|
This patient information page is designed to allow our
patients to gain more knowledge about our policies and
download forms to be completed prior to their appointment so
that we can better serve our patients at the time of their
visit.
Please click on one of the files listed below to download.
Please keep in mind that you will need Adobe Acrobat Reader
in order to view this files. If you need Adobe Acrobat
Reader, click on the Adobe icon below.
Patient Information Form
Medical History Form
Patient Injury Report
HIPAA Privacy Practices Notice and Acknowledgement Form
Information about our practice
Appointments
We see all patients on a
scheduled appointment basis and ask that you please call in
advance so we may reserve time for you. If you have an
urgent need for an appointment, we will make every effort to
accommodate you. If you cannot keep an appointment, notify
us by calling( 615) 449-0990 or 1-800-380-KNEE. This call
will help us accommodate those patients in need of the
appointments. We have the option of applying a no show
charge of $15.00 to your account for any appointment not
cancelled 24 hours prior to the appointment time.
The office is open Monday
thru Friday from 8:00 A.M>.to 5:00 P.M. When we are not in
the office, an on call physician may be reached by calling
our office number. This call will be handled by our
answering service. This call is for emergencies only. Our
office should handle all other issues during regular office
hours. We ask that you, please, do not call for medication
refills after hours.
In the event of an
emergency, go immediately to the emergency room of the
nearest hospital. If the situation is not that severe (and
arises while the office is closed), please call the office
and request the on-call physician to telephone you for
instructions. If your call is of a routine nature, please
call back when the office is open for business. When an
urgent situation occurs while our office is open, please
contact us and your physician will be in touch with you
directly or through office personnel who may give you
instruction for you care.
We encourage you to call
us with questions concerning your heath care, however, it
would be unfair to other patients if your physician were to
disrupt treatment to answer every phone call. Our staff is
trained to answer most questions. If your call requires
that the physician speak with you, please leave a message
and the practitioner or his staff will return your call at
the earliest possible time. Transferring a call or waiting
may be necessary to discuss your question with the
appropriate person. We appreciate your understanding.
Prescription and
Renewals
Each physician and his
staff handle prescription rewards in their own way during
normal office hours. Please check with them individually
for any specific instruction. It is best to have your
medications reviewed and refilled, if necessary, at the time
of your appointment. If that is not possible, please give
us at least 24 hours notice for prescription renewals, as
they are handled according to the physician’s schedule and
availability. Absolutely no medication will be refilled
outside of normal office hours. By law, your medical record
must be available to your physician for review, therefore;
please do not expect an on-call physicians to renew
medications prescribed by your physician.
Fee and Payments
We make every effort to
provide quality medical care at a reasonable cost. You
can help by bringing your insurance card with you for all
visits, as well as paying any co-payments or
patient-responsibility portions of your charges at the time
of service. We cannot bill for these charges. Any
exceptions to this policy must be discussed with our business office
prior to your appointment .
If it becomes necessary
for you to have surgery, our business office will counsel
you and give general information as to your financial
responsibility and what can be expected as far as the filing
for your insurance and when your patient-responsible portions will need to be
paid. If you have any question, please ask prior to your
procedure.
Insurance
Health care insurance is
intended to cover some, but not all, of the cost of your
treatment. Most plans include co-insurance, a deductible and
other expenses, which must be paid by the patient. We will
be happy to file your insurance for you, providing we have
all of the necessary information. To do so, however, your
portion is due at the time of service and you will be given
a receipt for any fees you have paid at the time of your
visit. Please make sure you check with your insurance
company before seeing our physicians for the first time to
make sure our practice meets all of the criteria for
minimizing your out-of-pocket expense.
It is your responsibility
to make sure to ask any questions you have regarding payment of our
charges. Our staff has some general information on
insurance plans but we are unable to keep all information on
all insurance plans and, ultimately, you are responsible for
knowing your insurance provider’s policy for payment. Our
billing office will be happy to assist you in answering
questions regarding filing of claims and payments from your
insurance company during regular business hours.
Workman’s Compensation
and 3rd Party Liability
If you were injured on the
job or as a result of negligence, please be aware that we
have special policies regarding your care. You will need to
ask our office for the necessary forms and information
regarding these injuries, prior to being seen in our
office. Our staff will be happy to answer any questions you
may have regarding this process.
No Smoking, Please
Because exposure to
tobacco is hazardous to your health, we ask that you refrain
from smoking any place in our building, including but not
to limited restroom, stairwells and elevators.
|