I understand that the Physician/Physician Assistants/Nurse practitioners and I must act as a team to manage my health problems. I understand that I must be active perticipant in my health care. I understand that overweight, poor nutrition, smoking, drugs and alcohol increases the risk associated with my health problems and with their treeatment. I understand that it is important to take medication only as prescribed and the medication alone may not "fix" health problems. I understand that medication is only part of medical treatment. I understand that the practice of medicine, medical problems and the prescription of dangerous medication for the treatment of health problems carry a risk, some of which may be minor, but some of which can be serious. I agree that it is my responsibility to inform the Physician/Physician Assistants/Nurse practitioners of any and all medical conditions, legal and illegal drugs and personal habits, current, recent, and long past, because any of these can increase the risk assoiciated with my medical condition. The Physician/Physician Assistants/Nurse practitioners will explain the common risks and adverse effects of the treatment plans, medications, procedures that may be utilized. However although uncommon, serious and fatal outcomes are never impossible. I agree that it is my responsibility to ask questions to educate myself and not to consent to any treatment, procedure, medication until I am satisfied and my questions and concerns are addressed.

I agree that I will promptly inform the Physician/Physician Assistants/Nurse practitioners of any adverse effects associated with my treatment and/or medication prescribed. I understand that delay in reporting such adverse effects may increase the likelihood of a negative outcome. I agree that non-urgent health concerns are reported during normal business hours and that medication refills are not urgent. I understand that whenever my call is not answered, Morning Star Health Care Services, PA will return my call as soon as possible, in order of severity of my complains relative to those of other patients, and to the patient the Physician/Physician Assistants/Nurse practitioners may be examining or attending to at the time of my call.

I agree that if I am having chest pain, severe shortness of breath, a rapid decline in my health condition, or any medical emergency, I will, without delay have someone take me to the hospital or dial 911 for an ambulance. I understand that Physician/Physician Assistants/Nurse practitioners are concerned about my health and me. I agree to keep Morning Star Health Care Services, PA informed of my situation.