Smoking Waiver

1. I understand that smoking may be hazardous to my health and smoking while hospitalized is against medical advice.
2. I understand that if I choose to leave the patient unit that a family member or friend who is over 18 years old must accompany me.
3. I understand that I have the responsibility to inform my caregivers whenever I am leaving the patient unit and when I return.
4. I have been advised that when I leave the patient unit to smoke that I interrupt the hospital’s ability to provide continuous medical care and monitoring. Should a medical emergency occur while at the designated smoking area, or while en route to/from the smoking area, I understand that hospital employees may not be able to respond as quickly to my medical needs as if I were in my patient room or treatment area.
5. I have read the Oklahoma Surgical Hospital Non-Smoking Policy and Procedures and agree to comply with them.
6. I waive any claims that may arise from or be caused in whole or in part by my violation of the Non-Smoking Policy and Procedures.
7. I waive any claims that may arise from or be caused in whole or in part by my decision to leave the patient care area to smoke.
8. The foregoing waivers shall extend to Oklahoma Surgical Hospital and my physician, and to their respective officers, directors, agents and employees.

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