CHI Memorial Horton Family Practice Associates - Dayton

Bring a list of all of your medications (over the  counter, vitamins, natural or herbal) along with  the dosage and directions to every visit with your provider. Bring a list of your health concerns for  your provider to address. Bring a list of the names, date of treatment(s), and contact information of any health care provider previously seen.

Please arrive 30 minutes prior to your  appointment time. Our goal is to have you in  the exam room at your appointment time. Thank  you for your assistance in helping us make our office run smoothly.

Questions for the provider - Please review your list of questions and ensure the top three were addressed during your visit.

Late arrival for appointments - It is our policy in order to help with our appointment wait times we must ask that you are no more than 10 minutes late to your appointment. We realize  emergencies, traffic, etc. can happen occasionally and we always try to accommodate you when we can.

Follow-up appointments - Please schedule your follow-up appointment prior to leaving  the office.

After hours - Only emergent issues will be addressed. Please make an appointment for medical concerns. Prescriptions are limited after hours.

Canceling appointments - Please notify  us no later than 48 hours of a cancellation.  Appointments not canceled prior to 48 hours are subject to a cancellation fee of $50. Canceled appointments help us ensure availability for patients who need urgent care, therefore please inform us of canceled  appointment.

If you have lab work or testing  performed during your visit, please  do not call the office for your results.  The nurse will call you regarding the results within 10 business days. If you  have additional questions please schedule an appointment to review  the results. Please do not call the  office unless you have not received results after 10 business days.

Please select your nurse’s line for medication refills delayed lab/test results or non-urgent health concerns. Please speak clearly and slowly and provide your full name, including spelling of name, phone number, date of birth, and reason for your call. If the message is referring to prescription refill, please provide medication, dosage, pharmacy name and phone number. Nonprescription messages must include symptoms, onset of health issue and home remedies you have tried.

Patient rights

• Access to considerate and respectful staff
  
• Access to the roles of staff providing treatment and information about your health care
• Access to your medical records, which require a 24 hour notice and a written form for release
• Access to health care rules and regulations that affect you, your treatment, charges, and payments
• The ability to consent or refuse treatment, as permitted by law

Your health information is kept confidential unless written consent is provided, preexisting guidelines established with healthcare insurance, or in case of a medical emergency.

Patient responsibilities

Your responsibilities include providing information about your health, medication, insurance, contact information, past illness, hospital stays, family or social history that may impact treatment or medication, and payment of fees not covered by insurance.

Update your personal information - Please bring your insurance cards, driver’s license and any documentation regarding change of  legal name. Ensure address, phone number emergency contact and email address are up to date. We use the information in our system  for appointment reminders and lab results. It is important to ensure all information is correct.

Prior authorization, FMLA, disability or  other legal forms - Bring your insurance company’s Prior Authorization form with you  to all appointments. Bring FMLA, Disability  or Medical Supply forms with you at your  next appointment. Allow 72 hours after the  appointment to complete the forms. Please  arrange for pick-up of all forms. In the event of  a denial for prior authorization for procedure, medication, etc. please contact your insurance company for additional information.

Please notify  the provider of all medications  requiring refills during your  scheduled appointment. All refills are subject to provider  approval. Refills for a controlled substance must be provided at an appointment every 90  days. No refills for controlled  substance will be filled outside of your appointment. All after  hours refills (except controlled substances) will be limited to a 3 day supply. Please schedule an appointment to obtain your medication refills.