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Sensible Bio Tech - Wound Care (Google)
HIPAA
Compliance
1
WHAT IS YOUR MAIN CONCERN?
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VENOUS LEG ULCER
DIABETIC FOOT ULCER
SACRAL ULCERS
PRESSURE ULCERS
BURNS
SURGICAL WOUNDS
SOMETHING ELSE
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2
HOW LONG AGO DID THIS HAPPEN?
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TODAY
1-7 DAYS AGO
1-4 WEEKS AGO
1+ MONTH AGO
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3
What kind of insurance do you have?
Our treatments are currently only covered by Medicare part B
Medicare B
Medicare Advantage
Georgia Pathways
Ambetter (Peach State Health Management)
Anthem Blue Cross Blue Shield of Georgia
Kaiser Permanente
Oscar Health
Cigna
United Healthcare
Unsure
Other Insurance
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4
DO YOU HAVE A MEDICARE POLICY?
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YES
NO
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5
WHAT IS YOUR NAME?
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ENTER FIRST & LAST NAME
First Name
Last Name
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6
WHAT IS YOUR EMAIL ADDRESS?
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example@example.com
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7
Terms and Conditions
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8
WHAT IS YOUR PHONE NUMBER?
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9
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