Agreements and Terms

I guarantee the information I have given to you is correct. I give permission to insurance companies or their providers for the disclosure  (including Medicare) of medical details required to process insurance claims for the purpose of filing and payment of medical claims. I approve payment by the provider of the medical benefits.

Disclaimer

Dr. Chippy Ajithan, M.D., is a board-certified medical doctor practicing Functional and Lifestyle Medicine in the state of Florida. Services through The Purpose Collective are provided on a private-pay basis and are not billed through or reimbursable by insurance. All consultations, recommendations, and programs are designed to educate and empower patients to make informed lifestyle choices that support their overall well-being. These services do not replace individualized medical care, diagnosis, or emergency treatment. Patients are advised to maintain ongoing care with their primary physician and consult their healthcare provider before making significant medical or lifestyle changes.

e-Visit Consent

The COVID-19 (Novel Coronavirus) viral disease was declared as a pandemic by The World Health Organization (WHO) on March 11, 2020. As a result of this rapidly evolving emergency, the need to treat patients are shifting online platform, which will be managed by the practice patterns for physicians, physician assistants, and nurse practitioners.

HIPAA

Under the Federal Health Insurance Portability and Transparency Act, patients over 18 years old are covered. This Federal Policy forbids any of Belaray Dermatology's staff members from sharing treatments, drugs, test results or treatment plans with someone other than the patient. Sometimes, this creates difficulties in accessing details for certain patients who would like family members or caregivers. If you want to encourage someone to address your medical condition, confirm appointments or get results for you, please mention their name(s) below. Details will be given only to certain individuals.