The following policies and procedures are necessary for us to provide the best health care possible for all of our patients. They answer some of the most important questions about how our practice operates and how this affects you. We hope you understand the necessity for such practices and request that you would carefully read through each document.
These documents are available in print form at our office or they may be printed out on your personal copier in a PDF format (You need an Adobe Reader to access PDF documents). You will find links to these PDF documents at the end of each policy statement. We require you to sign each statement to indicate that you have read and understand its contents. Again, this may be done in our office prior to your first appointment or you can print and sign the document at home and bring it with you when you come for your initial visit.
Please understand that these policies have become necessary due to insurance carrier policies and missed patient appointments.
- Please contact our office at least 24 hours in advance if you are unable to keep your scheduled appointment.
- We have adopted a policy for missed appointments and late cancellations(less then 24 hours ). You will be charged $50.00 for a regular appointment and $100.00 for an extended ( physical, procedure) or New patient appointment .
- Three missed visits are grounds for dismissal from our practice.
- Copayments are due at the time of service.
- Please bring a current medications list, picture ID and your insurance card to each appointment.
- It is helpful if you have a list of your medical problems or concerns. We will do our best to address each problem; however, a follow-up appointment may be necessary.
- We also ask that you complete the medical history sheet prior to your first appointment.
Notice Of Privacy Practices
To our patients: We hold all your health information confidential. We will use your health information for treatment, payment, and health care operations. Our physicians and nurses use your information to provide treatment. Our billing office uses your information to bill you and your insurance company. Our office uses your information for business purposes such as quality improvement and to send appropriate information to you.
Your Rights Regarding Your Health Information
- Right to access your records: You have the right to inspect and obtain a copy of your health information. You must submit your request in writing.
- Right to request restrictions: You may request a restriction in our use or disclosure of your health information for treatment, payment and health care operations.
- Right to confidential communications: You can request that our practice communicate with you about your health and related issues in a particular manner or location.
- Right to amend the record: You may ask us to amend your health information if you disagree with the content. Your request must be made in writing to your physician. You must provide us with a reason that supports your request.
- Right to an accounting of disclosures: You have the right to know everyone to whom our office discloses record information for purposes other than treatment, payment, and health care operations.
- Right to have a copy of this notice.
- Right to file a complaint: If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.
If you have any questions regarding this notice or our health information privacy policies, please contact our office manager.
In the interest of a good health care practice, it is desirable to establish a policy to avoid misunderstanding. Our primary responsibility is to help our patients experience good health and we wish to spend our time and energy toward that end. Therefore, we wish to clarify the following points:
- All accounts are due and payable at the time services are rendered unless prior arrangements have been made with our staff.
- Even though you may have an insurance claim pending, you will receive a statement each month for the outstanding balance of your account. We cannot accept responsibility for collecting an insurance claim or for negotiating a disputed claim. Insurance reimbursement is a contract between you and your carrier. You are responsible for payment of your account within the usual limits of our credit policy.