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We appreciate your selection of one
of our First Choice Community Health Centers to provide your
medical and/or dental care. We are committed to
providing you the best care available. To keep the cost
of your care to a minimum, we will work together and ask that
you read the following information. We look forward to
serving you and your family. |
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All forms on this page are in a ".pdf"
format, so you will need
Adobe Acrobat to read and print them. |
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First
Visit |
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Payment Policy |
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Walk In Patients |
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Late
Arrival |
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Returned Checks |
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No Show |
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What to
Bring to Your First Appointment |
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Transfer of Medical
Records |
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FIRST VISIT |
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Please show up
at least 30 minutes before your scheduled appointment
so that we may complete all required paperwork. |
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Failure to do so may result in a
longer waiting time on your visit. |
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PAYMENT POLICY |
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All co-payments are due at the time
of service. We do not bill for co-payments. |
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We accept checks, cash, American
Express, Visa, and MasterCard. Payment plans are also
available. |
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Any questions regarding your account
should be directed to our billing office at (910) 499-5333. |
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WALK IN PATIENTS |
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All First Choice Community Health
Centers clinics accept walk-in patients for emergency
and sick visits. |
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LATE ARRIVAL |
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We will do our best to accommodate
patients who arrive a few minutes late for their appointments.
However, it may be necessary to re-schedule your appointment
depending on the provider's schedule. |
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RETURNED CHECKS |
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A fee of $35.00 will be added to the
patient account for all returned checks. |
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NO SHOW |
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Patients who do not show up for an
appointment without twenty-four (24) hours notification may be
subject to a no show fee of $20.00. |
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Any patient who misses three
appointments in a one year period without providing the
twenty-four (24) hours prior notification may be
placed in a probationary status and barred from scheduling
future appointments. However, we will continue to see
those patients on a Walk-In basis (please see above) until the
one year probationary period ends. |
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Please ask us if you need further
clarification on our policy. |
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WHAT TO
BRING TO YOUR FIRST APPOINTMENT: |
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Completed
Adult or
Child package (i.e. Patient Data Form, Medical History, Parental
Consent for Child, etc.)
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Completed
Tuberculosis
Screening Form
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Completed
Sliding Fee Program
Application (if applicable - please refer to
Sliding
Fee)
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Completed HIPAA form specific to
the center you are visiting (please refer to
Privacy)
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All insurance cards
including Medicare, Medicaid, HealthChoice, or private
insurance
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A list of all medications you are
currently taking
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Immunization records
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If you have not already arranged for
your medical records to be transferred, please do so as soon
as possible (see instructions below). |
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TRANSFER OF MEDICAL
RECORDS FROM ANOTHER PROVIDER |
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If you are a patient who needs to
have copies of medical records from a previous provider sent
to a First Choice Community Health Centers Clinic, you can
pick up a Medical Record Request form at any of our
offices. |
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Once you have it, please fill it
out, sign it, and take it to your previous physician's office. |
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