Wilkes Family Medicine
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Minor Consent Form

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Patient Portal Users Guide

Policies & Forms

All of the following policies have been developed in order to ensure that you receive the BEST CARE POSSIBLE, and that the office runs smoothly and efficiently:

Appointments

In order to serve our patients effectively it is our goal to schedule an appointment for you on the same day if you are acutely ill or have an urgent need. For more routine needs we will have you schedule a future appointment.

Labs and Studies

We will notify you of your lab results and studies via the patient portal or phone. For results that require a more in depth discussion or management, we will ask you to make a follow up appointment. As an extra safety measure we ask if you have not received confirmation of your results within 10 days after they were done, that you call our office for results.

Medication Refills

We will authorize refills on an individual basis, and may request an office visit for some refills as medically necessary to provide you with the best and safest medical care. Request prescription refills by calling your pharmacy and asking them to send us a refill request. Some medications require a written prescription and will require you to pick up prescription at the office and hand deliver to your pharmacy. Prescriptions will be refilled 48 hours of the office receiving the request. We would ask that you plan ahead.

Timing

At the beginning of your appointment please advise us of your primary concerns so that we can address the most important problems at each visit. We will absolutely do our best to address each concern, but ask for flexibility to schedule follow-up appointments if time does not permit discussion of all your medical concerns.

Scheduling and Cancellation Policy

Our office strives to meet the needs of all our patients and in particular our patients needing more urgent attention. This necessitates we maintain an accurate and efficient scheduling system and minimize cancellations. We understand cancellations are sometimes necessary and have implemented the following policies:

    1. Routine exams will be scheduled according to availability by the scheduler. Other patient visits will be scheduled during the next available slot, with priority given to more urgent needs as deemed necessary by the office manager.

    2. One day prior to your appointment, the office will attempt to contact you to confirm your appointment. If we are unable to reach you, we will leave a message. Please be aware this service is a courtesy to our patients and you will still be responsible for charges incurred due to missed appointments.

    3. If you are not able to keep your appointment, we request that you call 24 hours in advance so that we may be able to provide more timely care to other patients who could be scheduled into your reserved time slot.

    4. There will be a $25 charge if you no show for your reserved 20 minute appointment and a $50 charge for a 40 minute appointment.

Child Supervision

Please ensure someone is available to supervise younger children if you will be having a procedure or an extensive exam on the day of your visit.

Phone Calls

Dr Wilkes is happy to respond to routine phone messages for focused questions. Please keep in mind for more extensive questions or management of a new medical issue that was not discussed at a prior visit, we will kindly ask that you make an appointment.

Prior Authorizations

Some medications and studies will require prior authorization from your insurance company. We will always work diligently to obtain the best medical care for you, however in some cases we are limited by what is approved by your Insurance, and approval may take 24 hours or more.

Forms

Any and all paperwork or forms that a physician is requested to complete need to be done by an office visit appointment. This includes, but not limited to: Work and school physicals, disability, DMV physicals, social security, entrance to nursing home, etc. Exceptions will be determined by office staff and subject to our standard form fees.

Insurance

As a courtesy, we will submit your visit to your insurance company with the information you provide us. We do not have access to retrieve your insurance ID or group number. Every insurance policy is different and your responsibility is to know what is covered and what is not covered. If for any reason your claim is denied due to wrong insurance information you provided, we must assume you have no insurance coverage and therefore are responsible for your bill.

Payment Policy

CoPay or payment is due at the time services are provided. We accept cash, checks, and credit or debit cards. Past amounts due need to be paid in full prior to appointments unless payment arrangements have already been made. There is a $20 service fee for any returned check. For your convenience, you can make payments at our secure website by credit or debit card or call the office to make payments over the phone.

Privacy/Security Policy

At Wilkes Family medicine protecting the privacy and safeguarding the personal and financial information of our patients is one of our highest priorities.

Wilkes Family Medicine does not sell, license, lease or otherwise disclose your personal information to any third party for any reason.

SecureNet Payment Systems employs leading-edge security software, systems, and procedures to offer you a safe and secure processing environment and protect your personal, financial and processing information. http://www.securenet.com/privacy.htm.

Please contact office with transaction errors and we will gladly refund or correct any discrepancy.

Insurance

We accept most all PPO insurance and Medicare. We are not contracted with HMO's, Medi-Cal or worker's comp.

You are welcome to call our office if you are uncertain about your insurance.

© 2012 Wilkes Family Medicine