prescribed must be on the VA formulary.

# 

# CHAMPVA

**What is CHAMPVA?**

CHAMPVA is a health care benefits program for dependents of veterans who
have been rated by VA as having a total and permanent disability;
survivors of veterans who died from VA-rated service-connected
conditions, or who at the time of death, were rated permanently and
totally disabled from a VA-rated service-connected condition; and
survivors of persons who died in the line of duty and not due to
misconduct who are not otherwise entitled to DOD Tricare benefits. Under
CHAMPVA, VA shares the cost of covered health care services and supplies
with eligible beneficiaries.

Due to the similarity between CHAMPVA and TRICARE (formerly known as
CHAMPUS\--a program administered by the Department of Defense for
military retirees as well as families of active duty, retired, and
deceased service members), the two programs are easily and often
mistaken for each other. For more information about TRICARE, call toll
free 1-800-406-2832 or visit *www.tricare.osd.mil* on the Internet.

**What are the benefits of CHAMPVA?**

In general, CHAMPVA covers most health care services and supplies that
are medically and psychologically necessary. Medications are free;
however, over-the-counter medications are not provided. CHAMPVA does not
include dental or eye care. Upon confirmation of eligibility, applicants
will receive program material that specifically addresses covered and
non-covered services and supplies.

**Where do I get more information about CHAMPVA?**

### On the Internet, visit *www.va.gov/hac/champva/champva.html*. You can call CHAMPVA, which is managed by the VA\'s Health Administration Center, at 1 (800) 733-8387. In Houston, the CHAMPVA's Women Veterans Program Manager can be reached at (713) 794-7926. Questions concerning CHAMPVA billing may be directed to (713) 791-1414 ext. 8728. However, the quickest way to obtain answers to questions is by sending an e-mail message to the following address*: hac.inq@med.va.gov*. 

### Participate in Your Care

### You are encouraged to be actively involved in your care.

### 

### How can I make the most of my health care appointments?

-   Arrive on time.

-   Keep an on-going list of questions or problems to ask your Prime
    Care provider. Bring the list with you to your appointment.

-   Be prepared to talk about any changes in your health. Keep a diary
    of things that are not normal such as pain, loss of appetite,
    frequent urination, lightheadedness, etc. Tell your provider about
    any unusual symptoms or lifestyle changes.

-   Ask about recent test results.

-   If you monitor your blood pressure, pulse, weight, or blood sugar at
    home, bring this record with you.

-   Bring your current medications or prescriptions (not more than 1
    year old) with you. Include what you are taking, the reason, and how
    often you are taking them. This should also include non-prescription
    (over the counter) and herbal preparations. These \"medications\"
    can interact with your other medications and also can have other
    effects on your health. Bring these items with you to all of your
    appointments.

-   Ask about your treatment options.

-   Tell your provider if you have had any recent medical care
    elsewhere.

-   Tell your provider if you think you need help from other members of
    the Primary Care team (nurse, social worker, dietitian, pharmacist).

-   Bring copies of recent medical records from any non-VA health care
    provider you are seeing in your community.

-   Bring something to take notes on at your appointment. If you are
    unable to or if you have trouble remembering things or trouble
    making sense of your provider\'s plan, bring someone with you to
    your appointment. If this is not possible, ask your provider or
    nurse to write out the plan for you to take home with you.

# Admission Procedures

**Where do I go for admission processing?**

Admissions are processed by the Bed Control Clerk, located in Room
1A-801 in the Admissions Clinic. This office is on the first floor
around the corner from the Wheelchair Check-out. The telephone number is
(713) 791-1414, ext. 3789.

After registering, the Bed Control Clerk will locate a bed for you with
the appropriate service. This process is handled after hours by the
Medical Administrative Assistant (MAA) in the same room at the
Registration/Sign-in counter (Station 1) in the Admissions Clinic. The
telephone number is (713) 791-1414, ext. 3808.

**What happens to my clothes and valuables when I am admitted?**

Upon admission to the medical center, you will be asked to change into
your pajamas and bathrobe. You will be supplied a hospital gown if you
do not have pajamas. Please do not remove your slippers and go barefoot.
For your own safety, always wear shoes or slippers. When leaving your
room, please wear your bathrobe.

It is recommended that valuables such as credit cards, driver's license,
jewelry, etc. be sent home with a relative or friend. Dentures should
never be placed on meal trays or bedside stands, but placed in a clearly
marked denture cup to avoid accidental discarding. Be sure to search the
pockets of your pajamas and robe before sending them to the laundry.

Safekeeping of clothing and valuables is your responsibility. Misplaced
or forgotten articles may not be recov­ered. The MEDVAMC cannot assume
responsibility for loss or damage to personal belongings kept in your
room.

**Should I bring my hearing aid?**

Hearing aids are often lost, damaged, or misplaced in a hospital stay.
Do bring your own hearing aid with you and wear it so you can hear
medical center caregivers, but realize that you are fully responsible
for it while you are an inpatient. It is important to bring along the
hearing aid carrying case with your name and social security number
inside. Store your hearing aid in the case any time you are not wearing
the aid.

**Do I get an ID bracelet?**

Upon admission to the Michael E. DeBakey VA Medical Center, an
identification band will be fastened to your wrist. This wristband must
be worn at all times, as treatment cannot be given to you without proper
identification. In an emergency, this tag could save your life.

**What do I do with the money I bring?**

Please deposit all funds over \$10 with the Agent Cashier, Room 1B-308
next to Prime Care Clinic #4. The Agent Cashier Office is open 8 a.m.
until 4:30 p.m.

During irregular hours, your money should be deposited with the Medical
Administrative Assistant (MAA) located in the Registration/Sign-In area
(Station 1) in the Admissions Clinic, Room 1A-801. Arrangements for
withdrawal of money must be made with the Patient Funds Clerk, Room
1B-306 between the hours of 8 a.m. and 4:30 p.m., Monday through Friday.
The money you keep in your room is your responsibility.

**Do I bring my medications with me?**

Please do not bring any medications from home with you to the hospital
unless requested by your physician. Any medication you bring will be
returned to a family member. Your physician will order appropriate
medications for you during your hospitalization and necessary
medications will be furnished to you when you are discharged. However,
it is a good idea to bring a list of your current medications.

**Who do I talk to if I have questions or concerns?**

Should you have any questions or concerns about your admission, please
contact the Bed Control Coordinator at (713) 791-1414 ext. 3789 or the
Medical Administrative Assistant (MAA) at (713) 791-1414, extension
3808.

# Your Hospital Stay

**Patient Safety**

Patient safety is of utmost importance. As a means of promoting patient
safety, you are encouraged to be an active participant in the care you
receive.

-   Don't hesitate to ask questions about your care or any safety
    concerns

-   Involve a family member or friend in your care

-   Learn as much as you can about your disease process, diagnosis,
    medical treatments and plan of care

-   Know what medications you are taking and why they have been
    prescribed

-   Help prevent the spread of infections by washing your hands after
    using the bathroom, before meals and before and after participating
    in other activities

-   Report any concerns regarding your care to your healthcare provider
    or unit management. If the concern is not satisfactorily addressed,
    follow the steps outlined regarding, "Who do I talk to if I have a
    complaint?"

Medication, weakness caused by illness, and an unfamiliar environment
can cause falls. If you are placed at bed rest and need something not at
your bedside, please use the call button provided.

**Calling Your Nurse**

A button to call your nurse is located at your bedside. When you press
the button, the nurs­ing station is alerted that you need assistance and
a light flashes above your door. A staff member will respond to your
call as soon as possible either by intercom or in person. Your safety is
one of our primary concerns; please let a member of your nursing staff
know when you leave your unit.

**Restrictions**

Patients are expected to be at the bedside for doctors' rounds,
laboratory rounds, and other treatments. Patients who wish to
communicate with a hospital staff member should ask the unit clerk for
assistance.

**Face Mask**

If your medical problem requires that you wear a facemask outside your
room, please do not remove the mask and expose others, or yourself, to
illness. Leave the mask in place at all times and follow your specific
instructions from your health care provider.

**Conduct and Behavior**

Please be considerate of others and help us maintain a quiet atmosphere.
Regulations do not permit the use of loud, abusive, or profane language;
loud music or televisions; gambling, soliciting, bartering, or
panhandling; or the sale, use, or possession of intoxicants or
unauthorized drugs. If you should observe such misconduct by anyone,
please report it immediately to a unit nurse. The VA Police are
authorized to make arrests on the premises.

Patients may be given an irregular discharge from the medical center for
the following reasons:

-   Violation of medical center rules

-   Leaving against medical advice (AMA)

-   Leaving the premises without authorized leave (AWOL)

-   Not returning by the stated time when on a pass

-   Non-compliance with treatment plan

-   Aggressive and/or abusive conduct towards staff and/or other
    patients

-   Using or possessing intoxicants or unauthorized drugs

**Smoking**

The Michael E. DeBakey VA Medical Center is a smoke free facility. The
designated smoking area is the ground floor terrace facing Old Spanish
Trail.

**Noise**

Please be as quiet as possible. Loud sounds are disturbing to patients
who are resting.

**Meals**

Good nutrition is the key to good health and an important part of your
medical care and treatment. Your physician will order a regular diet or
a modified diet, which will be planned to meet your medical
requirements. Upon request, a registered dietitian will visit you to
discuss your nutri­tional needs, eating habits, allergies, etc. If you
are placed on a modified diet to continue after you leave the hospital,
please request diet instructional materials. The nursing staff will
consult the registered dietitian to provide the information to you and
your caregiver before discharge or schedule an appointment for you with
the Prime Care dietitian for a later date.

Visitors are requested to check with the nurse or registered dietitian
before bringing food or snacks for patients to ensure that such items
are included in the menu plan. Patients are asked to check with their
nurse or registered dietitian before eating food brought in or purchased
in the cafeteria, retail store, or from vending machines. Should you
have a need to speak with a dietitian, please notify the nursing staff.

Breakfast is served daily from 7 to 8:30 a.m.; lunch from noon to 1:30
p.m.; and dinner from 5 to 6:30 p.m.

**Fire/Disaster Drills**

The Michael E. DeBakey VA Medical Center has a fire and disaster plan in
which all of the employees have been trained. Practice drills are held
to ensure prompt and efficient action in the event of a real fire. If
you hear fire bells, be calm and follow the instructions given to you by
the nursing personnel in your area.

**Patient Day Rooms**

Patient day rooms are located on every nursing unit. Most nursing units
also have dining rooms where patient activities also take place.

**Televisions**

Television sets are provided for your entertainment and comfort.
Televisions are to be turned off by 10:30 p.m. Please notify the unit
staff if you need this assistance.

**Hearing Impaired**

TDDs and TV captioners are available by request. Ask the unit nurse to
contact the Audiology Clinic as soon as you are admitted so these
services are provided to you.

**Telephones**

Bedside telephones are provided to each patient. Incoming calls cannot
be received at the bedside from 10 p.m. through 6 a.m. as the ringing
mechanism is disabled during this time period. Local calls can be made
any time from your room by dialing 97 and the telephone number.

To place a long distance telephone call, dial 97 + 00 to reach an
outside opera­tor MCI WorldCom). You will get an auto-attendant who will
say, "Enter the area code and number you are calling." After you enter
the number, you will hear "For collect calls, press 11. To bill this
call to a credit card or calling card, enter the card number now, or for
a third party billing, press 0 for operator assistance."

Do not dial 1 prior to entering the telephone number. When dialing
direct, the auto-attendant will instruct you in placing the call.

Our telephone system will not allow the receipt of incoming collect
calls. Calling cards may be purchased in the Canteen Retail Store.

You may tell your friends and family your telephone number is (713) 794-
and the number on your telephone

**Passes**

Under limited conditions, your physician may allow you a short period of
authorized absence from the MEDVAMC. If you are permitted to have an
authorized absence, you must return to your unit by the specified date
and time or you will be administratively discharged.

**Fisher House and Courtesy Quarters**

######### What is the Fisher House?

The Fisher House is a "home-away-from-home" providing temporary lodging
for families whose loved ones are receiving treatment at the MEDVAMC. 
The purpose of the Fisher House is to give families a clean, safe haven
while the veteran is receiving care associated with surgeries or other
medical conditions requiring the family to remain close. The Fisher
House opened May 24, 2005. There is no cost associated with staying at
the Fisher House. Families can request lodging at the Fisher House by
having their social worker or provider complete a consult. This will be
reviewed and every effort to accommodate the family will be made.

**What are Courtesy Quarters?**

The MEDVAMC Courtesy Quarters is lodging services for eligible veterans
(and caregivers on a space available basis) that require no ongoing
medical assessment and are able to follow the treatment plan on their
own or with their caregiver. Caregivers are individuals who accompany
the veteran to address activities of daily living and other necessary
care giving that the veteran cannot perform. Medical services,
medication, pajamas, and meals are not provided.  To request a room in
the Courtesy Quarters, any member of the patient's treatment team may
initiate a consult.  The consult will be reviewed and if the veteran is
eligible and a room is available, a room assignment will be made.

######### How can I get more information about the Fisher House or Courtesy Quarters?

You can contact the Fisher House/Courtesy Quarters Manager, Frank
Kelley, at (713) 794-8095 or by e-mail at frank.kelley@med.va.gov.

# Facilities & Services Inside the Hospital

**Canteen Services**

The Veterans Canteen Service is located on the first floor near the main
entrance to the Medical Center. The Canteen Service consists of a Retail
Store, Cafeteria, Papa's Best Pizza, Vending Services and a Barber Shop.

The Retail Store has a wide selection of retail merchandise to include
health and beauty aids, candy and snacks, men and ladies clothing, gift
items, greeting cards, electronic products, and long distance telephone
calling cards. The Canteen Cafeteria serving line is open for breakfast
and lunch. Also available in the Cafeteria is a deli, grill, salad bar,
and assorted dessert and snack items. The Canteen Main Vending room,
located on the first floor, Room 1A-660, is open 24 hours a day. There
are also snack and soda machines located near each Nursing Unit. The
Canteen Service also operates a Barber Shop located on the first floor.
Payment for barber services may be made in the Canteen Retail Store.

### Cafeteria

> Monday - Friday, 7 a.m. - 6 p.m.\
> Saturday - Sunday, 8 a.m. - 2:30 p.m.\
> Holidays, 8 a.m. - 2:30 p.m.

**Coffee House: Proudly Brewing Starbucks Coffee**

Monday -- Friday, 6:30 a.m. -- 4:30 p.m.

### Barber Shop Fresh Choice Bistro

> Monday - Friday, 7:30 a.m. - 4 p.m. Monday - Friday, 7 a.m. - 6:00
> p.m.

### 5th Avenue Deli Papa's Best Pizza

> Monday - Friday, 10:30 a.m. -- 2:00 p.m. Monday - Friday, 11 a.m. -
> 2:00 p.m.\
> Saturday - Sunday, Holidays Closed

**Information Desk**

The information desk, located on the first floor in the main lobby, is
open Monday through Friday, 7 30 a.m. to 4 p.m. You can obtain
information on such topics as the location of offices and services
within the Michael E. DeBakey VA Medical Center, location of inpatients
(with their consent), where to register for emergency care services,
where to report for admission, where to check in for outpatient clinic
visits, and how to get to the regional office.

**Lost and Found**

All articles classified as lost and found are forwarded to the Patient's
Clothing Room, Room BA-203, at the end of each workday. Individu­als
searching for any lost item should report to Room BA-203, Monday through
Friday between the hours of 8 a.m. and 4:30 p.m.

**Patient Mail**

Mail will normally be delivered to patients daily, Monday through
Friday. All mail received after you have been discharged will be
for­warded to your home address. It is, therefore, important to make sure
we have your current address. Any changes should be reported to your
nursing unit staff.

Mail sent to you while a patient should be addressed as follows:

(Your Full Name, Nursing Unit, and Room Number)

Michael E. DeBakey VA Medical Center

2002 Holcombe Blvd.

Houston, TX 77030-4298

**Parking**

Parking on VA grounds is restricted to patients and their family members
or visitors. All others will be ticketed or towed. As of January 5,
2004, free valet parking is available at the main entrance for our
veterans. This service will operate Monday through Friday, 7 a.m. to
5:30 p.m., except for federal holidays. A "No Tipping" sign is posted at
the main entrance and this policy is strictly enforced.

Veterans using the new valet parking are greeted by a uniformed,
valet-parking attendant when they pull up to the valet parking area at
the main entrance. Veterans are asked to present their VA I.D. card
and/or their appointment letter to the attendant. The attendant will
then ask the driver how long he or she expects to stay at the MEDVAMC.
Next, the attendant gives the driver a claim check and parks the car in
a parking space based on the length of stay, or directs the driver to a
spot for self-parking. All attendant-parked vehicles are locked, and the
keys are appropriately secured. All the parking attendants are in
uniform and hold a valid Texas driver's license.

When customers return, they hand over their claim tickets and are given
the option of having the valet parking attendant deliver their vehicle
or retrieving it themselves. After 5:30 p.m., parking attendants turn
over the keys of any vehicles still on the premises to the VA Police
Section. Owners of these vehicles are able to pick up their keys at the
VA Police Station at the main entrance.

Handicapped persons can be dropped off at the main entrance, and the
attendant will park the car or direct the driver to a handicap space for
self-parking. Parking attendants also assist parking patrons by removing
wheelchairs and carts from their automobiles. Drivers with buses or
large vans, who wish to park their own vehicles, are directed to a
designated area by a parking attendant. Veteran service organization
vans are able to drop off and pick up patients at the main entrance, and
are directed to a designated area if they wish to park.

Veterans who are admitted should make arrangements for their vehicle to
be removed from the property. The Department of Veterans Affairs cannot
assume responsibility for the theft of or damage to any car on medical
center property.

Handicap parking spaces are clearly marked by a standard sign indicating
that they are reserved for those vehicles which either a VA handicap
sticker or the appropriate handicap placard assigned by the State of
Texas. The require­ments to obtain a Handicap Sticker from the VA Police
include the following: those confined to a wheelchair, lower limb
amputees, and/or those with lower limb impairments that require the use
of devices for ambulation. If you have a handicap license plate or hand
tag from the Texas Department of Motor Vehicles, you are allowed to park
in the spaces reserved for handicap persons here at the MEDVAMC and do
not need to request one from the VA Police Section.

Restricted parking areas include curbs painted with either yellow or red
paint, and areas marked with signs pro­hibiting or limiting parking.

**Release of Medical Information**

In most cases, your written authorization is needed for MEDVAMC to use
or disclose your health information. However, Federal law allows MEDVAMC
to use and disclose your health information without your permission for
certain purposes. If you wish to request or release your health
information, please contact the Release of Information Unit, located in
the basement, Room BA-200. For more information about patient privacy
and your rights, turn to that section in this booklet.

**Religious Services**

Chaplains are on duty from 8 a.m. to 4:30 p.m. daily. The Chapel is open
from 8 a.m. -- 4 p.m. daily. Chaplains are available for crisis ministry
24 hours a day, seven days a week. To assure prompt response to your
needs for a pastoral visit or consulta­tion, indicate your request to the
nurse or clerk on your nursing unit. The message will be promptly
delivered to the chaplain.

If you wish to attend services or visit the chapel, it is located on the
second floor, above the lobby, just to the left of the main elevators.
Devotional literature is available in the chaplain's office upon
request. Protestant services are offered on Sundays at 9 a.m. Roman
Catholic Mass is offered Monday through Saturday at 11 a.m. Sunday Mass
is held at 10 a.m., with an "anticipatory mass" on Saturday at 4 p.m.
All services may be viewed on television Channel 37 in patient rooms.

**Social Workers**

Social Workers are assigned to each nursing unit in the medical center
and also provide coverage for most outpatient programs. They are
available to help you with personal or family problems. The social
worker has information about many community agencies and resources,
which may be of assistance to your family while you are undergoing
hospital treatment. The social worker can help those who need special
post-hospital care to plan and prepare for whatever is needed. If you
are in need of legal services your social worker can help you identify
resources in the community. Please notify your nursing unit or clinic
staff if you need to contact your social worker or call the main
hospital operator (713) 791-1414 and ask to be put in contact with the
social worker assigned to your Primary Care doctor or unit.

**Veterans Benefits Counselors**

Veterans Benefits Counselors, representa­tives from service
organizations, and the Texas Veterans Commission counselors are assigned
to the Medi­cal Center to assist you in matters concerning VA benefits
such as compensation, pension, government insurance, education, GI
loans, vocational rehabilitation, etc. The Veterans Assistance Office is
located on the second floor, Room 2A-112.

**Voluntary Service**

Voluntary Service is affiliated with over 40 different community groups
and service organi­zations and provides volunteers to assist the medical
center's patients and staff with their daily activities.

The American Legion Auxiliary, Veterans of Foreign Wars Auxiliary, the
American Red Cross, and Women Veterans of America provide personal care
items and toiletries to in-patients as needed. Please notify your
nursing unit staff if you are in need of these items. If you would like
a volunteer to visit you, please contact the Volunteer Office or your
nursing unit staff will assist you in getting in touch with Voluntary
Service.

Volunteers are an integral part of the health care system provided by
the Department of Veterans Affairs Medical Centers serving veterans
throughout the United States. Volunteers are a valuable supplemental
addition to the staff at the MEDVAMC. In FY2007 MEDVAMC volunteers gave
over 131,609 hours of service to our veterans. To find out how you can
be a part of the volunteer team contact the Volunteer Office at
713-794-7135 or stop by Room 2A-104 for a visit.

**Escort Section**

The Escort Section provides transport assistance to patients and
hospital visitors and provides pick up and delivery of laboratory
specimens throughout the medical center, Sunday through Saturday, from 6
a.m. to 10 p.m. The Escort Section also provides wheelchair checkout
service in the Main Lobby from 7:30 a.m. until 6:00 p.m., Monday through
Friday.

**Recreation Therapy**

Recreation therapists are assigned to psychiatry, nursing home, rehab,
and spinal cord injury units. Unit level activities are available
through the recreation therapists assigned to your unit.  Your physician
may write a consultation to recreation for units without assigned
therapists.  Periodically, self-directed hospital wide activities such
as bingo, socials, and various tournaments are held.  These are
coordinated by Recreation Therapy and/or spon­sored by volunteer groups.
These activities are publicized within the MEDVAMC prior to the event.

# Visiting Hours and Guidelines

**General Visiting Hours**

11 a.m. -- 9 p.m. daily

**Intensive Care Units (SICU, MICU, CCU, Unit 3D) Visiting Hours**

9 a.m. -- 6 p.m. and 9 p.m. -- 10 p.m. Two visitors may stay at the
bedside.

**Mental Health Care Line Visiting Hours**

Monday -- Friday, 6:30 p.m. -- 9 p.m.

Weekends & Holidays, 1:30 p.m. -- 4 p.m. and 6:30 p.m. -- 9 p.m.

**Geriatric Psychiatry Visiting Hours**

Please contact the Nursing Station on NU6F for details.

### What are the guidelines regarding visiting a patient?

Visiting hours may be changed to meet the needs of individual patients.
Immediate family members may visit a patient before surgery.

Children 15 years of age and over are permitted to visit inpatient care
areas. Children under 15 years of age may visit an inpatient when the
attending physician and nurse have granted permission. However, children
are required to be accompanied by an adult at all times.

Patients are limited to two visitors at any one time. If limitations on
visitors, telephone calls, or other communications are indicated for a
particular patient, these limitations will be discussed and determined
with the full participation of the patient and the patient's family. All
such restrictions will be fully explained to the patient and the
patient's family. Please keep in mind that if a patient requires medical
attention or personal care, or if visitors are unsettling to the
patient, nursing staff members might ask visitors to leave regardless of
the posted visiting hours.

**Patient Privacy**

Due to a recent change in privacy laws, the Veterans Health
Administration (VHA) wants to provide you with a summary VA Notice of
Privacy Practices.

The following Summary Notice provides a summary of the VA Notice of
Privacy Practices and briefly states 1) How your health information may
be used and disclosed; 2) Your rights regarding your health information;
and 3) Our legal duty to protect the privacy of your health information.
For a more complete description of our privacy practices, you should
carefully review the Detailed Notice of Privacy Practices available at
your VA medical facility. This Summary Notice does not modify or limit
the VA Detailed Notice of Privacy Practices.

## **What does health information include?**

## Health information is any information we create or receive about you and your past, present, or future physical or mental health or condition, health care, or payment for medical services. 

## **How does the VA use and disclose health information?**

In most cases, your written authorization is needed for us to use or
disclose your health information.

However, Federal law allows us to use and disclose your health
information without your permission for the following purposes:
treatment, payment, health care operations, eligibility and enrollment
for VA benefits, law enforcement, coroner or funeral activities (with
limitation), public health, judicial or administrative proceedings,
national security, research (with strict limitations), services, health
care oversight, abuse reporting, correctional facilities, military
activities, workers' compensation, when required by law, health or
safety activities, patient directories, and family members or others
involved in your care (with limitations). All other uses and disclosures
of your health information will not be made without your prior written
authorization.

# Do I have privacy rights?

# You have the right to review your health information, obtain a copy of your health information, request your health information be amended or corrected, request that we not use or disclose your health information, request that we provide your health information to you in an alternative way or at an alternative location in a confidential manner, an accounting or list of disclosures of your health information, and receive our VA notice of the privacy practices upon request.

# Does the VA change its privacy practices?

# We reserve the right to change the VA Notice of Privacy Practices. The revised privacy practices will be effective for all health information we already have about you, as well as information we receive in the future. We will send to your last address of record, and otherwise make available to you, a copy of the revised Notice within 60 days of any change.

**Who do I contact if I have a complaint about my privacy?**

If you are concerned that your privacy rights have been violated, you
may file a complaint to VHA or to the Secretary of the U.S. Department
of Health and Human Services. To file a complaint with VHA, you may
contact your VA health care facility Privacy Officer, the VHA Privacy
Officer, or VHA via Contact the VA at http://www.va.gov or dial
toll-free 1-877-222-8387. At the Michael E. DeBakey VA Medical Center,
the Privacy Officer can be reached by calling (713) 791-1414, extension
5529. Complaints do not have to be in writing, though it is recommended.
You will not be penalized or retaliated against for filing a complaint.

[**Quality &
Satisfaction**](http://www.puget-sound.med.va.gov/hb/Quality_Satisfaction/Quality_Care.htm)
**With Your Health Care**

### 

### How can I be sure that I am getting high quality care?

MEDVAMC is committed to providing you high quality medical care. We base
medical decisions, including what tests, treatments, and other
interventions to provide to you, concerning your health care needs.

We meet or exceed the same standards for quality and safety that private
health care facilities do. The Michael E. DeBakey VA Medical Center is
fully accredited by the Joint Commission, the Commission on
Accreditation of Rehabilitation Facilities (CARF), the Commission on
Cancer of the American College of Surgeons, American Dental Association,
American Psychological Association Office of Accreditation, American
Dietetic Association, as well as several other external review
organizations.

### Who do I talk to if I have a complaint?

The Michael E. DeBakey VA Medical Center strives for excellence in
patient care. To ensure that we are meeting your needs, we want to help
you know what action to take if you have a problem and what you can
expect from our staff.

Please remember that there are some problems that result from expecting
services that are outside our mission, not in keeping with acceptable
clinical standards of care, or beyond our capacity to provide. Our goal
is to resolve issues at the point of occurrence. To obtain solutions to
concerns you have with our services, please take the following steps:

*Step 1:* Speak clearly and calmly to the person with whom you are
having a problem. Make sure they understand what you want. It is our job
to listen to your concerns in an appropriate and effective manner. Your
care will never be jeopardized because you have a complaint. If you are
unable to resolve the issue, proceed to Step 2.

*Step 2:* Ask another person to help you resolve the issue - a person on
your treatment team, the supervisor, or the administrative officer in
the area. If your concerns are not addressed to your satisfaction,
proceed to Step 3.

*Step 3:* You may ask to speak to the Care or Service Line Executive, or
Service Chief in the area where you are having a problem. The Executive
or Service Chief will listen to your concerns and help to find a
solution to your problem. If you are unable to resolve the issue at this
level, proceed to Step 4.

*Step 4:* Seek the help of a Medical Center Patient Advocate in the
Consumer Affairs Department (contact information is on the inside front
cover of this publication). The first questions the Advocate will ask
you are: "With who have you talked?" and "How have you tried to resolve
this problem?" As a direct representative of the Medical Center
Director, the Advocate's goal is to help you work with the staff.

After following the steps above, you believe the organization has not
satisfactorily addressed your concerns regarding quality and safety of
care, you may contact the Joint Commission's Office of Quality
Monitoring to report your concern or register a complaint by calling
1-800-994-6610 or by e-mailing
[complaint@jointcommission.org.]{.underline}

Since you are a partner in your health care, we want to help you manage
your medical needs with your team. Toward this effort, the Advocate may
prepare you to talk with the person with whom you are having the
problem. Our Patient Advocates will also review your concerns and
provide guidance on effective ways for you to deal with the issues.

**Care Choices**

Your Prime Care Team needs to know if you have a living will and durable
power of attorney for medical care. This means you have chosen someone
to make medical decisions about your care only when you cannot make your
wishes known. Information will be provided to you annually regarding
Advance Directives and a Social Worker is available to assist you in
implementation if you so desire. The Ethics Advisory Committee is also
part of your health care team. This group can assist with identifying
and resolving ethical issues. Ask your provider, social work service, or
Patient Advocate for assistance.

**Pain Management**

In order to help you, you and your health care provider need to work
together. Your Prime Care Team will refer you to the MEDVAMC Pain
Management Clinic if your case requires specialized attention. The Pain
Management Clinic uses state-of-the-art pain relief minimally-invasive
procedure therapies along with pharmacological approaches when required;
however, the emphasis is on the psychosocial issues of pain.

**As a patient, you can expect:**

-   Information about pain and pain relief measures

-   Concerned staff committed to pain prevention

-   Health professionals who respond quickly to reports of pain

-   State-of-the-art pain management including referral to the MEDVAMC
    Pain Management Clinic if your pain is difficult to manage

**As a patient, we expect that you will:**

-   Ask your doctor or nurse what to expect regarding pain and pain
    management

-   Discuss pain relief options with your doctor or nurse

-   Work with your doctor or nurse to develop a pain management plan

-   Ask for pain relief when pain first starts

-   Help the doctor or nurse measure your pain

-   Tell the doctor or nurse if your pain is not relieved

-   Ask about managing side effects such as constipation

-   Participate actively in non-medication management of your pain

**You will be asked to answer these questions:**

-   Where do you hurt?

-   Describe the quality of your pain (gripping, stabbing, burning, dull
    ache, stinging, crushing, sharp, gnawing, penetrating, etc.).

-   What is the level of the pain on a scale of 0 to 10, with 5 being
    moderate and 10 being unbearable?

-   Describe its pattern-occasional, continual, clusters.

-   What makes it better? Worse?

-   When did it first start?

-   What are you doing for it now? Medication? Exercise? Do these things
    help?

-   Has your pain affected your lifestyle? Relationships? Work? Sleep?
    Appetite?

It is important for your provider to know what diagnostic tests you have
had. Keep a log of tests, medications, and their doses, and whether they
worked or not. Also keep track

of any side effects you experienced.

of any side effects you experienced.

**Patient Rights & Responsibilities**

Veterans Health Administration (VHA) employees will respect and support
your rights as a patient. We are pleased you have selected us to provide
your health care. We plan to make your visit or stay as pleasant for you
as possible. Your basic rights and responsibilities are outlined in this
document. Please talk with VA treatment team members or a patient
representative if you have any questions or would like more information
about your rights.

### Respect and Nondiscrimination

-   You will be treated with dignity, compassion, and respect as an
    individual. Your privacy will be protected. You will receive care in
    a safe environment. We will seek to honor your personal and
    religious values.

-   You or someone you choose have the right to keep and spend your own
    money. You have the right to receive an accounting of VA held funds.

-   Treatment will respect your personal freedoms. In rare cases, the
    use of medication and physical restraints may be used if all other
    efforts to keep you or others free from harm have not worked.

-   As an inpatient or long-term care resident, you may wear your own
    clothes and keep personal items. This depends on your medical
    condition.

-   As an inpatient or long-term care resident, you have the right to
    social interaction and regular exercise. You will have the
    opportunity for religious worship and spiritual support. You may
    decide whether or not to participate in these activities. You may
    decide whether or not to perform tasks in or for the Medical Center.

-   As an inpatient or long-term care resident, you have the right to
    communicate freely and privately. You may have or refuse visitors.
    You will have access to public telephones. You may participate in
    civic rights.

-   As a long-term care resident, you can organize and take part in
    resident groups in the facility. Your family also can meet with the
    families of other residents.

-   In order to provide a safe treatment environment for all patients
    and staff, you are asked to respect other patients and staff, and to
    follow the facility's rules. Avoid unsafe acts that place others at
    risk for accidents or injuries. Please immediately report any
    condition you believe to be unsafe.

### Information Disclosure and Confidentiality

-   You will be given information about the health benefits that you can
    receive. The information will be provided in a way you can
    understand.

-   You will receive information about the costs of your care, if any,
    before you are treated. You are responsible for paying for your
    portion of the costs associated with your care.

-   You will be informed of any injuries caused by your medical care.
    You will be informed about how to request compensation for injuries.

-   Your medical record will be kept confidential. Information about you
    will not be released without your consent unless authorized by law
    (i.e., state public health reporting). You have the right to
    information in your medical record and may request a copy of your
    records. This will be provided except in rare situations where your
    VA physician feels the information will be harmful to you. In that
    situation, you have the right to have this discussed with you by
    your VA provider.

### Participation in Treatment Decisions

-   You, and any persons you choose, will be involved in all decisions
    about your care. You will be given information you can understand
    about the benefits and risks of treatment. You will be given other
    options. You can agree to or refuse treatment. Refusing treatment
    will not affect your rights to future care, but you have the
    responsibility to understand the possible results to your health. If
    you believe you cannot follow the treatment plan, you have a
    responsibility to notify the treatment team.

-   As an inpatient or long-term care resident, you will be provided any
    transportation necessary for your treatment plan.

-   You will be given, in writing, the name and professional title of
    the provider in charge of your care. As a partner in the health care
    process, you have the right to be involved in choosing your
    provider. You will be educated about your role and responsibilities
    as a patient. This includes care at the end of life.

-   Tell your provider about your current condition, medicines including
    over the counter and herbals, and medical history. Also, share any
    other information that affects your health. You should ask questions
    when you don't understand something about your care. This will help
    in providing you the best care possible.

-   You have the right to have your pain assessed and to receive
    treatment to manage your pain. You and your treatment team will
    develop a pain management plan together. You are expected to help
    the treatment team by telling them if you have pain and if the
    treatment is working.

-   You have the right to choose whether or not you will participate in
    any research project. Any research will be clearly identified.
    Potential risks of the research will be identified and there will be
    no pressure on you to participate.

-   You will be included in resolving any ethical issues about your
    care. You may consult with the Medical Center's Ethics Committee
    and/or other staff knowledgeable about health care ethics.

-   If you or the Medical Center believes that you have been neglected,
    abused, or exploited, you will receive help.

### Complaints

-   You are encouraged and expected to seek help from your treatment
    team and/or a patient advocate if you have problems or complaints.
    You will be given understandable information about the complaint
    process available to you. You may complain verbally or in writing,
    without fear of retaliation.

# Patient Education Resource Center

# 

Do you need information about that new prescription your doctor gave you
or want to find out more about melanoma, myopia, or migraines? The
MEDVAMC has a Patient Education Resource Center (PERC) that offers
health books, journals, handouts, and videos on numerous medical
conditions. Internet access is also available to find up-to-the-minute
health data. Veterans and their families are encouraged to stop by the
Patient Education Resource Center located in room 4A-400. The library
staff will put together a packet of information for you on any medical
or health topic you are interested in. The staff is trained in providing
consumer health information and medical reference. If you aren't able to
visit the PERC, they will send health information to veterans using
regular mail, E-mail, or fax. Bedside delivery is available to inpatient
veterans. The PERC is open 8 a.m. to 4:30 p.m., Monday through Friday.
Call the library at (713) 794-7856 to make a request. An answering
machine will take your request after normal business hours.

# Discharge from the Hospital

The doctors, nurses, social workers and other health care professionals
on your unit will plan your discharge with you. If you have any special
concerns about leaving the medical center, please let them know. If you
need a "return to work statement," please discuss this with your
physician before leaving the medical center. You and/or your family
member will need to pick up your discharge medications and supplies
before you leave. Your physician and nurse will provide you with
information regarding your discharge and answer any other questions you
may have.

**The following information is important in preparing to be
discharged:**

-   Understand your diagnosis

-   Know how to use your equipment for therapy or treatments

-   Understand how to manage your pain

-   Recognize the limitations of your physical activity that, possibly
    short term, may include lifestyle changes

-   Know what your diet should be, the types of food you can and can't
    eat

-   Understand the procedures for doing your post discharge treatments

-   Know what symptoms to report after discharge to your physician or
    health care contact at MEDVAMC

-   Understand your medications, including purpose, when and how to take
    medication, side effects and any special instructions

-   Know what activities that may improve or worsen your condition

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-   Know some resources in your community for follow-up care when
    appropriate

**Also, be sure you have:**

-   A friend or family member who knows how to help you with your care
    at home.

-   Transportation arranged to get home and to return for appointments.

-   Supplies/equipment you will need at home.

-   Medications you are to take home and instruc­tions about how to get
    your medications refilled.

-   A clinic appointment if your doctor wants you to return for a
    follow-up.

-   Withdraw any funds you have on deposit with the Agent Cashier during
    the operating hours, 8 a.m. to 4:00 p.m., Monday through Friday.

Remember, it is a federal crime to take VA property. We ask for your
assistance to assure that VA property is not removed from the Michael E.
DeBakey VA Medical Center. The cost of replacing lost or stolen VA
property reduces the amount of money we have for high quality medical
care.

# Mental Health Services 

# 

The Mental Health Care Line offers comprehensive inpatient and
outpatient services for veterans with mental health needs. Referral to
any of the mental health programs described below is done through the
Psychiatric Evaluation and Admission Clinic (PEAC). The hours are 8 a.m.
to 4:30 p.m., Monday through Friday. The PEAC telephone number is (713)
794-7101. For mental health emergencies after hours, please call the
MEDVAMC Operator at (713) 791-1414 and ask for the psychiatrist on call.

**Comprehensive Mental Health Program (CMHP)**

The Comprehensive Mental Health Program (CMHP) provides comprehensive
treatment to veterans with serious and persistent mental illness. This
program treats patients with a variety of diagnoses, which include, but
are not limited to psychotic disorders, mood disorders, and behavioral
problems associated with dementia disorders. Family involvement is
strongly encouraged since symptoms of these illnesses greatly influence
family life. The CMH Program is a flexible program that allows veterans
to enter the part of the program best designed to serve their individual
needs.

**Trauma Recovery Program (TRP)**

The Trauma Recovery Program (TRP) offers comprehensive treatment to
veterans with a diagnosis of posttraumatic stress disorder (PTSD) or a
related disorder. This program provides a wide range of services to help
veterans better manage their symptoms. TRP uses a team approach because
bringing together professionals from psychiatry, nursing, social work,
psychology, and other disciplines allows the program to better assess,
plan for, and treat veterans seeking assistance.

**Substance Dependence & Vocational Rehabilitation Program (SDVR)**

The Substance Dependence & Vocational Rehabilitation Program has two
sections, the Substance Dependence Rehabilitation Section and the
Vocational Rehabilitation Section.

The Substance Dependence Rehabilitation Section (SDRS) assists veterans
recovery from drug and alcohol dependence through comprehensive
treatment which may include detoxification, case management, addiction
education, relapse prevention skill training, support groups, urine,
drug and alcohol screens, social work services, health screening,
referrals for medical care and/or vocational rehabilitation, psychiatric
assessment and care, grief , sober seniors, women's support groups, and
certificates of successful completion. Levels of care include partial
hospitalization; day and night-time schedules for low intensity and
aftercare, and alumni groups. Specialty opiate replacement (often
Methadone) treatment is provided by the opiate treatment team.

The Vocational Rehabilitation Section (VRS) is committed to assisting
veterans with psychiatric or physical disabilities reach their highest
level of vocational productivity. The program helps veterans referred by
their Mental Health Care Line or rehabilitation team by providing
vocational counseling, work therapy, job readiness training, job search,
referrals to community resources including the Texas Work Source and the
Department of Rehabilitative and Assistive Services (formerly TRC, the
Texas Rehabilitation Commission), and Vocational Rehabilitation &
Employment (VR & E) at the VA Regional Office. Supported Employment
services are available to veterans with severe mental illnesses.

### Health Care for Homeless Veterans Program (HCHV)

This program actively seeks homeless veterans in the community,
evaluates their physical and mental health needs, and links them with VA
and community services. The program gives special emphasis to the needs
of the homeless chronically mentally ill, and provides supportive
housing options for eligible veterans.

### Services for Women Veterans

All the programs above serve women veterans as well as men. In addition,
our facility provides special mental health services for women including
a Women's Therapy Group and a Women's Behavioral Health Liaison within
the MEDVAMC Women's Center that provides psychiatric evaluation and
treatment. The Women Veterans Coordinators at the Veterans Outreach
Centers also offer a Sexual Trauma Counseling Program (aided by the
Trauma Recovery Program) and individual, group, and family counseling.

**Legal Clinic**

The MEDVAMC offers access to free or low cost legal services for
veterans.  The MEDVAMC has partnered with the Houston Volunteer Lawyer's
Program (HVLP) to provide a once a week, on-site Legal Clinic every
Friday from 2:30 -- 5 p m.  Volunteer attorneys from the various legal
firms provide legal assistance or counseling to veterans at the
MEDVAMC/HVLP Legal Advice Clinic.  This is done by appointment only to
qualifying veterans. See the Social Worker located in your Clinic or
Unit for a referral. Once your referral is received by HVLP staff, you
will be contacted with an appointment date and time.  Services offered
include:

-   Divorce

-   Child Support

-   Custody/Guardianship

-   Wills/Probate

-   Incapacity Planning

-   Consumer/Contracts

-   Landlord/Tenant

-   Property

-   Chapter 7 Bankruptcies

-   Veteran's Disability claims

-   Social Security issues

-   Immigration Law

If you have a legal issue not listed above, you will still be referred
to speak with an attorney.

**Support Groups**

**Alcoholics Anonymous (AA)**

This group meets every Wednesday, 7 p.m., Room 6C-105. Contact Person:
Billy M. (Bo) Cook, (713) 791-1414, ext. 6987.

### Alzheimer's/Dementia Caregiver's Support Group

This group meets the third Tuesday of each month, 5 -- 6 p.m., in Room
1C-270. Contact group facilitator: Yvonne S. Mack, (713) 791-1414, ext.
4082.

**Amputee Support Group**

This group meets on the 4th Wednesday of each month, 3 p.m. in Nursing
Unit 2A Dining Room. For more information, contact group facilitators
Betty Baer, OTR at (713) 794-7793 or Stacy Flynn at (713) 791-1414, ext.
4441.

**Better Breather's Club**

The group meets the last Wednesday of every month, 1:30 p.m. in Room
3C-371, Home Oxygen Clinic. Group facilitator: Paula Denman, (713)
794-8979

### Breast Cancer Support Group

This group meets the last Tuesday of each month, 12 p.m., in the Cancer
Center Conference Room, 4C-345. Contact group facilitators: Magdalena
Ramirez, LCSW, (713) 791-1414, ext. 5287 or Shirley LaDay Smith, RN,
MSN, (713) 794-7926.

**Cancer Support Group**

The group meets the second Tuesday of every month, 2-3 p.m. in the
Cancer Center Family Room, 4C-365. Group facilitators: Maria
Lozano-Vasquez, LMSW, (713) 791-1414, ext. 5273 and Chaplain Douglas
Ensminger, D.Min., (713) 794-7200

**Depression and Bipolar Support Group**

This group meets every Monday, 8:30 -- 10 a.m., in Room 6B-111. Contact
(713) 600-1131 for more information.

**Fibromylgia Education/Support Group (Restricted membership---Call Dr.
Tan for information)**

The group meets every Monday, 10 a.m. and 11:30 a.m., in Room 5C-215.
Group facilitator:  Gabriel Tan, PhD, ABPP (713) 794-8794

### Hepatitis C Support Group

The group meets the first Friday of every month, 1:30 -- 2:30 p.m. in
Primecare Clinic 5 (NASA). Group facilitators: Garfield Norris, (713)
791-1414 ext. 6189 and Jodi M. Francis, RN, ext. 3394 or 3656.

**HIV Support/Educational Group**

The group meets every Tuesday, 2 p.m. in Clinic 4, Room 1A-442. Group
facilitator: Kathy Molitor, (713) 791-1414, ext. 6177 and Belinda
Rainer, ext. 5292

**Mended Hearts Support Group**

This group meets on the 3^rd^ Thursday of each month, 11 a.m. -- 12:00
p.m., in Nursing Unit 2A Dining Room. Contact group facilitators
Patricia Suarez, LCSW at (713) 791-1414, ext. 6101 or Rosa Lane-Smith at
(713) 791-1414, ext. 4034.

**Pain Coping Skills Training Group**

The group meets every Tuesday, 1 p.m., in Room 5C-215. Group
facilitator:  Gabriel Tan, PhD., ABPP (713) 794-8794

**Pain Education Group**

The group meets every Wednesday, 2 p.m. in Room 5C-215. Group
facilitator:  Gabriel Tan, PhD, ABPP (713) 794-8794

**Pain Relaxation Training Group**

The group meets every Wednesday, 1 p.m., in Room 5C-215. Group
facilitator: Gabriel Tan, PhD, ABPP (713) 794-8794

**Parkinson\'s Disease Education/Support Group**

Contact group facilitators: Naomi Nelson, RN, Ph.D., (713) 794-8938 or
Lisa Whipple, LCSW, (713) 794-7951 for a monthly schedule and meeting
location.

### 

### Prostate Cancer Support Group

The group meets the third Wednesday of every month, 10 -- 11 a.m., in
the Cancer Center Conference Room, 4C-345. Group facilitator: Tonjala
Seals, (713) 791-1414 ext. 6227

**Stroke Support Group**

This group meets on the 3^rd^ Tuesday of each month, 3 -- 4 p.m., in the
Nursing Unit 2A Dining Room. Contact group facilitators Kathryn Kertz,
OTR at (713) 791-1414, ext. 4192 or Laura Lawhon, KTR at (713) 791-1414,
ext. 4241 or Lisa Whipple, LCSW, at (713) 794-7951.

**Vet to Vet Support Group**

This peer education and support group meets every Wednesday, 6 -- 7
p.m., in Room 6B-117 and every Thursday, 9 -- 10 a.m., in Room 6B-117
and 11 a.m. -- noon in Room 6C-166.   For more information, contact Dr.
Sara Allison at (713) 791-1414 ext. 6729 or Dr. Cristy Gamez-Galka at
(713) 791-1414 ext. 4378.

Important VA Telephone Numbers and Contact Information

######## 

######## Michael E. DeBakey VA Medical Center

2002 Holcombe Blvd., Houston, TX 77030

\(713\) 791-1414 or toll free 1 (800) 553-2278

[www.houston.med.va.gov](http://www.houston.med.va.gov/)

### Galveston Community Based Outpatient Clinic

6115 Avenue L, Corner 61^st^ & L

Galveston, TX 77551

\(409\) 741-0256 or

*toll free* 1 (800) 310-5001

**Texas City Community Based Outpatient Clinic**

9300 Emmett F. Lowry Expressway

Texas City, TX 77591

\(409\) 986-1129 or

*toll free* 1 (800) 310-5001

**Conroe Community Based Outpatient Clinic**

800 Riverwood Court

Conroe, TX 77304

\(936\) 522-4000

*toll free* 1 (800) 553-2278, ext. 1979

### Pharmacy

Refills: (713) 794-7648 or *toll free* 1 (800) 454-1062

Helpline: (713) 794-7653 M -- F 8 a.m. -- 4:30 p.m.

### Automated Appointment Information

\(713\) 794-7648 or *toll free* 1 (800) 454-1062

### VA Eligibility and Enrollment

\(713\) 794-7288 or www.va.gov/elig

### VA Network Telecare Center

\(713\) 794-8985 or *toll free* 1 (800) 639-5137

The VA Network Telecare Center Hotline can assist you with a wide
variety of medical problems and concerns including symptom analysis,
medication questions, test results, appointments, and eligibility.

**Suicide Prevention Hotline**

1-800-273-TALK (8255) toll free

### Internet Medical Information

www.medlineplus.org

**Patient Education Resource Center (PERC)**

\(713\) 794-7856

### Medical Administrative Assistants (MAA)

Houston: (713) 791-1414, ext. 3808

Medical Administrative Assistants (MAA) handle such issues as the
transfer of patients, hazard surveillance, and manage emergency
situations after normal business hours.

### Veterans Affairs Regional Office

www.vba.va.gov

Main Number: toll free 1 (800) 827-1000

Compensation/Pension: toll free 1 (800) 827-1000

Home Loans: toll free 1 (888) 232-2571

Education: toll free 1 (888) 442-4551

Insurance: toll free 1 (800) 669-8477

Headstones and Markers: toll free 1 (800) 697-6947

### Houston National Cemetery

www.cem.va.gov

\(281\) 447-8686

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