When establishing yourself as a new patient, there are various standard forms that need to be filled out completely before your appointment. These forms include the following:
- Patient Demographics: includes important details about you including your address, contact information, date of birth, employer information, etc.
- Medical History: includes your current medications, allergies, past eye medical and eye history, surgical history, and family history.
- HIPAA Information and Consent: this document gives your designees permission to be notified of and have access to your Protected Health Information (PHI).
- Patient’s Rights and Responsibilities: this document outlines the expectations we have of and what you rights are as a patient of The Eye Institute of West Florida.
- Medicare Authorization: this document authorizes us to bill Medicare and Medicaid (when applicable) for rendered services.
- No-Show/Cancellation Policy: this document outlines our policy in regards to patient’s not showing and cancelling appointments.
- Arbitration Agreement: this document informs you of an available dispute resolution process between The Eye Institute of West Florida and the patient.
- Consent, Assignment of Benefits, and Financial Agreement: this document informs you that we will bill your insurance(s) for services rendered.
Category:
Patient Paperwork
