Office Policies Clause Samples
Office Policies. E-mail data may be unsecured and result in health information being distributed to unknown third parties for which EFM is not responsible. Use of the secured patient portal is the preferred route of communication for routine matters. Phone call is the preferred route of communication for urgent matters. EFM does not provide emergency care. There may be times when Dr. Black is unavailable. If a health matter is urgent I agree to seek care at an urgent care or emergency room. The preferred urgent care for Empower Family Medicine is Urgent Care at Druid Hills ▇▇▇▇ ▇ ▇▇▇▇▇ ▇▇▇▇▇ ▇▇ ▇▇ ▇▇▇▇▇ ▇, ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇. All prescription refills for chronic medications should be requested at office visits. Routine refills will not be issued by phone, fax or call. ▇▇▇▇▇▇▇ ▇▇▇▇▇ M.D. This agreement ("Agreement") is entered into by and between Empower Family Medicine, LLC, a Georgia professional corporation, owned and operated by Dr. ▇▇▇▇▇▇▇ ▇▇▇▇▇, MD, (the "Physician"), whose principal medical office is located at ▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇, and , a beneficiary enrolled in Medicare Part B ("Beneficiary"), who resides at .
Office Policies a. Appointments and Cancellations. Appointments will ordinarily be 50 minutes in duration, once per week at a time we agree on, although some sessions may be more or less frequent as needed. The time scheduled for your appointment is assigned to you and you alone. If you need to cancel or reschedule a session, I ask that you provide me with 48 hours notice (2 business days). If you miss a session without canceling, or cancel with less than 48 hour notice (2 business days), my policy is to collect the amount of the full session. If there is an emergency or illness, please contact me so we can discuss it. In addition, you are responsible for coming to your session on time. If you are late, your appointment will still need to end on time and you will still be charged the full cost of the session. If I am running late, I will do my best to give you a full session. If I am unable to do so, then a prorated amount of my hourly rate of $115 will be charged. _____ I understand that sessions must be cancelled 2 business days (48 hours) in advance or there will be a charge of $115. (Please initial.)
Office Policies. My fee is $80.00 per fifty minute session. You are responsible for paying for each session at the time of service. I also accept some EAP and insurance, and upon verification of an active policy and appropriate coverage, you will be responsible for copays and deductibles as your policy dictates. Checks and Cash are accepted. Administrative fees, such as FMLA or disability reports, are charged at a $50.00 hourly rate. Legal fees are charged at a $150.00 hourly rate. Administrative and legal fees must be paid in advance. If you are unable to attend a session please notify me as far in advance as possible. If you do not show up or fail to cancel at least 24 hours prior to your appointment, you will be responsible for paying $35 for the missed session for whatever reason. If you are late for your appointment, you still will be charged. Periodically, I raise my fee and you will have at least a 60 day notice of any future fee increase. I consult with other psychotherapists and discuss clinical issues. I may discuss some clinical aspects of your care with them, however, your identity is not revealed during consultations. I take about two weeks off each year for clinical trainings and vacations. When I am out of the office, information regarding back-up coverage will be provided to you. It will be available on my voice mail greeting, as well.
Office Policies. ▇▇. ▇▇▇▇▇▇▇▇▇ is committed to providing a welcoming environment for her patients. Your time is valuable as is that of all the families served by this practice. The following policies are designed to improve everyone’s patient experience: Please arrive on time for your visit. Other patients have appointments after yours and thus families that arrive more than 10 minutes late may be asked to reschedule the visit. If you cannot make the appointment, please call more than ONE office business day ahead of time to reschedule. Last minute cancellations and no-shows may be charged a fee. Reminder calls are made as a courtesy only. It is your responsibility to know the time and date of your appointment. Tests (labs and X rays) may be requested prior to the appointment. Please ensure you have the test done on time so the results can be reviewed with you at your upcoming appointment. The due date is indicated on your visit summary and test order sheet. You may be asked to reschedule if the results are not available in time or if the tests have not been obtained. Patients who miss more than 3 appointments may be asked to continue their care with another practice. Please have your medication list ready for review during office visits. Please contact your pharmacy for all prescription refill requests. Please allow at least 2-3 business days for processing. Prescription refills require regular office visits. To ensure you or your child’s safety, a regular evaluation of the condition and medication interactions is required. If you are transferring care from another provider or center, please ensure that all previous clinic notes have been sent BEFORE the scheduled appointment.
Office Policies. Appointments are specific times reserved for you. Sessions typically run fifty (50) minutes in length. Service Fee Agreement:
Office Policies. Appointments
Office Policies. I / We hereby authorize mutual exchange of information between providers of Statesboro Pediatric Dentistry ▇▇▇ ▇. ▇▇▇▇▇ Street, Statesboro, Ga. 30461. And any other medical or dental provider (except: ) for our child necessary to provide appropriate dental care. • The following information from his/her records can be obtained: X-Rays, Medical and Dental records Indicate nature or extent ofinformation: • The above information is to bereleased for the following purpose only: Dental Treatment and update Medical/Dental • I understand that I may revoke this authorization at any time, except to the extent that action has been taken based on this authorization before it is revoked.
Office Policies. Hourly appointments are 60 minutes long and are usually scheduled for once a week. Longer sessions may be accommodated, agreed upon by you and I in advance in the therapist requesting that either (a) the client pays for phone consultation time, or (b) the client increase the frequency of sessions.
Office Policies. It is usual and customary for the fee to be paid at the beginning of each counseling session. Other arrangements will have to be made in advance. Sessions start on the hour and are usually held once a week at first to ensure the greatest change possible. All requests for copies of your file or amendments are to be made in writing.
Office Policies. APPOINTMENTS/COMMUNICATIONS: ▇▇. ▇▇▇▇▇▇ can be reached at ▇▇▇-▇▇▇-▇▇▇▇ to schedule an appointment or for other inquiries. At times, ▇▇. ▇▇▇▇▇▇ may be in session with a client and unable to answer the telephone. If this should occur, please leave a message on our confidential voicemail. Your call will be returned promptly. Please note that email is not a secure form of communication and does not ensure confidentiality. Therefore, we request that it only be used for non-clinical communication (e.g. scheduling appointments, etc.) MISSED APPOINTMENTS/LATE CANCELLATIONS: When you schedule an appointment, the time is reserved specifically for you. If you are unable to keep the appointment or need to reschedule, please do so as soon as possible. Appointments cancelled without at least 48 hours notice may be charged a Missed Appointment/Late Cancellation Fee of $50. Insurance companies do not provide reimbursement for these fees. EMERGENCY SERVICES: We do not provide emergency services. If you are experiencing a life-threatening emergency, please call 911, go to your local emergency room or follow emergency procedures per your insurance carrier.