Common Contracts
1 similar Registration and Financial Agreement contracts
REGISTRATION AND FINANCIAL AGREEMENT – PINNACLE HEALTHCARE – PINNACLE MEDICAL GROUPRegistration and Financial Agreement • February 9th, 2021
It is understood that this authorization for medical treatment and/or testing is given in advance for any specific diagnosis, treatment of emergency care or testing that may be required by the physician in the exercise of their best medical judgment. I understand that it is my responsibility to know the specific benefits of my insurance coverage. Insurance coverage is an agreement between myself and my insurance company. Therefore, it is my responsibility to make payment for non-covered services, including co-payments or co-insurance and deductibles. I hereby authorize the release of any pertinent medical information or records to the insurance carrier, ifdeemed necessary to process my medical claim. I hereby acknowledge that I have received a copy of Pinnacle HealthCare’s notice of Privacy Practices. I further acknowledge that a copy of the current Privacy Practice notice is posted in the reception area, and that I will be offered a copy of any amended notice of Privacy Practice at
