Please note for the following types of insurance, we cannot schedule an appointment for you until we have received a REFERRAL from your Primary Care Physician as your insurance requires this. Please contact your PCP and ensure they have submitted this to our office before you attempt to schedule an appointment:
KAISER ADDED CHOICE
ALL HMO PLANS
Please note that we do not currently accept the following Insurance plans:
Assignment of Benefits:
I request that payment of authorized Medicare or Private Benefits be made on my behalf to Portner Orthopedic Rehabilitation Inc. for any services furnished to me by that Provider.
I hearby authorize the release of medical information requested for completion of medical claim forms for the above mentioned insurance companies covering services redered to the patient.
I understand that failure to cancel any appointment at least 24 hours in advance may result in a no-show fee for the appointment that was given to me.
Everyone at Portner Orthopedic Rehabilitation is pleased you have chosen us to be your health care provider. We are committed to maintaining your health and to be your partner during the recovery process. To help us be a better resource for you, please take a few moments to read over our office policies. Should you have any questions, please feel free to ask any one of our staff members.
WHAT IS A PHYSIATRIST PHYSICIAN?
Physiatrists, or rehabilitation physicians, are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move
Rehabilitation physicians are medical doctors who have completed training in the medical specialty of physical medicine and rehabilitation (PM&R). Specifically, rehabilitation physicians:
Diagnose and treat pain Restore maximum function lost through injury, illness or disabling conditions Treat the whole person, not just the problem area Lead a team of medical professionals Provide non-surgical treatments Explain your medical problems and treatment/prevention plan
The job of a rehabilitation physician is to treat any disability resulting from disease or injury, from sore shoulders to spinal cord injuries. The focus is on the development of a comprehensive program for putting the pieces of a person's life back together after injury or disease – without surgery.
Rehabilitation physicians take the time needed to accurately pinpoint the source of an ailment. They then design a treatment plan that can be carried out by the patients themselves or with the help of the rehabilitation physician’s medical team. This medical team might include other physicians and health professionals, such as physical therapists. By providing an appropriate treatment plan, rehabilitation physicians help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions
Portner Orthopedic Rehabilitation is miles apart from many healthcare experiences you have had. We pride ourselves on our "patient centered" approach. One of the first things you will notice is that unlike other medical office’s we run strictly “on time” for our schedule. We rarely ask patients to wait past their appointment time for intake. In order to provide this service we must insist that all patients must check in for their appointments 30 (thirty) minutes early for new patients and 10 (ten) minutes early for follow up visits. This time is needed for intake by the doctors staff, to collect copayments, paperwork, insurance information, etc. If you come earlier and we can accommodate you early, we will. However, patients who arrive late for their appointment are subject to being rescheduled and billed a fee. Please refer to Portner Orthopedic Rehabilitation’s detailed policy on missed appointments for more information. http://portnerorthopedic.com/new-patient-forms For our regular patients requiring "same-day" scheduling, we often keep a few time slots open daily for that purpose.
GETTING THE MOST FROM YOUR VISIT
- Bring a complete list of ALL of your medications and supplements with you to all Doctor’s visits
- Try to focus on only the problems you reported while being scheduled during each visit to ensure your problem gets the attention it deserves. Any other problems will require a separate appointment.
- Please inform the nurse if you have had lab work or tests to review with the doctor
Please note, patients are not always seen on a "first come, first serve" basis. Although we try to adhere to our schedule as closely as possible, sometimes the severity of one's condition may warrant modification. We appreciate your understanding.
COURTESY TO OTHER PATIENTS
Many of our patients suffer from respiratory problems, allergies, migraines, etc., As a courtesy to those patients please:
- Refrain from wearing perfumes or cologne to your office visit
- Place all cell phones and mobile devices on silent upon entering the clinic and limit all phone conversations and food consumption to outside the clinic
- Bathe or shower appropriately before your visit
- If you have a cough or believe you have a contagious illness, please inform the receptionist and wash your hands upon arrival and at departure
We are happy to address your questions or concerns via telephone whenever possible. Our focus in the clinic is providing excellent service, however, please note that sometimes the staff will be unable to answer patient phone calls. To address this, we have designed a detailed phone system which allows us to track all messages to ensure you always get a call back. Do not be afraid to leave us a detailed message and provide a reasonable amount of time before you follow back up with us. Please do not get frustrated if you cannot get the staff on the phone immediately. Our staff operates most efficiently by utilizing our messaging system and electronic requests from our Website. We would like to provide many convenient options for patients to communicate with our staff and so provide many of the services you need right from our website. You can request medication refills, medical or billing records, appointments, and all manner of other items. Please visit http://portnerorthopedic.com/new-patient-forms to get started.
For those issues that can be resolved via telephone however, we strive to address them by the conclusion of each business day. However, unexpected circumstances do occasionally occur so please allow at least one full business day for answers to telephone inquiries.
We ask that you utilize the online medication refill request on our website for routine medication refills. Please visit http://portnerorthopedic.com/new-patient-forms to get started.
If you are unable to use the website you may also call the office (not your pharmacy) during regular business hours for routine medication refill authorization. Conversely, we kindly request that you contact the pharmacy to inquire when they are ready (not our office). As previously noted, it may take up to 1-2 business days for refill requests to be processed. Thus, we kindly ask that you do not wait until you are nearly out of your medication before requesting a refill. If it has been more than a year since your last visit, we may not be able to refill your medication without an appointment first.
LAB AND TEST RESULTS
Although we will make every effort to contact you regarding your lab or test results, please do not assume that "no news is good news." Occasionally, due to factors beyond our control, results do not get sent to our office or rarely become lost. Thus, it is your responsibility to follow-up on the results of your tests particularly if you have not heard back from us in a timely manner.
Please be aware that although Portner Orthopedic Rehabilitation does manage ACUTE pain, e.g., injuries, flare-ups, etc., we do NOT manage chronic, non-malignant pain, so please do not ask to make you an exception. If you require management of your chronic, non-malignant pain, we can refer you to a pain management specialist. Under NO circumstance can we prescribe ANY controlled substance without an office visit. Due to federal regulations, we must notify local law officials of any patient suspected of "doctor shopping," diverting and/or misusing controlled substances.
OFFICE HOURS / AFTER HOURS
Our office is open Monday through Friday from 7:00AM until 6:00PM and Saturdays from 8:00AM until 12:00PM. As noted previously, it is inappropriate to treat you without a proper exam, thus medical advice that can be provided by telephone is very limited. IF YOU HAVE AN EMERGENCY, PLEASE GO TO THE EMERGENCY ROOM OR CALL 911!
Throughout the year, there are times when we take vacations or we are away continuing our education. If issues arise during these times, or if you need to be seen, one of our other providers will be pleased to see you in the office. We will do our best to give you advance notice when these times occur.
If you need a chaperone, i.e., someone to accompany you at any time during your visit, please inform the receptionist, and/or nurse and one will be provided. There will also be occasions when our staff requests a chaperone as well.
GIFTS FROM PATIENTS
We appreciate all of our patients who wish to thank us for our care with a gift. In fairness to all our patients however, it is our policy not to accept gifts of any kind from our patients. Instead, we suggest that if you feel compelled to give a gift because you are pleased with the care you received from our staff, that you write a testimonial about your experience which we may share with other potential patients.
We love children, however it is against our policy to allow patients to bring their children with them to appointments and leave them unsupervised in any area of the clinic or waiting room at any time. Please arrange child care before you schedule an appointment or ask someone to come with you to you appointment to supervise your children. Anyone accompanying a patient who causes a disturbance may be asked to leave the premises at any time.
Please be prepared to pay for any applicable insurance copayments or deductibles upon check in for your appointment. Your scheduling staff or reception can provide you with an estimate of the amount due. Please note that any past due balances must be settled before new appointments can be scheduled. If you have questions, please don’t hesitate to reach out to us via email, website contact, or telephone.
Notice Of Privacy Practices: Please Read Carefully
As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE ) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (HPI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your HPI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.
We realize that these laws are complicated, but we must provide you with the following important information:
The terms of this notice apply to all records containing your HPI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.
B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (HPI) IN THE FOLLOWING WAYS
The following categories describe the different ways in which we may use and disclose your HPI.
1. Treatment. Our practice may use your HPI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your HPI in order to write a prescription for you, or we might disclose your HPI to a pharmacy when we order a prescription for you. Many of the people who work for our practice – including, but not limited to, our doctors and nurses – may use or disclose your HPI in order to treat you or to assist others in your treatment. Additionally, we may disclose your HPI to others who may assist in your care, such as your spouse, children or parents.
Finally, we may also disclose your HPI to other health care providers for purposes related to your treatment.
2. Payment. Our practice may use and disclose your HPI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your HPI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your HPI to bill you directly for services and items. We may disclose your HPI to other health care providers and entities to assist in their billing and collection efforts.
3. Health Care Operations. Our practice may use and disclose your HPI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your HPI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. We may disclose your HPI to other health care providers and entities to assist in their health care operations.
OPTIONAL (if applicable to practices):
4. Appointment Reminders. Our practice may use and disclose your HPI to contact you and remind you of an appointment.
OPTIONAL (if applicable):
5. Treatment Options. Our practice may use and disclose your HPI to inform you of potential treatment options or alternatives.
6. Health-Related Benefits and Services. Our practice may use and disclose your HPI to inform you of health-related benefits or services that may be of interest to you.
7. Release of Information to Family/Friends. Our practice may release your HPI to a friend or family member that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter take a child to the pediatrician’s office for treatment of a cold. In this example, the babysitter may have access to this child’s medical information.
8. Disclosures Required By Law. Our practice will use and disclose your HPI when we are required to do so by federal, state or local law.
D. USE AND DISCLOSURE OF YOUR HPI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may use or disclose your identifiable health information:
1. Public Health Risks. Our practice may disclose your HPI to public health authorities that are authorized by law to collect information for purposes such as:
2. Health Oversight Activities. Our practice may disclose your HPI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
3. Lawsuits and Similar Proceedings. Our practice may use and disclose your HPI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your HPI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain a court or administrative order protecting the information the party has requested.
4. Law Enforcement. We may release HPI if asked to do so by a law enforcement official:
5. Deceased Patients. Our practice may release HPI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.
6. Organ and Tissue Donation. Our practice may release your HPI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
7. Research. Our practice may use and disclose your HPI for research purposes in certain limited circumstances. We will obtain your written authorization to use your HPI for research purposes except when an Internal Review Board or Privacy Board has determined that the waiver of your authorization satisfies the following: (i) the use or disclosure involves no more than a minimal risk to your privacy based on the following: (A) an adequate plan to protect the identifiers from improper use and disclosure; (B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (C) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted; (ii) the research could not practicably be conducted without the waiver; and (iii) the research could not practicably be conducted without access to and use of the PHI.
8. Serious Threats to Health or Safety. Our practice may use and disclose your HPI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
9. Military. Our practice may disclose your HPI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
10. National Security. Our practice may disclose your HPI to federal officials for intelligence and national security activities authorized by law. We also may disclose your HPI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
11. Inmates. Our practice may disclose your HPI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.
12. Workers’ Compensation. Our practice may release your HPI for workers’ compensation and similar programs.
You have the following rights regarding the HPI that we maintain about you:
1. Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Peter Wisiorowski (808) 596-7300 firstname.lastname@example.org specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your HPI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your HPI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your HPI, you must make your request in writing to Peter Wisiorowski(808) 596-7300 email@example.com. Your request must describe in a clear and concise fashion:
(a) the information you wish restricted;
(b) whether you are requesting to limit our practice’s use, disclosure or both; and
(c) to whom you want the limits to apply.
3. Inspection and Copies. You have the right to inspect and obtain a copy of the HPI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to in order to inspect and/or obtain a copy of your HPI. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to Peter Wisiorowski (808) 596-7300 firstname.lastname@example.org. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the HPI kept by or for the practice; (c) not part of the HPI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.
5. Accounting of Disclosures. All of our patients have the right to request an "accounting of disclosures." An "accounting of disclosures" is a list of certain non-routine disclosures our practice has made of your HPI for non-treatment, non-payment or non-operations purposes. Use of your HPI as part of the routine patient care in our practice is not required to be documented. For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to Peter Wisiorowski(808) 596-7300 email@example.com. All requests for an "accounting of disclosures" must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact Peter Wisiorowski (808) 596-7300 firstname.lastname@example.org.
7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact Jaimie Fujioka. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your HPI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your HPI for the purposes described in the authorization. Please note, we are required to retain records of your care.
Again, if you have any questions regarding this notice or our health information privacy policies, please contact Peter Wisiorowski(808) 596-7300 email@example.com