Dear Patient,

Surgery was discussed during your visit today. We understand that this can be an overwhelming and confusing time for some people. We have compiled this packet of information to help make this a seamless process and to answer any questions that you may have. Please read the information and keep it on hand, as it contains important phone numbers and details regarding your upcoming surgery. We are always happy to answer any questions you may have so please feel free to contact us at any time.

Dr. Erik Nilssen & Dr. Sonya Ahmed

850-435-4800


Frequently Asked Questions

What day is my surgery scheduled for? We will typically give you a surgery date at the time of your visit. Other times we allow you a few days to look at your schedule and to think about what surgical date works best for you. In this case, please contact our office at (850) 435-4800 and press option 4 or 5 in order to schedule surgery. If you get the voicemail, please leave a detailed message with your name, number, and date of birth and your message will be returned as soon as possible. Our normal surgical days are Tuesday and Wednesday. Dr. Nilssen performs surgery at the Andrews Institute Ambulatory Surgery Center, Cornerstone Surgicare Center in Pensacola, and Gulf Breeze Hospital. What time is my surgery? The operating room will contact you 24 to 48 hours prior to your surgery date to give you the specific time to arrive and up to a week prior to give you more information. Please be aware that surgery is an unpredictable experience and your time may be sooner or later than your scheduled time. We make every effort to stay on time, but unexpected delays do occur. Consider bringing some reading material, a crossword puzzle etc. to help make the time go by faster. On the day of surgery, the operating room may also call you to come in earlier if things are moving more quickly than planned. Please be available by phone on your surgical day in case we need to contact you. We respectfully ask for your patience the day of surgery. What about my insurance? You will receive bills from three separate

What time is my surgery? The operating room will contact you 24 to 48 hours prior to your surgery date to give you the specific time to arrive and up to a week prior to give you more information. Please be aware that surgery is an unpredictable experience and your time may be sooner or later than your scheduled time. We make every effort to stay on time, but unexpected delays do occur. Consider bringing some reading material, a crossword puzzle etc. to help make the time go by faster. On the day of surgery, the operating room may also call you to come in earlier if things are moving more quickly than planned. Please be available by phone on your surgical day in case we need to contact you. We respectfully ask for your patience the day of surgery. What about my insurance? You will receive bills from three separate

What about my insurance? You will receive bills from three separate billing Departments: the physician, the facility, and anesthesia. Both our office and the surgical facility will verify your insurance benefits prior to surgery. If there are any problems or concerns you will be contacted. Please understand that your insurance company requires us to collect any deductible and copayment before the date of surgery. Payment will be expected prior to surgery or your surgical case may be canceled or postponed. What can help me recover faster? After your surgery, our office will give you detailed postoperative instructions. It is critical that these instructions are followed to ensure success. What about short term disability or work notes? You may have short term

What can help me recover faster? After your surgery, our office will give you detailed postoperative instructions. It is critical that these instructions are followed to ensure success. What about short term disability or work notes? You may have short term

What about short term disability or work notes? You may have short term disability, Family Medical Leave Act or other paperwork needing to be completed following surgery for your employer. If so, please provide all forms prior to surgery. There is at least a 5-7 day time period to complete all paperwork. Also, there is a one-time 25.00 processing fee due before the return of paperwork. This may be paid at the time of drop off, by phone or at pick up. If you would like these forms to be faxed or mailed, please let our office know. A self-addressed envelope is appreciated. Contact us at 850-916-8461 with any questions concerning work leave paperwork.

PATIENT INSTRUCTIONS PRIOR TO SURGERY

Please make sure that you have received, read and understand your patient acknowledgment forms and surgical consent forms. Please sign and return them to the office at least a week prior to surgery. If you have any questions about the surgery or the forms, do not sign the forms until your questions have been answered.

The pre-admission nurse will contact you prior to your surgery to discuss pre-admission orders. If you have not received that phone call, please contact them 24 hours before your procedure. If you are having surgery at the Andrews Institute Surgery Center, you may contact them at 850-916-8500. If your surgery is at Gulf Breeze Hospital, the number to call is 850-934-2080. At Cornerstone Surgicare, the number is (850) 912-6505.

The surgery schedule is determined by Dr. Nilssen the day before surgery. You should expect a phone call from the surgery department the afternoon before surgery giving you your expected arrival time. If you do not hear from the surgery center by 3:30pm the day before surgery, contact them for your arrival time.

Do not eat or drink anything after midnight the evening before surgery. This includes chewing gum, breath mints, water, coffee or other liquids. You may brush your teeth the morning of surgery.

Medications: Take blood pressure, heart, seizure, and asthma medication with less than a tablespoon of water as soon as you wake up the morning of your surgery. If you use an inhaler, please bring it with you. If you are on aspirin, aspirin products, blood thinners, MAO inhibitors or diet pills, please notify the pre-admission nurse immediately for instructions.

Insurance: Please bring your insurance card and picture ID with you on surgery day.

If there any changes in your medications or medical conditions that are not listed on your initial medical intake form, please let us know immediately so we can update your chart.

Do not take oral diabetic medication or insulin the day of surgery unless instructed to do so.

Shower the evening before surgery with an antibacterial soap or scrub. (Hibiclens or Chlorahexadine - both can be found in the first aid aisle of any drugstore.)

Do not shave the surgical site the night before surgery.

Remove any nail polish or acrylics from fingers and toenails.

Please note that the type of anesthesia you receive is a decision that is made between you and the anesthesiologist. Dr. Nilssen is not part of the administration or choice of anesthesia. Please discuss any concerns you have with the anesthesiologist. Make sure you are aware of the risks and complications associated with each type of anesthesia you are considering.

Leave all valuables and jewelry at home. Remove all body piercings.

If you require glasses or contacts in order to read, please bring a case for them. You will be reading and signing documents. Contacts must be removed before surgery.

Wear loose fitting clothes that will fit easily over bulky dressing and/or braces. Please wear cotton underwear.

A family member or friend over the age of 18 must accompany you the day of your surgery. They must be able to make decisions on your behalf, listen to postoperative instructions, and drive you home. They must remain on site during your surgery. Please make appropriate arrangements prior to your surgery date or your surgery may have to be canceled. There are no exceptions.

If you will be staying overnight in the hospital, you may bring a small bag packed with personal items for use after surgery.

Please notify our office immediately if you develop an infection, fever or rash/cut/abrasions to the limb we are operating on.

If you have been placed on any antibiotics 10 clays, prior to your surgery, please call us so we can reschedule. This protocol comes directly from the anesthesiologist.

If you develop a head cold close to your surgery then you will still be okay. If the symptoms are .in your chest, please call us so we can reschedule your surgery.

FAILURE TO COMPLY WITH THESE INSTRUCTIONS MAY RESULT IN THE CANCELLATION OF YOUR SURGERY.

PRE-OPERATIVE CLEARANCE INFORMATION

In order to ensure that you receive the best possible care during and after surgery, you may need to arrange for medical clearance prior to surgery from your primary care physician or cardiologist if any of the following medical conditions apply to you:

If you are over the age of 60 years old please make an appointment with your primary care physician to discuss the fact that you will be having surgery. If you are having surgery at Cornerstone Surgicare, you will have to have a blood work and an Electrocardiogram prior to your surgery.

If you have a previous history of heart problems please make an appointment with your cardiologist/primary care physician to see if an EKG is required for surgical clearance.

If you are diabetic or hypoglycemic please make an appointment with your treating physician to advise them of your plan to have surgery.

If you are on any type of blood thinners or have had blood clots or a pulmonary embolism in the past, please let us know. You will need clearance and advice from your treating physician. You will also need to discontinue certain medications 7 days prior to surgery.

You may be prescribed Arixtra, Fragmin or Lovenox after certain procedures. These medications are used to prevent blood clots and are injected once a day.

Any other medical problems or concerns should be addressed with the appropriate treating physician.

If you have any of the issues listed above, please be sure to have your treating physician fax a note stating you are cleared for surgery, along with any pre- and post- op recommendations, to the office @ 850-807-5209 (must dial 850).

INSURANCE QUESTIONS

As a courtesy to our patients, we will contact your insurance company regarding your upcoming surgery to see if prior authorization is required. In order to do this, we need your correct and current information.

Should there be any questions or problems concerning your insurance, our office will contact you.

Insurance carriers often have different requirements for different policies. We recommend that you contact your carrier since they may need additional information from you. They should be able to inform you of the following information, which you may find helpful.

  1. Verification of your benefits for surgery (80%, 90%, 100% etc.)
  2. Surgical co-payment
  3. Deductible (the amount and if any of the amount has been met for your current year)
  4. Answer any questions you may have regarding the payment of your upcoming surgery.

Please note that you will be billed separately for the following services (if they apply to you and your surgery): Dr. Nilssen, the assistant surgeon, the facility, the anesthesiologist, laboratory, physical therapy, and home health care.

You are responsible for understanding your insurance policy. It is a contract between you and your insurance company. We are not responsible for a lack of coverage or failure to pay by your insurance company. You are expected to pay your bill regardless of the insurance company's coverage.

DISCHARGE AND POST OPERATIVE ORDERS

Your first post-operative visit will be approximately 2 weeks following surgery. This appointment will be made for you and given to you the day of your procedure. All post­operative appointments will be in our cast room. You will be evaluated by Justin who is our Post-Operative and Cast Technician who will review your surgery details with Dr. Nilssen. When appointments are made for cast changes or suture removal, you may only be evaluated by Justin. We are here to help answer your questions and you can call (850) 435-4800 option 3.

Ambulatory: You will be non-weight bearing until your postoperative follow-up date. At that time Dr. Nilssen will determine your ambulatory status. (Plan to be non-weight bearing for at least 4-6 weeks). If you are not comfortable with crutches you may consider a Knee Walker or Knee Scooter. You can rent this device with Decubex at 800- 332-8239 to discuss rental fees, drop off and pick up.

Driving: You can begin driving once you are completely off pain medications and once you have been given the OK by the physician. We recommend you start in a parking lot to make sure you are able to have complete control of the vehicle before driving on the street.

Bathing: The surgical incision should be kept dry until your follow-up appointment in approximately 2 weeks. You may sponge bathe, use waterproof band-aids, or place a sealed plastic bag over the extremity to keep the surgical site dry.

Bracing: If you have been fitted with a brace or boot postoperatively; you must wear it at all times except while washing, changing clothes, or doing your physical therapy. Normally these items will be billed to you through our office or through Baptist Hospital/Andrews Institute Surgical Center. DO NOT ADJUST THE SETTINGS ON YOUR BRACE. You may loosen or adjust the tightness of the straps

Limb Elevation: Keeping the extremity elevated above the heart is essential. This is your best defense against swelling and blood clotting. Elevate the entire limb above the actual level of your heart.

Ice (Cryotherapy): Cryotherapy may be performed immediately following surgery. We recommend using ice bags at home. This method of using cold pack applications has been clinically proven to reduce pain and help control swelling after your surgery.

When Using an Ice Bag: Apply no longer than 20-30 minutes per session. You may repeat 4-5 times daily or as needed for a minimum of 5 days after your surgery.

CAUTION WHEN USING COLD THERAPY: Injuries can occur due to cold therapy. This can be caused by the temperature being too cold and/or leaving it on longer than the recommended time.

*USE OF ICE BAGS. NEVER PLACE ICE DIRECTLY ON SKIN

DO NOT USE COLD THERAPY IF YOU HAVE ANY OF THE FOLLOWING:

  1. History of cold injury or frost bite
  2. Local Infection
  3. Wound healing problems or circulation problems on the affected limb
  4. Neuropathy with decreased sensation over arms or legs
  5. Reynaud's, Buerger's, peripheral vascular disease, vasospastic disorders, sickle cell anemia, a hypercoagulable clotting disorder.

If you have any questions or concerns, please call our office.

Physical Therapy: In most cases, our surgical patients do not begin physical therapy for at least 6-8 weeks following surgery. You will be taught a simple home exercise program to begin after your 1st postoperative visit. You will be given a physical therapy prescription (if needed) at your 2nd or 3rd postoperative visit. At that time, we advise that you schedule your physical therapy to ensure no delays in starting your therapy. You need to bring the prescription, insurance card, and driver's license with you to your first therapy visit. Listed are several physical therapy locations in the southeast area. Please contact our office if you have any questions regarding your therapy or choice of location.

Understanding Surgery Center Facility Bill

Billing Process

Upon receiving the Insurance Company's determination of your claim, you will receive a bill which covers the use of the Surgery Center (facility) and any implants used. Your surgeon, as well as other health care professionals, will bill you separately for their services. These charges are not included in your facility fee. Although these charges may be covered by insurance, they are your responsibility, and you will need to make separate payment arrangements for them. In addition to your primary surgeon's bill, you may be billed for, but not limited to Anesthesia, Radiology Services with Radiologist, Pathology Services with Pathologist, and Laboratory Services.

Financial Policy/ Estimated Patient Responsibility

If you have medical insurance, our office will verify your benefits for you. After verification of benefits, we will contact you directly with your co-pay and deductible amounts which are due before surgery. Insurance companies require us to collect these co­pays and deductibles. Our facility accepts cash, checks, money orders and most major credit cards. If you haven't been contacted by our office regarding your co-pay or deductible, please call our office at least 5 days before your surgery date.

In the event, you are unable to meet your financial obligation or you do not have insurance, please contact our office before your scheduled procedure to discuss options.

Our office will file your insurance assignable claims as a courtesy. Insurance plans vary widely and can be affected by many issues. Some policies have specific requirements and if the requirements are not met, your insurance may not pay for your care. It is your responsibility to make certain all requirements have been met. Should you have any questions regarding your insurance coverage or requirements, please contact your insurance company directly.

The business office expects payment from most insurance companies within 45 to 60 days of filing the initial claim. We will work diligently on your behalf to monitor the status of your claim during this time. If we have difficulty collecting from your insurance company, we may ask for your assistance. Once all insurance payments have been received or if your insurance company does not respond with payment, you may become responsible for the balance due.

Customer Service

If you have questions about your bill, please call our business office at 850-916-8496. Representatives are available Monday through Friday from 8 a.m. to 4 p.m. Your calls are welcome. We will be able to help with your questions more quickly and accurately if you have your account number and bill available when you call.

IMPORTANT PHONE NUMBERS

Please be aware when calling our office that we may be in clinic seeing patients or in surgery and may not be able to answer your call immediately. We make every effort to get back to you as soon as possible. If you don't hear back from us in a timely manner, please call the main number and explain your situation. If you have an emergency please dial 911. Also, our website contains very useful information regarding the types of surgeries that we perform, along with interactive videos that you can view.

Dr. Nilssen Office:

Main Office/Clinic Line - 850-435-4800

Postoperative/Cast Technician (Justin) - 850-435-4800 opt. 3

Practice Coordinator (Evan) - 850-418-0187 cell

Practice Manager (James) - 850-418-0022 cell

Scheduler (Tara) - 850-435-4801

Medical Records/Front Desk (Libba)

Office Fax - 850-807-5209 (must dial 850)

Andrews Institute Surgery Center (AISC) - 850-916-8500

Gulf Breeze Hospital Main Line - 850-934-2000

Surgery Department - 850-934-2080

Cornerstone Surgicare Main Line - 850-912-6505

IMPORTANT INFORMATION ABOUT YOUR CARE AT HOME

Our sole purpose is to provide you with the best possible care while you are here with us and follow-up after your procedure while you are recovering at home.

Together with our team, you have elected to have a procedure performed on a lower extremity (knee, ankle or foot). After your procedure, you may be advised that you are to walk with crutches or a walking boot in order to facilitate with your healing. Crutches allow you to walk without bearing weight on the affected extremity.

In preparation for walking after surgery, please purchase and bring your crutches with you on the day of your surgery. This will ensure that you will be best prepared for walking and caring for yourself at home. If you have elected to use a knee scooter and have one, then you can keep it at home the day of surgery.

For your convenience, crutches can be purchased at the following locations if you do not own a pair (or are unable to borrow a pair from a friend or family member):

**If you are having surgery at ,Andrew's: Crutches are provided**

**If you are having surgery at Gulf Breeze Hospital or Cornerstone:

Crutches are not provided**

You can call your local pharmacy store or online purchase crutches

Please refer to Knee Scooter page if you would like to rent one.

You can call your insurance company to see if they will pay for one. If they will, you can call us to request a prescription.