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Patient Registration Info


When you arrive to receive any sort of care at T.J. Samson Community Hospital, your first step will be the registration process. We work hard to expedite the registration process as efficiently as possible; however, we do ask that you arrive 15 minutes prior to your scheduled appointment to allow for registration. It is crucial that the staff collect pertinent information about you prior to administering services.


T.J. Samson offers pre-registration for patients who are interested in reducing their wait time at the hospital on the day of elective services. Pre-registration can be done in person or online. Online pre-registration must be completed 24 hours prior to service. For procedures scheduled for Mondays, online registration must be completed by noon of the preceding Friday. T.J. Samson Community Hospital is committed to maintaining patients' privacy. We have put in place appropriate physical, electronic and administrative procedures to safeguard and secure the information we collect from you. The information you transmit in your pre-registration form will be encrypted during transmission and we will only use the information you provide only to pre-register you for the appropriate service.

Fill out the pre-registration form

Advance directive

Advance care planning has been shown to significantly impact the quality and experience when a patient reaches life's final stages, yet these conversations are often difficult to have. Having early and ongoing advance care planning conversations provides direction to physicians and loved ones and significantly increases the likelihood that care will be delivered in accordance with the patient's wishes.

Learn more about Advance Directives in our Health Library.

You can make an advance directive by filling out a form. Make sure you read all instructions carefully to ensure that you include all required information and that your documents are witnessed properly.

You can download advance directive forms at:

Consult your doctor or an attorney to ensure that you are going through the correct steps to create an advance directive.

Canceling or changing an advance directive

Directives can be canceled or changed by you at any time. You should review your advance directives periodically to be sure they still reflect your wishes.

All changes should be signed and dated. Again, you may wish to consult your doctor or an attorney to be sure the changes comply with your state's laws. If the changes are substantial, you should complete a new document. Notify your agent and healthcare provider in writing of the changes.

What should your directive say?

Writing advance directives requires you to make some difficult decisions. According to the NHPCO, asking these questions can help:

  • Are there specific medical treatments you do not want?
  • Are there specific medical treatments you do want?
  • Would you want to receive treatments such as mechanical ventilation or tube feeding for a time, but have them stopped if there was no improvement in your condition?
  • Do want to receive these specific treatments no matter what your medical condition? Would you want to receive them on a trial basis?
  • If your heart stopped, under what conditions would you want doctors to use CPR to try to resuscitate you?

Remember, you don't need to give your agent a long list of specific directions. Because situations may occur that you did not anticipate, you need to talk with your agent about your values and your views on quality of life. That will give him or her adequate information to make care decisions for you.

However, if you have specific wishes or preferences, you should detail them in your directive.

If you don't have a directive

If you haven't created any advance directives, healthcare providers generally consult with the family to help make care decisions. The hospital's ethics committee may also be involved. A directive can spare your family members the stress of being forced to make difficult decisions when they are unsure of your wishes.

Once your directive is signed

Copies of your completed directives should be given to your doctor, your agent, your alternate agent, and any close relatives or friends who might be involved in your care. Your local hospital might also be willing to file your directives in case you are admitted in the future.

Living will

A Living Will gives you a voice in decisions about your medical care when you are unconscious or too ill to communicate. As long as you are able to express your own decisions, your Living Will will not be used and you can accept or refuse any medical treatment.

Living will packet (PDF)

Durable power of attorney for healthcare

You can also complete a durable power of attorney for healthcare. This type of advance directive allows you to appoint a person who will make medical care decisions for you if you are unable to do that yourself. Here you also can include instructions about any treatment you want or do not want.

Patient safety

At T.J. Samson Community Hospital, patient safety is always a priority. To truly be effective, however, our desire is that you and your family become part of our patient-safety team. One of the most critical components of this partnership will be to keep you informed and active in your care; therefore, we pledge the to following to each patient:

  • To provide you with information about your condition.
  • To make every effort to ensure you understand your diagnosis and treatment plan clearly, and know what to expect.
  • To inform you of any changes in your condition.
  • To encourage you to ask questions about any aspect of your care.