Hi, you must be NAME/ Great to meet you, my name is CA NAME.  We’ve been expecting you for your new patient exam at TIME.  How are you today?

Have you had a chance to fill out your new patient paperwork? #

• Yes

  Great! I’ll take that paperwork for you now.

  💡

  Give patient HIPPA Packet.

  Just a couple more places for you to sign here. This is paperwork that will ensure you understand that you are responsible for payment for today’s exam. This is the cost (since you are getting this special rate, you’ll pay AMOUNT for your exam today) plus the cost of any x-rays the doctor recommends. Those are AMOUNT per view.

  Next you will see information about how we follow HIPPA procedures and Privacy Policy and protect your rights. Please check that we can keep records here in our office. You can add any names of those we can share these files with and sign there on the bottom.

• No

  Give patient the clipboard with the HIPPA Pack first.

  Just a couple places for you to sign here. This is paperwork that will ensure you understand that you are responsible for payment for today’s exam. This is the cost (since you are getting this special rate, you’ll pay AMOUNT for your exam today) plus the cost of any x-rays the doctor recommends. Those are AMOUNT per view.

  Next you will see information about how we follow HIPPA procedures and Privacy Policy that protect your rights. Please check that we can keep records here in our office. You can add any names of those we can share these files with and sign there on the bottom.

  If patient is over 65 give them the ABN form.

  • ABN Form Script

    This explains that since we are a cash practice, we do not file with insurance. Medicare will not cover the preventative and wellness care that we provide in our office , because of this we do not file or allow filing of documents for reimbursement. Sign here to signify that you understand that.

  💡

  When they return the HIPPA give patient the NP Paperwork

  If you would please take a seat and take five minutes to complete both sides as completely as you can.  The first page is front to back and please make sure to sign and date the last page at the bottom.  I will take it back when you’re done!

If New Patient is taking too long to fill out paperwork or is late, follow our NP Slow/Late Procedure: