Patient Responsibilities. In order to protect the privacy of confidential information and to ensure that communications are properly routed, the Patient has the responsibility to: • Limit or avoid use of public computers and public networks; • Promptly inform INTEGRATE INTERNAL MEDICINE of changes in your email address or telephone number; • Ensure that any email or text is addressed to the intended recipient before sending; • List the key topic in the email subject line; • Put your name in the body of the email or text.
Patient Responsibilities. As conditions to membership, and without waiving any other obligation or condition listed elsewhere in this Agreement, Patient agrees to the following:
a. To provide the Clinic current contact information and notify the Clinic of any changes;
b. To provide the Clinic with valid payment information at all times during the membership;
c. To pay Membership Fees and any other applicable fees for service provided to the Clinic in a timely manner (which includes payment for non-covered services at the time of service);
d. To provide complete and truthful information about Patient’s health, activities, and needs to the Clinic;
e. Except in rare cases where it is not reasonable to do so, to schedule appointments with the Clinic at least 24 hours in advance and to arrive for each appointment in a timely fashion or, in the event an appointment cancellation is necessary, to provide notice of cancellation at least 24 hours in advance of the scheduled appointment;
f. To complete all necessary consent, HIPAA, and other forms or documents reasonably required by the Clinic or by applicable law, rule or regulation, including any applicable tele-health forms if Patient desires to engage the Clinic on a tele-health basis.
Patient Responsibilities. The patient will: Have the required blood monitoring tests as set out in these guidelines Not be eligible for treatment if monitoring blood tests are not carried out. Attend hospital and primary care appoints as required Consult GP/ Hospital clinician if any change in health status or any new concern with regard to medication or monitoring
Patient Responsibilities. To take the prescribed medication regularly unless advised by GP or specialist team To attend scheduled reviews with specialist team and for monitoring as detailed in this document Report any adverse effects to the specialist team or GP Share any concerns in relation to treatment Report to the specialist team or GP if they do not have a clear understanding of the treatment
Patient Responsibilities. 7.1 You agree (as well as paying the membership fees) to:
a) attend the Dentist’s practice when invited to do so for check-ups or treatment purposes;
b) accept the advice and recommendations from the treating dentist in respect of remedial work which safeguards Your general dental health; and
c) inform the treating dentist of any injury, difficulty or other relevant matter affecting Your dental health generally. If You fail to comply with the terms of this condition 7.1 You may be liable for fees for dental treatment as a result of Your failure.
7.2 Unless You have attended the dental practice for an examination at least once a year and have all necessary remedial work completed (whether or not this is covered under the Plan), then to the extent this impacts any treatment You might need as a result of a dental emergency/trauma, You may not be eligible to request assistance from the Scheme.
7.3 All appointments made by You with the Dentist’s practice are subject to the Dentist’s practice rules and procedures. You will be liable for any reasonable charges charged by the Dentist for missed appointments and cancellations where You have not provided sufficient notice. You will not be entitled to a refund for any fees paid or payable (including the membership fee) for missed appointments or appointment cancellations. You should check the Dentist’s practice rules and procedures to find out the required notice periods and applicable charges.
7.4 It is Your responsibility to ensure that Your and, where applicable, Your Payer’s contact details are kept up to date with Practice Plan and the Dentist’s practice.
Patient Responsibilities. The Patient and any Household Members shall provide PrimaCare Direct with a complete medical history and shall inform PrimaCare Direct of any changes in the Patient’s or Household Member’s health or medical condition. The Patient and any Household Members shall disclose all information relating to his/her health condition and shall actively collaborate with the PrimaCare Direct Partner practitioners and inform such practitioners about any health care services received outside of their PrimaCare Direct Partner clinic. The Patient and any Household Members shall comply with policies
Patient Responsibilities. In the event that your health plan determines a service is not covered, you will be responsible for the services performed. If we are unable to verify your insurance is active and valid, you will be responsible for charges at the time of service or you are welcome to reschedule. The physicians and mid-level practitioners will be unable to change their “normal course of treatment” due to non-covered service limitations of your insurance benefits. Payment for non-covered services will be due at the time of service or upon receipt of a statement from our office. Statement balances must be paid within thirty days to avoid your account being placed on hold. If an account goes past 180 days past due, it will go to collection for processing. A collection fee (30% of the outstanding balance) will be assessed.
Patient Responsibilities i. Patient shall make all payments to YPMD in the form of Master Card, Visa, Check, or other forms previously approved by YPMD. Patient shall ensure that their account with YPMD is current or that they are willing to make current at the time of any office visit.
Patient Responsibilities. 2.1. Patient will identify to SFM staff that they have an ABA on file with SFM when accessing products and services.
2.2. Patient will pay for all ABA products and services at the time services are rendered.
2.3. Patient will make ABA payments to remain in good standing.
2.4. Patient must provide a credit card to be used for recurring payment of the ABA.
2.5. Patient will notify SFM of any changes of residency, insurance or payment information.
2.6. Failure to keep the ABA in good standing can result in Termination in accordance with Section 5 below.
2.7. Patient will participate in any utilization review of ABA products and services.
Patient Responsibilities. As a patient of Orthopaedic Xxxxxx Therapy Specialists, I understand it is my responsibility to provide accurate and complete information regarding medical needs, medical history, medications, demographics, and health insurance. It is my responsibility to report changes in my medical condition, medications, demographics, or insurance to the therapist and/or staff. It is my responsibility to request additional information about my medical condition or treatment when I do not fully understand the information or instructions given to me. I understand there is a medical records copying fee per page charged for obtaining copies of my medical records as allowed by Maryland law. This fee must be paid prior to picking them up. I understand that there is a charge for filling out disability and other miscellaneous forms. One page is $10.00; more than one page is $20.00. It is my responsibility to give at least 24 hours’ notice when I must cancel or postpone my appointment. I understand that my first missed or postponed appointment with Xxxx X. Xxxxxx D.P.T. not given within 24 hour notice will be waived, no questions asked. If the second appointment is missed or postponed we will charge Office hours are Monday-Friday 8:00am to 5:00pm. We are closed daily from 12:00pm to 1:00pm for lunch. Your therapist will see you in a timely fashion. If the therapist is running late, you will be given your full appointment allotment. Your therapist or will answer questions to the best of his or her ability. If you are unsure of any aspect of care, be sure to ask for clarification. Your therapist will strive to return calls within one (1) business day. Should you therapist decide to terminate services, you will be given the names of qualified therapists along with a copy of your medical records at your request. We appreciate the opportunity to assist you in your functional recovery and rehabilitation. As required by the Health Information Portability and Accountability Act of 1996 Orthopaedic Manual Therapy Specialist, LLC (OMT) may use your personal health information for the purposes of treatment, payment or health care operations. The specific disclosures that we intend to make are described in our Notice of Privacy Practices. You have the right to review the Notice O Privacy Practices prior to signing this consent form. You may request restrictions on the uses and disclosures described in the Notice of Privacy Practices by describing the requested restrictions in the “restricti...
