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Murray Internal Medicine
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NEW POLICY
(Patients will be asked to sign and date this form)
Dear Patient,
It is always our goal to serve you better. In order to do so, we ask for your help. Due to time
constraints and respect for all of our patients, we request you comply with our new office policies.
Bring your current medications or a list of all of your current medications on each office visit. Call your pharmacy for a refill on any medications you take on a regular basis, they will fax the request to us and we can get it handled much faster.
In order to assure that you have the appropriate amount of medication you must allow at least 24 hours for Murray Internal Medicine to write or call in your prescription refills.
Messages called after 12:00 noon will be answered the following day, unless it is an emergency.
Samples of medications will only be given on an office visit.
Patients on medical, assistance can pick up pre-arranged medications between 8 AM to 9 AM and 4PM to 5 PM.
There is a $5.00 - $10.00 fee for completing forms by the physician. The amount of the fee will depend on the length of the form.
All MRI, Hormone Testing, CT, DEXA scan results require an office visit to go over the results.
Lab results and X-Ray results will be sent by letter whether or not it's normal, with a written message from the provider regarding the plan of action. If an office visit is needed you will be contacted to set a time to see your medical provider. All co-pays and deductibles will be due at the time of service.
All previous balances must be paid before services are provided at each visit unless a prior arrangement has been made with the office manager.
Any special payment arrangements must be made with the office manager at the time of service.
If there are any changes to your patient information you must let the receptionist know before your office visit, so we can update our records and get the correct information filed with your insurance carrier.
At the beginning of every year you will be required to complete a patient information sheet updating your address, contact information and insurance information.
I have read the new policy and I agree to comply with this new policy.
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Signature Date
Copyright 2010 Murray Internal Medicine. All rights reserved.
MURRAY INTERNAL MEDICINE
WEBSITE (MurrayInternalMedicine.com) IS TAKEN DOWN AS OF AUGUST 1, 2016
