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October 2017 Brand Guidelines Jefferson Health | October 2017 | Jefferson.edu/Brand HOME OF SIDNEY KIMMEL MEDICAL COLLEGE

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Page 1: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

October 2017

Brand GuidelinesJefferson Health | October 2017 | Jefferson.edu/Brand

HOME OF SIDNEY KIMMEL MEDICAL COLLEGE

Page 2: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

October 2017

Contents

1. BRAND IDENTITY Brand Elements ...........................................1

Scale + Space ...............................................3

Color Formats ............................................. 4

Incorrect Use ................................................5

Donor Acknowledgment .......................... 6

Typography ...................................................7

Color Palette ............................................... 9

Imagery ...................................................... 10

2. BRAND APPLICATION Stationery ................................................... 12

Letterhead

Business Cards/Appointment Cards

Envelopes/Mailing Labels

Buck Slips/Note Pads

Forms ...........................................................17

Prescription Slips ...................................... 18

Page 3: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

1. Our Brand IdentityOur core brand elements set the foundation for the Jefferson Health visual identity system. This combination of elements — including logo, typography, color palette, imagery, illustration and other entity logos — helps us to powerfully and uniquely express the Jefferson personality. Used consistently, these elements help us to differentiate our brand in a highly competitive market and create preference in the hearts and minds of our audiences.

1

Page 4: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

StructureOur logos are the simplest, most immediate and recognizable representation of our brand. They combine nearly two centuries of Jefferson history with a contemporary look. Each communicates a confident and renewed energy that represents our future.

All Jefferson Health logos are composed of the symbol and a wordmark. This shared structure unifies us in the eyes of the consumer.

Registration NoticeThe ® or TM must always appear with the Jefferson logo file as supplied by Creative Services and should never be removed or altered.

Brand Elements

CLINICAL BRAND

symbol wordmark

logo

Page 5: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Lock-Up SizeA unified brand appearance is essential for our new modern look and feel. The use of consistent logo sizes on all communication materials will establish and maintain this objective. The size of the logo is based on a percentage of the electronic art file supplied by Creative Services.

The preferred logo size is 100%. This is the appropriate size for most hand-held items. On larger pieces, the logo may be used at 125%. No other sizes are permissible on printed pieces without approval from Creative Services.

Larger sizes may be used for banners and signage.

On especially small items, such as give-aways, the logo may be used as small as 60%. If the imprint area won’t allow for the minimum size logo, type may be used instead. Please see section of acceptable typeface options.

Clear SpaceTo uphold recognition and clear legibility of the logo, a minimum amount of clear space based on ½ height of the symbol must be left around the logo. See the diagram at right for specific guidelines for clear space.

This area must be maintained as the protected area between the logo and all other elements, including: type, busy photography, illustrations, page trim, color breaks, etc.

Jefferson department, program, and entity names must not be placed in proximity to the logo so as to suggest that they are part of the logo. If necessary to include, these names must be completely separate from the logo.

The name in the logo must never be repeated in the headline or other prominent feature of the piece.

The Jefferson logo is a legally owned trademark and cannot be used with non-Jefferson logos without prior approval. Please visit Creative.Jefferson.edu to request approval.

Scale + Space

½ the symbol (head) height

100% (preferred size)

LOCK-UP SIZE

CLEAR SPACE

Because all Jefferson Health logos share the same symbol, the same Clear Space guidelines apply to all. See examples.

60% (minimum size)

Page 6: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Consistent Logo VisibilityPeople tend to notice visuals before they ever read a word. That’s why it’s critical for our logo to always be used precisely in both positive and reverse forms. Select positive or reverse artwork for achieving the best contrast between the logo and background, regardless of background color. Backgrounds include not only printed or applied color, but also colored paper stock, plastics, fabrics or video.

The full color logo on a white background is the preferred version. When applying the logo to a PMS 282 background the full color negative (reverse) logo is preferred. 1 color version of the logo may be used only when reproduction methods will not allow for full color usage (e.g. silk-screen printing, embroidery and certain inter-office applications).

Color Formats

Full Color Preferred Positive

Full Color Preferred Reversed

1 Color PMS 282 (only for use on small-run spot color materials)

1 Color PMS 2915 (only for use on small-run spot color materials)

1 Color Black (only for use on small-run 1-color materials)

1 Color White (only for use on small-run spot color materials)

Color formats are the same for all Jefferson Health logos.

POSITIVE

NEGATIVE (REVERSED)

Page 7: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Visual identity is an important component of every successful brand. To preserve the integrity and the legal protection of the trademark, it’s critical that we all recognize and understand when an application is unacceptable. While not a complete list, the examples here are a sampling of logo misuses, which work against our brand building efforts. Under no circumstances are any of these examples acceptable in the marketplace.

Incorrect Use

DO NOT add department/program name, phone numbers or address.

NO DECAPITATION! Never separate the head symbol from the logo.

DO NOT use multiple logos together. Use the enterprise or appropriate flagship logo instead.

DO NOT use previous Jefferson logos

DO NOT use only the wordmark.

DO NOT create a new logo by using the symbol with other text.

DO NOT use the logo on backgrounds that do not provide proper contrast.

Center for Medical Treatment

Page 8: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

OverviewThe Sidney Kimmel Donor Acknowledgment Line is intended to promote and create awareness of Sidney Kimmel Medical College (SKMC), brand the nexus of Jefferson and SKMC and acknowledge the donor gift. All communication, in whatever form, of Jefferson shall include the line “Home of Sidney Kimmel Medical College.” The Line must be used in Enterprise, TJU and Jefferson Health level communications, with the message being that Jefferson is the home of Sidney Kimmel Medical College.

COMPLIANCE IS REQUIRED PER THE DONOR AGREEMENT.

ExemptionsThese Supporting Brands would not utilize this donor acknowledgment line: • Jane and Leonard Korman Respiratory Institute • Jefferson Health | Nemours duPont Pediatrics • Marcus Institute of Integrative Health • Rothman Institute at Jefferson • Sidney Kimmel Cancer Center • Vickie and Jack Farber Institute for Neuroscience

Some Examples of Implementation• printed and electronic communication • stationery • advertising • signage • websites

Kimmel Donor Acknowledgment Requirement

H O M E O F S I D N E Y K I M M E L M E D I C A L C O L L E G E

(R)EVOLUTION

JeffersonHealth.org

Transforming the patient experience and giving you accessible

and a­ ordable care — when and where you need it most.

Providing treatment options informed by some of the region’s most

experienced and renowned specialists — across 13 respected hospitals

and more than 50 outpatient and urgent care locations.

INTRODUCING

Je­ erson Cherry Hill Hospital | Je­ erson Stratford Hospital

Je­ erson Washington Township Hospital

NOW JOINING

Abington Hospital – Je­ erson Health | Abington – Lansdale Hospital – Je­ erson Health

Je­ erson Bucks Hospital | Je­ erson Frankford Hospital | Je­ erson Torresdale Hospital

Je­ erson Hospital for Neuroscience | Methodist Hospital – Je­ erson Health

Physicians Care Surgical Hospital | Rothman Orthopaedic Specialty Hospitals

Thomas Je­ erson University Hospital

KENNEDY HEALTH IS NOW JEFFERSON HEALTH

JeffConnect™ is Here for You 24/7

FREE to Employees and Their DependentsOn-Demand Doctor Visits via Your Computer or Mobile Device

Starting October 1 You and your dependents have FREE use of our new

JeffConnect On-Demand Virtual Care telehealth service

until December 31, 2015.

Available 24 Hours a Day/Seven Days a Week Schedule a JeffConnect On-Demand Virtual Care video

visit with a Jefferson doctor using your computer, tablet

or smartphone from anywhere within PA, NJ or DE.

The Fast, Convenient Way to See a Doctor Common uses for JeffConnect video visits include:

• Sinus infections • Urinary Tract Infections

• Bronchitis • Upset stomach

• Flu • Minor skin wounds

• Sore throat • Rashes

• Allergies

Register Now for Access to JeffConnect’s On-Demand Virtual Care

Download the free JeffConnect app today:

The screen to the right appears when you are in App Store, giving you the option to download the app.

Or use your computer to enroll at Jefferson.edu/JeffConnect

Get Started for Free

1. Employees who download and register with JeffConnect by December 31 will automatically be entered into a drawing to win a fitbit®, a wearable activity tracker designed to help you lead a healthier lifestyle. Download the app at:

2. Each time you or your dependents initiate a virtual visit, enter coupon code JeffFamily in order to have your fee waived until December 31, 2015.

3. If you are using a computer for your virtual visit, make sure your computer has a webcam so the doctor can see you during the call.

For employee FAQs about the service, visit the BING.

Get it on

CS 16-0452

Get it on

HOME OF SIDNEY KIMMEL MEDICAL COLLEGE

Page 9: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Typography: Primary

Museo SansThe typeface to be used expressly for Jefferson is Museo Sans. All text in publications, advertising, signage and other external communication materials should be set in Museo Sans. This typeface is modern and easy to read, and comes in a wide range of styles and weights, making it incredibly versatile.

Limited Use AlternateFor business communication (the body of a letter, spreadsheets, etc.) and on approved Jefferson templates, Trebuchet may be used. It is not for situations that require custom design. Trebuchet has been chosen because of its clarity both on-screen and in printed correspondence. It is widely available on both Mac and PC-based computers.

MUSEO SANS 100

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?MUSEO SANS 100 ITALIC

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?MUSEO SANS 300

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?MUSEO SANS 300 ITALIC

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?MUSEO SANS 500

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?MUSEO SANS 500 ITALIC

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?MUSEO SANS 700

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?MUSEO SANS 700 ITALIC

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?MUSEO SANS 900

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?MUSEO SANS 900 ITALIC

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?

Page 10: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Typography: Complementary

ITC CenturyThis complementary typeface is primarily used as accent and for body text on long passages. All weights and styles are approved for use.

Museo SlabThe display typeface Museo Slab contrasts and coordinates nicely with both Museo Sans and ITC Century, and may be used sparingly as an accent.

Limited Use Alternate SerifGeorgia may be used for business communications (the body of a letter, spreadsheets, etc.). It is not for situations that require custom design. Georgia has also been designed for clarity on computer monitors, even at small sizes. It is also well suited for laser-printed output. Like Trebuchet, it has been chosen for its wide availability on both Mac and PC-based computers.

ITC CENTURY LIGHT

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz 1234567890!@#$%^&*()_+?ITC CENTURY LIGHT ITALIC

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?ITC CENTURY BOOK

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?ITC CENTURY BOOK ITALIC

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?ITC CENTURY BOLD

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?ITC CENTURY BOLD ITALIC

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?ITC CENTURY ULTRA

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?ITC CENTURY ULTRA ITALIC

ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz1234567890!@#$%^&*()_+?

Page 11: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Color Palette

PMS 241 C33 M100 Y0 K0 R175 G31 B142

Hex af1f8e

PMS 250 C7 M28 Y0 K0

R230 G191 B218 Hex e6bfda

PMS 242 C33 M100 Y9 K45

R112 G0 B95 Hex 700052

PMS 319 C62 M0 Y20 K0 R77 G196 B207

Hex 4dc4cf

PMS 406 C5 M8 Y10 K16

R205 G198 B193 Hex cdc6c1

PMS 628 C20 M0 Y5 K0

R200 G233 B239 Hex c8e9ef

PMS 730 C30 M60 Y95 K16 R160 G103, B45

Hex a0672d

PMS 612 C7 M5 Y100 K22 R195 G182 B13

Hex c3b60d

PMS 410 C22 M33 Y27 K62

R98 G84 B84 Hex 625454

PMS 616 C10 M4 Y49 K6

R218 G214 B144 Hex dad690

PMS 5825 C22 M15 Y86 K55

R110 G107 B35 Hex 6e6b23

PMS 179 C0 M89 Y84 K0 R239 G68 B56

Hex ef4438

PMS 169 C0 M31 Y25 K0

R250 G188 B174 Hex fabcae

PMS 727 C13 M30 Y46 K0 R221 G179, B140

Hex ddb38d

PMS 130 C0 M35 Y100 K0 R252 G175 B23

Hex fcaf17

PMS 134 C0 M12 Y60 K0 R255 G221 B127

Hex ffdd7f

PMS 1205 C0 M2 Y28 K0

R255 G244 B195 Hex fff4c3

PMS 2727 C76 M50 Y0 K0 R70 G120 B188

Hex 4678bc

PMS 2706 C19 M13 Y0 K0

R201 G209 B235 Hex c9d1eb

PMS 656 C12 M6 3 K0

R221 G228 B236 Hex dde4ec

PMS 2915 C60 M10 Y5 K0 R89 G183 B223

Hex 59B7DF

PMS 282 C100 M90 Y25 K40

R1 G30 B64 Hex 152456

Jefferson Deep Blue Jefferson Bright Blue

Brand Foundation ColorsColor is a critical identifier of the new contemporary Jefferson. Inspired by our new vision, the overall theme of our colors is smart, energetic and vibrant.

The primary colors for our brand are Jefferson Dark Blue and Jefferson Bright Blue. Primary colors must be used in all communications and can be supported with neutral and/or accent colors.

Accent ColorsOur color palette allows for great flexibility. We chose these accent colors to bring life to the new Jefferson. These colors provide a vibrant, passionate and optimistic tonality when used in combination with the Jefferson Brand Foundation colrs.

Pantone®, CMYK, and RGB equivalents are specified here in order to maintain consistency across all Jefferson communications.

EmbroideryJEFFERSON DEEP BLUE Robison-Anton Super Brite® Polyester RA #122: 5739 Blue Ribbon or Madeira Polyneon 1967 Dark Denim

JEFFERSON BRIGHT BLUE Robison-Anton Super Brite® Polyester RA #122: 9039 Blue Splendor or Madeira Polyneon 1871 Porcelain Blue

ACCENT COLORS

BRAND FOUNDATION COLORS NEUTRAL COLORS

Page 12: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

October 2017

Imagery: Photography

Overall Tone and FeelPhotography serves as a powerful, emotional attachment to our audience. It should be spontaneous, dynamic, active, optimistic, warm, bright, spirited and naturally lit when possible. When appropriate, nature should be used to capture our spirit of growth, openness and optimism. Empty public spaces should not be shown.

Diversity and InclusionEvery attempt must be made to reflect the rich diversity of our students, staff and the communities we serve.

Dynamic MovementJefferson Health is an organization in perpetual motion. For this reason, our photos should always be active and engaging. By using a motion blur effect where appropriate, we highlight our positive energy and our progressive thinking. Images that show empty public spaces should never be used.

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Page 13: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Imagery: Illustration

When medical illustrations are used, they should support that Jefferson is at the forefront of medical technology by being clear, dynamic and cutting-edge.

For custom illustrations, contact: Medical Media Services jeffline.tju.edu/MMS 215-503-7841

Creative Services Creative.Jefferson.edu

What To AvoidIllustration should be used for diagrams and medical explanation. It should never be substituted for photography. Cartoon-like or poor quality graphics, inconsistent styles, and “spot” illustrations are not appropriate.

Page 14: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

2.Our Brand in Action

12

Page 15: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Stationery: Letterhead

Home of Sidney Kimmel medical college

John Smith, MDDirector, Medicine Programs Department of Medicine

1200 Old York Road Abington, PA 19001T 215-481-2000F [email protected] abingtonhealth.org

Minimal and modern, our letterhead is formatted as shown in the example at right. To ensure consistency in our branding, Jefferson stationery items can only be ordered via the link below, and may not be recreated, produced or printed by any other means. To order, please visit Creative.Jefferson.edu.

The Sidney Kimmel Donor Acknowledgment line will automatically be included when appropriate.

Page 16: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Stationery: Business/Appointment Cards

Minimal and modern, our business cards are formatted as shown in the examples at right. To ensure brand consistency, Jefferson stationery items can only be ordered via the link below, and may not be recreated, produced or printed by any other means. To order, please visit Creative.Jefferson.edu.

The Sidney Kimmel Donor Acknowledgment line will automatically be included when appropriate.

Home of Sidney Kimmel medical college

John Smith, MDDirector, Medical Programs Department of Medicine

1200 Old York Road, Abington, PA 19001T 215-481-2000 F [email protected] abingtonhealth.org

NameTitle/Department

123 Street Avenue, Suite 456 Your City, PA 12345T 123-456-7890 F [email protected] Jefferson.edu

NameTitle/Department

123 Street Avenue, Suite 456 Your City, PA 12345T 123-456-7890 F [email protected] Jefferson.edu

123 Street Avenue Suite 456 Your City, PA 12345T 123-456-7890 F 123-456-7890

4567 Road Highway Suite 456 Different City, PA 34567T 223-456-7891 F 123-456-7892

Business Card

Appointment Card Front

Appointment Card Back

☐ M ☐ T ☐ W ☐ TH ☐ F ☐ S

APPT DATE APPT TIME

Please telephone one day in advance if you will be unable to keep the appointment.

Page 17: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Stationery: Envelopes/Mailing Labels

Minimal and modern, our envelopes and mailing labels are formatted as shown in the examples at right. To ensure consistency of our brand, Jefferson stationery items can only be ordered via the link below, and may not be recreated, produced or printed by any other means. To order, please visit Creative.Jefferson.edu.

Department Name 123 Street Avenue, Suite 456 Your City, PA 12345

Department Name 123 Street Avenue, Suite 456 Your City, PA 12345

Department Name 123 Street Avenue, Suite 456 Your City, PA 12345

Page 18: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Stationery: Buck Slips/Note Pads

Minimal and modern, our letterhead is formatted as shown at right. To ensure consistency in our branding, Jefferson stationery items can only be ordered via the link below, and may not be recreated, produced or printed by any other means. To order, please visit Creative.Jefferson.edu.

The Sidney Kimmel Donor Acknowledgment line will automatically be included when appropriate.

123 Street Avenue, Suite 456 Your City, PA 12345T 123-456-7890 F 123-456-7890 [email protected]

NameTitle/Department

To Date

Page 19: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Forms

Forms often have specific technical requirements that make their standardization difficult. Nonetheless, every effort should be made to create a common look for forms. A sample layout for forms is shown here.

For new or revised forms, please visit Creative.Jefferson.edu. Medical Records should be submitted to the Director of Health Information Management, 2130 Gibbon Building. To search the Jefferson Forms Library, visit: tjuh.jeffersonhospital.org/forms

Procedure Consent Form

*015600.0609*

MR#

Acct#

Name

DOB

COMPLETE OR IMPRINT WITH ADDRESS-O-PLATE

FORM 0156-00 (REV. 06/09) PAGE 1 OF 2

IMP

OR

TA

NT

: DO

NO

T W

RIT

E I

N M

AR

GIN

S

1. I hereby authorize Dr.(s) to perform upon

(Patient Name) the following surgical and/or medical procedures: (State specific nature of the procedure(s) to be performed and describe its benefits

and likelihood of achieving treatment goals)

2. I authorize the following device(s) to be implanted during the above named procedure(s). (Describe type of device/implant):

3. I understand that the procedure(s) will be performed at Thomas Jefferson University Hospitals, Inc. by or under the supervision of the attending physician. He/She is authorized to utilize the services of such other health care professionals and trainees, including physicians and members of the house staff, as he/she deems necessary or advisable in the performance of the procedure(s) listed above. I understand that Thomas Jefferson University Hospital is an academic medical center and that students and trainees may be participating in my care, under appropriate supervision.

4. I understand that, during the course of the surgical procedure(s), unforeseen conditions may be revealed that necessitate an extension of the original procedure(s) or different procedures than those set forth in Paragraph 1 above. I authorize and request that the above-named surgeon, his/her assistants, or his/her designees perform such surgical procedures as are necessary and desirable for my medical condition in the exercise of their professional judgment.

5. I acknowledge that the available anesthesia options have been explained to me along with their respective benefits and risks. I consent to the administration of the following type of anesthesia/sedation to be applied by or under the direction of my physician:

M Moderate Sedation (“Conscious Sedation”) M Local Anesthesia

6. If my physician determines that other anesthesia is necessary, a physician member of the Anesthesiology Department will obtain consent for any additional anesthesia required. I understand that during the course of the surgical procedure(s), unforeseen changes in my condition may arise which may necessitate a change in the care being provided to me. Should such an instance arise, I permit the anesthesiologist to provide treatment which he/she deems necessary for my safety and well being.

7. Dr. has fully explained to me the nature and the purpose of the procedure(s), the benefits, possible alternative methods of diagnosis or treatment, the risks involved, the possible complications, the

foreseeable consequences of the procedure(s), the likelihood of achieving treatment goals, and the possible results of non-treatment. I acknowledge that no guarantee or assurance has been made as to the results of the procedure.

Specifically, the risks identified to me include, but are not limited to, the following:

Procedure Consent Form

*015600.0609*

MR#

Acct#

Name

DOB

COMPLETE OR IMPRINT WITH ADDRESS-O-PLATE

FORM 0156-00 (REV. 06/09) PAGE 1 OF 2IM

PO

RT

AN

T: D

O N

OT

WR

ITE

IN

MA

RG

INS

1. I hereby authorize Dr.(s) to perform upon

(Patient Name) the following surgical and/or medical procedures: (State specific nature of the procedure(s) to be performed and describe its benefits

and likelihood of achieving treatment goals)

2. I authorize the following device(s) to be implanted during the above named procedure(s). (Describe type of device/implant):

3. I understand that the procedure(s) will be performed at Thomas Jefferson University Hospitals, Inc. by or under the supervision of the attending physician. He/She is authorized to utilize the services of such other health care professionals and trainees, including physicians and members of the house staff, as he/she deems necessary or advisable in the performance of the procedure(s) listed above. I understand that Thomas Jefferson University Hospital is an academic medical center and that students and trainees may be participating in my care, under appropriate supervision.

4. I understand that, during the course of the surgical procedure(s), unforeseen conditions may be revealed that necessitate an extension of the original procedure(s) or different procedures than those set forth in Paragraph 1 above. I authorize and request that the above-named surgeon, his/her assistants, or his/her designees perform such surgical procedures as are necessary and desirable for my medical condition in the exercise of their professional judgment.

5. I acknowledge that the available anesthesia options have been explained to me along with their respective benefits and risks. I consent to the administration of the following type of anesthesia/sedation to be applied by or under the direction of my physician:

M Moderate Sedation (“Conscious Sedation”) M Local Anesthesia

6. If my physician determines that other anesthesia is necessary, a physician member of the Anesthesiology Department will obtain consent for any additional anesthesia required. I understand that during the course of the surgical procedure(s), unforeseen changes in my condition may arise which may necessitate a change in the care being provided to me. Should such an instance arise, I permit the anesthesiologist to provide treatment which he/she deems necessary for my safety and well being.

7. Dr. has fully explained to me the nature and the purpose of the procedure(s), the benefits, possible alternative methods of diagnosis or treatment, the risks involved, the possible complications, the

foreseeable consequences of the procedure(s), the likelihood of achieving treatment goals, and the possible results of non-treatment. I acknowledge that no guarantee or assurance has been made as to the results of the procedure.

Specifically, the risks identified to me include, but are not limited to, the following:

(REV. 06/15)

Page 20: Brand Guidelines - Creative Servicescreative.jefferson.edu/...Health-Brand-Guidelines.pdf · successful brand. To preserve the integrity and the legal protection of the trademark,

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October 2017

Prescription Slips

There are three approved prescription form layouts: single prescription (vertical or horizontal format) or a large prescription (vertical format only). The physician name(s), address and phone number should be preprinted on the form. The information in the bottom half of the form is required by law and cannot be altered. Department prescription forms (those without specific physician names listed) must carry the line “NOT VALID FOR SCHEDULE II

CONTROLLED SUBSTANCES.” • Medications cannot be preprinted. • Pads are printed in black ink only. • Nurse Practitioners (CRNP) must have a collaborating

physician’s name on the prescription form.• The physician’s license number must be listed with the

physician name. If not listed, the prescription form must carry the line “NOT VALID FOR SCHEDULE II CONTROLLED SUBSTANCES.”

To order, please visit Creative.Jefferson.edu.

Department/Practice Name

123 Street Avenue, Suite 456 Your City, PA 12345T 123-456-7890 F 123-456-7890 [email protected]

Indication ☐ Place Indication on Prescription Label

Refill Times Substitution Permissible Unless Indicated

Physician Signature

Ext/Beeper (where physician can be reached)

DEA #

Physician Name

MD-XXXXXX-L NPI-XXXXXXXXXX

NAME DOB

ADDRESS DATE

IN ORDER FOR A BRAND NAME PRODUCT

TO BE DISPENSED, THE PRESCRIBER MUST

HANDWRITE “BRAND NECESSARY” OR “BRAND

MEDICALLY NECESSARY” IN THE SPACE BELOW.