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 NOTICE OF PRIVACY PRACTICES - HIPAA STATEMENT Click here for full document Appointments: We will try to schedule an appointment at a time that is convenient for you. Because some visits require more time than others, please provide the receptionist with as many details as possible when making your appointment. If you are a new patient to our clinic or have not been seen for several years, you may download and print out the Patient History Form and the Patient Information Form prior to your appointment to save you time in registering. If you need to cancel your appointment, please let us know 24 hours in advance by calling the main office number (414) 647- 0033 at any time. You may leave a message with our receptionist or on the answering machine. Patient History Form - click to print Insurance Release Form - click to print Co-Payments: With many insurance policies, the patient is responsible for co-payments and/or deductibles. We expect that these payments will be made at the time of service. For your convenience, we accept cash, check, VISA and MasterCard. Referrals: If your insurance company requires a referral for specialist treatment, it must be obtained prior to the appointment. The patient and the primary care physician are responsible for the referral approval. If a valid referral is not available, the appointment may be delayed or rescheduled. Emergencies: If you should have a medical emergency, please go to the nearest hospital emergency department. Prescriptions: We will make every attempt to provide and refill prescriptions for you in a timely fashion. However, since the "on-call" physician is not familiar with each patient in the practice, we generally will not refill prescriptions during non-office hours (weekdays after 5 p.m., weekends and holidays). Prescriptions can be refilled by calling our office and speaking with your Physician's Team. We will contact you or your pharmacy after the doctor has given authorization. Fees, Insurance and Payments: Fees for services provided include physician evaluation and decision making, preparation and storage of medical records and x- rays, and services provided by our staff. We will file insurance claims for you if you provide us with current insurance cards and claim forms. If you have problems with your insurance claims or in getting reimbursed, we will be happy to assist you. However, the responsibility for payment of our charges rests with the patient and not with the insurance company. You will receive a monthly statement from our office to inform you of the current status of your account. If you require assistance with insurance claims or with payment of your bill, please contact our Billing Office. We will always attempt to work out an acceptable payment plan if your financial situation requires. |
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