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Patient Resources

Welcome Letter

Leigh Orthopedic Surgery Center

6201 E. Virginia Beach Blvd, Suite 200, Norfolk, VA 23502

Last updated: January 6, 2021

Welcome to Leigh Orthopedic Surgery Center (LOSC). Thank you for choosing us for your health care needs. We are committed to taking care of you and your family members in the most professional and safest way possible.

All of our staff here including, registered nurses, surgical technicians, surgical assistants, sterile processing technicians, service associates, administrative associates, inventory analyst, and our volunteers take great pride in living up to the commitments that are our mainstay. We strive to keep you safe, keep you informed and involved. We will treat you with respect, dignity and compassion. We will listen and respond to your concerns as we work together to meet your surgical needs.

As the Clinical Director of the Surgery Center, I am very proud to work with the staff in this facility. They are an exemplary group of people that are both professional and committed to the safety of our patients. I hope you will find this to be true in your experience here at LOSC.

If you would like to reach me for any reason, please feel free to ask any of the staff members to contact me, or you can call me at (757) 624-0728.

Sincerely,

Terani Perry, BSN, RN
Clinical Director, Leigh Orthopedic Surgery Center

Billing & Insurance

Billing and Insurance

Leigh Orthopedic Surgery Center

6201 E. Virginia Beach Blvd, Suite 200, Norfolk, VA 23502

Phone: 757-241-5405 Fax: 757-470-5827

Leigh Orthopedic Surgery Center works with all major insurance providers. Our staff will assist you in verifying what your insurance will cover. According to some insurance plans, patients are responsible for a co-pay made directly to the outpatient facility at the time of the surgery, we will notify all patients in advance of any co-pays that are due on the day of surgery. Leigh Orthopedic Surgery Center accepts, cash, check, and Visa and MasterCard credit cards.

We currently participate with the following insurance providers:

Aetna
Anthem, Anthem Healthkeepers, Anthem Medicare, Anthem FEP, and Anthem Healthkeepers Plus
Cigna
United Healthcare HMO and PPO, United Medicare and United Medicaid
Humana Commercial and Humana Gold
Medicare
Tricare and Tricare for Life
Optima PPO, HMO, Optima Medicare, and Optima Medicaid
Medcost

Patient Brochure

Leigh Orthopedic Surgery Center

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6201 E. Virginia Beach Blvd, Suite 200, Norfolk, VA 23502

Phone: 757-624-0700 Fax: 757-470-5827

Patient Information:

Welcome to Leigh Orthopedic Surgery Center, a facility designed and built to provide patients and surgeons the latest capabilities and amenities in outpatient surgical and procedural care. This brochure will answer your questions and provide you with information you need to make your outpatient surgery/procedure go smoothly.

Before Your Surgery:

A registered nurse will conduct a pre-admission interview by phone prior to your scheduled day of surgery. The nurse will review your medical history and your medication history with you, review your instructions, answer your questions and tell you what time to arrive at the center for your procedure.
The center is open between the hours of 6:30 am and 5:00pm for regular business hours; our doors open at 6:00 am for patient entry. If you have not heard from us by 2:00pm the day before your scheduled procedure, please call us at 757-624-0710.
In the event you need to cancel your scheduled surgery, please notify your physician’s office or the center at 757-624-0727.
Medication instructions for taking or withholding medicines, especially for blood pressure, diabetes, and/or seizures should be reviewed with your physician prior to the day of surgery.
If you become ill within a few days before your procedure, even with a mild cold or flu symptoms, notify your physician.
Transportation arrangements need to be made prior to the day of your procedure. You will NOT be allowed to drive after receiving general anesthesia or sedation. Your transportation arrangements should include someone to take you home AND be able to stay with you for 24 hours after your procedure. The driver must be present during the check-in process in order to proceed with the scheduled surgery time. Due to COVID-19 restrictions the driver will need to stay at the center during your procedure and wear a mask at all times unless otherwise instructed.

***DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT THE EVENING BEFORE YOUR SURGERY, UNLESS YOUR PHYSICIAN TELLS YOU OTHERWISE***

Day of Surgery:

Please bring your insurance cards, photo I.D. and co-pay’s that are due at time of service.
Wear loose fitting clothing, remove or leave your jewelry and all valuables at home.
Take all medications as instructed by your doctor with a small sip of water.
Arrive promptly at your scheduled time so you have adequate time for all necessary admission procedures.
A parent or legal guardian must accompany patients under 18 at the center during the entire visit. Legal guardians most provide proof of guardianship for medical treatment.
The nursing staff will offer family members periodic updates on your progress and recovery.

Recovery:

After your surgery we will move you to our post-anesthetic care unit and monitor you until you are ready for discharge. You will receive specific discharge instructions from your physician for your recovery at home. Also, you may receive a prescription for one or more medications to take during your recovery.

***SHOULD YOU EXPERIENCE ANY COMPLICATIONS WHILE AT HOME, PLEASE CONTACT YOUR PHYSICIAN’S OFFICE DIRECTLY***

Insurance and Co-Pays:

Leigh Orthopedic Surgery Center takes most major insurances. Our staff will assist you in verifying what your insurance will cover prior to the date of service, and we will notify all patients of any out-of-pocket expenses that are due on the day of surgery. Leigh Orthopedic Surgery Center accepts, cash, check and Visa and MasterCard credit cards.

Our Focus:

All of our staff here including, registered nurses, surgical technicians, surgical assistants, sterile processing technicians, service associates, administrative associates, inventory analyst, and our volunteers take great pride in living up to the commitments that are our mainstay. We strive to keep our patients safe, keep them informed and involved in the care they receive. We will treat you with respect, dignity, and compassion. We will always listen and respond to your concerns as we work together to meet your surgical needs.

Leigh Orthopedic Surgery Center is located at 6201 E. Virginia Beach Blvd, Suite 200, Norfolk, VA 23502. This state of the art facility is designed explicitly for outpatient surgical procedures.

Some of our comforts & conveniences include:

Free parking next to the building with handicapped and wheelchair accessibility
Covered carport area for easy drop-off and pick-up
Waiting room with free coffee, tea and water for waiting family members, WIFI, cellphone charging ports, satellite television and comfortable seating (please feel free to bring snacks or food to eat while you wait as we do not have vending machines).

Our location:

We are located at the corner of Kempsville Road and East Virginia Beach Blvd. down the street from Sentara Leigh hospital at entrance C. We are across the street from Rick Hendrick’s Cadillac and share the same parking lot as the Brock Cancer Center.

Our proud owners:

Leigh Orthopedic Surgery Center, LLC is a joint venture between Sentara Hospitals, DBA as Sentara Leigh Hospital, and the following surgeons: Dr. Samuel Robinson, Dr. Kevin Bonner, Dr. Joseph Gondusky, Dr. Jack Siegel, Dr. Louis Jordan, Dr. James Dowd, Dr. Nicholas Midis, Dr. Justin Griffin, Dr. Blake Moore, Dr. Chad Manke, Dr. Lawrence Donato, Dr. Michael Campbell, Dr. Bradley Butkovich, Dr. Paul Warren and Dr. Bradley Carofino.

Financial Assistance Policy

Financial Assistance

Financial assistance application

Leigh Orthopedic Surgery Center

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6201 E. Virginia Beach Blvd, Suite 200, Norfolk, VA 23502

Phone: 757-624-0700 Fax: 757-470-5827

If you are unable to pay your bill, please contact us at the telephone number or address listed below to see if you are eligible for financial assistance. Each patient’s need for financial assistance is evaluated according to the level of his/her household income, to include reported income, assets, liabilities, expenses, and other available resources. Free care is available to patients whose household income is 200% or below the federal poverty level. See aspe.hhs.gov for the current federal poverty guidelines published by the U.S. Department of Health and Human Services.

The complete financial assistance policy (“FAP”) is available for download here. Paper copies are also available at the surgery center’s patient registration area and will be mailed free-of-charge to a patient upon request:

Requests by phone:
757-624-0701

Requests by mail:
Leigh Orthopedic Surgery Center, LLC.
6201 E. Virginia Beach Blvd. Suite 200
ATTN: Business Office Manager
Norfolk, Virginia 23502

Individuals may apply for financial assistance under the surgery center’s FAP by mailing a completed application, along with proof of household income, to the above address or by bringing in the application and proof of household income to the surgery center’s patient registration area. Patients may also call or visit the above location to receive assistance with the application process.

In case of medically necessary care covered under the FAP, patients eligible under the surgery center’s FAP may not be charged more than amounts generally billed to individuals who have insurance covering such care.

Financial Assistance Information

Translations of the Financial Assistance Policy, and the application for financial assistance are available below. Please click the links below to download a copy. You will need Adobe Acrobat Reader to view the PDF documents. You may download Adobe Acrobat Reader for free here.

English

Financial Assistance Policy
Financial Assistance Application
Plain Language Summary

Español (Spanish)

Print Application

Frequently Asked Questions (FAQ)

Leigh Orthopedic Surgery Center

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6201 E. Virginia Beach Blvd, Suite 200, Norfolk, VA 23502

Phone: 757-624-0700 Fax: 757-470-5827

Why is it so cold in here?

Because germs produce faster in warm humid air, to help prevent infection, the Surgery Center is kept at a cooler temperature to stop or slow down the rate of germ reproduction and spreading. Warm blankets are provided for your comfort upon request.

Why can’t I eat or drink before my procedure?

If your stomach is empty, the risk of vomiting during surgery is greatly reduced. Vomiting during surgery can cause serious complications such as aspiration, pneumonia, or even death. You can even aspirate during light sedation if you do not have an empty stomach. Also, do not chew gum or tobacco prior to surgery.

Why do I need to arrive so early?

For your safety, there are many things we need to do to prepare for your surgery. Some of these things include completing your registration, going over your plan of care, taking your temperature, blood pressure, and heart rate. We may need to start an IV, shave and/or clean the area of your procedure, or begin your anesthesia plan. We also want to be sure we have time to answer any questions you or your family may have. Additionally, your Surgeon and Anesthesia Provider will visit with you prior to your surgery.

Will I have my surgery at the time I am scheduled?

Your time is important to us and we will make every effort to meet your expected surgery time. We will keep you and your family informed of any delays. Your scheduled surgery time is an estimated time because some procedures may be shorter or longer than expected. This is why we cannot give an exact time. Please feel free to ask if you have any concerns or if you wait more than 30 minutes without someone checking in with you and giving you an update.

I have seen people come in after me go into surgery before me. Why?

We have different doctors working in multiple operation rooms at the same time and on different schedules which impacts wait times. Your time is important to us. We apologize for any delays.

How long will I be in recovery?

Everyone reacts differently to the medications, so recovery depends upon the individual. When you are awake and doing well, your nurse will go over your post-operative instructions with you and your family. For your safety, you must have someone with you for the first 24 hours. You may be at risk of falling and injuring yourself or have an adverse reaction or complication related to your procedure or medications you received. Your safety is our primary concern. Please follow your instructions carefully.

Why do I keep having to verify my name and date of birth?

Patient safety checks are an important component of medical care. For your safety, every staff member who cares for you will verify your name and date of birth to ensure that we have the correct patient.

Why is the same information about my procedure repeated?

For your safety and to help ensure a good outcome for you, we want to be sure you understand important information about your care here at the center and after you go home. We will ask you to tell us what procedure we are doing for you today and what you know and expect about your procedure and recovery. Please take your time to review consent forms and instruction forms carefully and do not hesitate to ask us any questions. We want you to be informed about and comfortable with your plan of care.

At our center, we are all committed to living our mission. We would appreciate if you would let us know if you have any ideas of how we may improve and please share any other questions or concerns you may have.

Anesthesia Side Effects

Side effects of anesthesia can occur during a surgery or procedure, or afterward when you are recovering and the anesthesia is wearing off. The possible side effects vary, depending on what kind of anesthesia you have: general, sedation (monitored anesthesia care), local. While some side effects that occur after surgery may be uncomfortable or frustrating, most don’t last long.

If you’ve had any of these or other side effects or complications with past procedures, tell your anesthesiologist, who may be able to give you medicine before or after the procedure, or make other adjustments to prevent it from happening again.

General Anesthesia or Monitored Anesthesia Care (sedation provided through inhaled or intravenous – IV – medications):

The side effects of anesthesia can include:

Nausea & vomiting – This very common side effect can occur within the first few days of having surgery & can be triggered by a number of factors such as medication, motion, and type of surgery.
Sore throat – If there is a tube put in your throat to help you breathe, it can leave you with a sore throat after it’s removed.
Confusion – Confusion when waking up from surgery is common, but for some people – particularly those who are older – confusion can last for days or weeks.
Itching – This is a common side effect of narcotics, one type of pain Chills and shivering (hypothermia) – This is common when patients regain consciousness after surgery. It can occur in up to half of patients. Researchers aren’t sure, but think it might be related to the body cooling down.

Rarely, anesthesia may cause more serious complications, including:

Postoperative delirium or cognitive dysfunction – In some cases, confusion and memory loss can last longer than a few hours. Occasionally, patients can become confused, disoriented or have problems remembering things. It can come and go, and usually disappears after about a week.
Cognitive dysfunction – People with heart disease, lung disease, Alzheimer’s disease and Parkinson’s disease, or who have had a stroke, may be at risk for long-term memory loss. Their ability to learn, concentrate and think may be lessened.
Malignant hyperthermia – Some people inherit this serious, potentially deadly reaction to anesthesia that can occur during surgery, causing a quick fever and muscle contractions. If you or your family member has ever had heat stroke, or suffered from the condition in a previous surgery, be sure to tell the physician anesthesiologist.

Regional Anesthesia regional (numbing only part of your body):

The potential side effects of regional anesthesia (such as a nerve block, in which an anesthetic is injected near a peripheral nerve that affects sensation to an area of the body), include:

Hematoma – Bleeding beneath the skin can occur where the anesthesia was injected.
Serious but rare complications include:
Pneumothorax – When anesthesia is injected near the lungs, the needle may accidentally enter the lung. This could cause the lung to collapse and require a chest tube to be inserted.
Nerve damage – Although very rare, nerve damage can occur, causing temporary or permanent pain.
Seizures or Heart rhythm problems

Local Anesthesia Injection (numbing a small area):

Injection of local anesthesia numbs just the part of your body requiring minor surgery or a procedure. Side effects are minimal and usually are related to how much anesthesia is injected. The anesthesia department must still monitor you during your procedure.

Important Information: What to Expect During Recovery

ANESTHESIA: The side effects of anesthesia or sedation can last more than 24 hours, therefore you must have a responsible adult to stay with you for at least 24 hours. Please rest the remainder of the day. Although you may feel “normal”, your reflexes and mental ability may be impaired. You may feel dizzy, lightheaded, and/or sleepy for 24 hours or longer. After general anesthesia, it is normal to feel generalized aching and sore muscles for 24 hours. In addition, a sore throat may occur.
Do not consume alcohol, drive, operate appliances or hazardous machinery, and/or make any important personal or business decisions for 24 hours or while taking pain medication. Make sure you have assistance when up and about to avoid injury as a result of a fall.

DIET: Drink plenty of fluids and progress to your normal diet as tolerated, unless otherwise instructed by your doctor.

NAUSEA: It is not uncommon to experience nausea and/or vomiting after surgery. If you are unable to keep food and/or liquids down or your nausea/vomiting is persistent, please contact your surgeon’s office. Your surgeon’s office may decide to call in and/or write a prescription to help with the nausea/vomiting if needed.

BLEEDING: It is not uncommon to experience some minor bleeding after surgery. However, if bleeding is excessive or blood is coming through your dressing, please apply light pressure and call your surgeon’s office right away for further instructions. If you feel this is an emergency, dial 911, or go to the nearest Emergency Department.

INFECTION: Call your surgeon if you experience any signs/symptoms of infection including: foul smelling or unusual drainage, excessive pain, redness, heat, or swelling near the site and/or fever greater than 100.4.
Good hand hygiene is important during your recovery. Your dressing should remain clean and dry until otherwise instructed by your physician. Follow your physician’s instructions regarding bathing and wound and/or dressing care to help prevent infection.

PAIN: For your comfort and safety, please follow your doctor’s instructions regarding postop activity and taking pain medication. Some discomfort after a procedure may be expected, please notify your doctor of any excessive or intolerable pain that is not controlled by your pain medication and other comfort measures.

Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE): These are dangerous blood clots that may occur after surgery. Please follow doctor’s instructions and adhere to specific weight bearing restrictions. Examine legs daily for increased swelling or pain. Wear support hose if prescribed, change positions often or walk, drink plenty of fluids. Keep your legs elevated above the level of your heart while sitting at rest. If you experience worsening symptoms such as pain in the calf or lower leg, swelling of the leg or lower extremity, surface veins becoming more visible, any signs of complications from anticoagulation therapy (when prescribed) such as unusual bleeding (e.g. nosebleed, bleeding gums, red or cola colored urine, black bowel movements). Call your doctor with any questions or concerns.

If you develop sudden onset of difficulty breathing, shortness of breath, or chest pain, Call 911 and/or go to the nearest Emergency Room immediately!

Once you are home, if you have any questions/concerns regarding your procedure or home care instructions please call your surgeon’s office.

Non Discrimination Policy

Leigh Orthopedic Surgery Center

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6201 E. Virginia Beach Blvd, Suite 200, Norfolk, VA 23502

Phone: 757-624-0700 Fax: 757-470-5827

Chapter Name: 1 – Patient Rights and Responsibilities

Title: Non-Discrimination

Policy # : 1.90

AAAHC Standard:

Medicare CfC:

Date:

Policy Statement

Section 1557 is the nondiscrimination law of the Affordable Care Act (ACA). Section 1557 builds upon longstanding nondiscrimination laws and provides civil rights protections by prohibiting discrimination on the basis of race, color, national origin, sex, age, or disability. This is important to achieving the ACA’s goals of expanding access to health care and coverage, eliminating barriers, and reducing health disparities.
This facility does not segregate, delay, or deny services or benefits to individuals based on race color, national origin, sex, age, or disability
-Sex discrimination includes, but not limited to, discrimination on an individual’s sex, including pregnancy, related medical conditions, termination of pregnancy, gender identity (sense of gender, which may be male, female, neither, or combination of both) and sex stereotypes (notions of masculinity or femininity)
-Nondiscrimination covers Individuals with limited English proficiency (LEP)
~Please refer to Policies 1.8 and 1.85
This facility complies with necessary changes to provide equal access for individuals with disabilities, including such measures as service pets, electronic health information, physical access to facility, and effective communication.
-Communication aides includes auxiliary aids and services, including interpreters, large print materials, and text telephones
-Communication services are not the responsibility of the individual, are not to be provided by a minor or unqualified interpreter (staff or contracted), or at the individual’s preference if there are concerns of competency, confidentiality, or other
This facility complies with the nondiscrimination prohibitions from Section 1557 of the ACA
Section 1557 protects individuals in the United States, whether lawfully or not, who experience discrimination based on any of the section’s prohibited bases

No Surprises Act

Leigh Orthopedic Surgery Center

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6201 E. Virginia Beach Blvd, Suite 200, Norfolk, VA 23502

Phone: 757-624-0700 Fax: 757-470-5827

Important Information for Patient’s to be aware of:

The No Surprises act establishes rules and objectives for eliminating surprise healthcare billing or more commonly known as balance billing
Establishes patient’s rights to clear and timely cost estimates in advance of care and healthcare facilities to obtain written consent for balance billing
We are responsible for requesting and confirming patient insurance coverage
Providing the patient with an estimate of their portion of the cost for their procedure 72 hours before their procedure
Obtaining patient written consent before billing the balance of a patient’s account to them
Must openly disclose the insurance plans that we participate with and maintain an accurate directory
Must openly disclose the No surprises act on the website, in the facility

Patient Rights and Responsibilities

Leigh Orthopedic Surgery Center

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6201 E. Virginia Beach Blvd, Suite 200, Norfolk, VA 23502

Phone: 757-624-0700 Fax: 757-470-5827

I. Patient Rights

Each patient treated at the Leigh Orthopedic Surgery Center has the right to:

Be treated with respect, consideration, and dignity.
Be afforded appropriate personal privacy
Be given verbal and written notice of rights and responsibilities in a language and manner that ensures the patient, the representative or surrogate understands.
Receive full information in layman’s terms concerning appropriate and timely diagnosis, evaluation, treatment, prognosis and preventive measures; if it is not medically advisable to provide this information to the patient, the information shall be given to the responsible person on his/her behalf.
To participate in decisions involving their health care, except when such participation is contraindicated for medical reasons.
Receive information on the services, fees and payment policies of the center.
Receive information on after-hour and emergency care.
Obtain information on the center’s policy on patient’s advanced directives.
Be provided information on the credentials of the health care professionals at the center.
Receive information regarding the absence of malpractice insurance, if applicable.
Voice or file complaints or grievances regarding treatment or care that is (or fails to be) furnished.
Change primary or specialty physicians if other qualified physicians are available.
Receive an informed consent for the procedure and administration of any anesthetic.
Be given the name of their attending physician, the names of all other physicians directly assisting in their care, and the names and functions of other health care persons having direct contact with the patient.
Be given, in writing if requested, a list of physicians who have financial interest or ownership in the center.
Be free from any act of discrimination or reprisal and to be free from all forms of abuse or harassment.
Be provided medical and nursing services without discrimination based upon race, religion, color, national origin, sex, age, disability, marital status or source of payment, nor shall any such care be denied on account of the patient’s sexual orientation or gender identity.
Receive care in a safe setting by competent and appropriately qualified personnel.
Have records pertaining to their medical care treated as confidential.
Expect emergency procedures to be implemented without unnecessary delay.
The expedient and professional transfer to another facility when medically necessary and notification of the responsible person and the facility that the patient is transferred to prior to transfer.
Be provided with, upon written request, access to all information contained in their medical record.
Refuse drugs or procedures and have a physician explain the medical consequences of the drugs or procedures.
Be advised of participation in a medical care research program or donor program; the patient shall give consent prior to participation in such a program; a patient may also refuse to continue in a program that has previously given informed consent to participate in.
Receive appropriate and timely follow-up information of abnormal findings and tests.
Receive appropriate and timely referrals and consultation.
Receive information regarding “continuity of care”.
Expect the absence of clinically unnecessary diagnostic or therapeutic procedures.

II. PATIENT RESPONSIBILITIES

Each patient treated at the Leigh Orthopedic Sentara Surgery Center has the responsibility to:

Provide a complete and accurate medical history including medications, over-the counter products, dietary supplements, and any allergies or sensitivities.
Follow the treatment plan established by the physician, including instructions of nurses and other health care professionals as they carry out the physician’s orders.
Arrange for a responsible adult to drive you home and stay with you for 24 hours after surgery (as may be required by your physician).
Fulfill financial responsibility, for all services received, as determined by the patient’s insurance carrier (if applicable).
Provide the surgery center with all information regarding third-party insurance coverage.
Behave respectfully toward all health care professionals, as well as other patients.
Keep your appointment and notify the facility if you are unable to do so.
Read and understand all consents you sign. Please ask questions for clarification before signing consents.
Carry identification with you.
Let us know if you don’t understand any part of your treatment. Ask questions and take part in your healthcare decisions.
Let us know when you are having pain or when your pain is not being managed.
Respect the Surgery Center’s property and equipment.

VOICE YOUR CONCERNS OR SUGGESTIONS

To know how to file a complaint or grievance: To file a complaint or grievance with Leigh Orthopedic Surgery Center, please contact call the Risk Management Officer, Maureen Hartley at 1-757-624-0730 and a written response will be mailed to you within 7 days of receipt.

To file a complaint in writing a patient should visit: vdh.virginia.gov and download a complaint form.
The complaint form may be submitted via mail, fax or email. By US Mail:
Complaint Intake Office of Licensure and Certification
Virginia Department of Health
9960 Mayland Drive, Suite 401
Henrico, VA 23233-1463

1-800-527-4503

By email: OLC-Complaints@vdh.virginia.gov

Contact the Medicare Ombudsman at the following number:

1-800-633-4227

website address:
cms.gov

The above information shall be posted in a conspicuous location at the reception desk.

Preoperative Joint Replacement Education (PDF - 1MB)

Leigh Orthopedic Surgery Center

Leigh Orthopedic Surgery Center

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Leigh Orthopedic Surgery Center

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Leigh Orthopedic Surgery Center

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Leigh Orthopedic Surgery Center

Financial assistance application

Leigh Orthopedic Surgery Center

Financial Assistance Information

Frequently Asked Questions (FAQ)

Leigh Orthopedic Surgery Center

Anesthesia Side Effects

Important Information: What to Expect During Recovery

Non Discrimination Policy

Leigh Orthopedic Surgery Center

No Surprises Act

Leigh Orthopedic Surgery Center

Patient Rights and Responsibilities

Leigh Orthopedic Surgery Center

VOICE YOUR CONCERNS OR SUGGESTIONS

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