PATIENT AND CLINIC INFO
Preparing for Your Visit
In order for us to provide the best care for you, it is important that you bring the following items to your visit:
- Insurance cards
- Driver’s license or photo ID
- Relevant xrays or other studies such as MRI’s, CT’s, bone scans, with corresponding reports
- List of medications
- Referral if required by your insurance carrier
Obtaining a complete medical background on every patient is an early important step in your care. You can facilitate this process by accessing patient forms from our practice. You can quickly and conveniently download them below, request them by fax, or pick them up at our office.
Download Patient Forms
To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com
. Please bring your completed forms with you to our office at the time of your visit.
Patient Information Form
Medical Records -
Patient History Form
Privacy Consent Disclosure Form
Notice of Privacy Practice
If you require a copy of your medical record for any purpose, you are required to submit the request in writing on our authorization form
. Under Kentucky law, individuals are entitled to one free copy of their medical record. Once the copies have been provided for free, a charge may be assessed for additional copies. It is the policy of Etown Ortho to charge $1.00 per page for additional copies, and once an authorization is completed, we have 5 to 7 business days to provide the records to you.
Completion of Forms
- Please bring all forms requiring completion by the physician to your appointment. This includes forms for employment, school, sports, disability, etc… There will be a charge of $10.00 per completed form and you should allow 5 to 7 business days for completion. Be sure and let our office staff know if you plan to pick up the form, or any other details on where to send it.
To check the status of forms or medical records, you can contact our office at 270-737-4343 and dial extension 107.
- Appointments are scheduled during regular business hours which are Monday through Friday from 8:30 a.m. to 5:00 p.m. Patients are scheduled by appointment and medical need. You can help us by arriving at or before your scheduled time. We will make every effort to see you on time, however, our physicians are always on emergency call, so emergencies and surgeries may cause unexpected wait times. If this happens, we will try and keep you informed of any delays and if necessary you may reschedule your visit.
If you are a previous patient, appointments are normally scheduled with the physician who treated you during your last visit. It is best that you are treated by the same physician since they know your history and treatment plans,etc…
If the patient is a minor (under the age of 18), they must be accompanied by a legal guardian or have written permission by their legal guardian to be treated. If they come to their appointment without written permission or without someone with them, the appointment will need to be rescheduled.
Prescriptions & Refills
- Requests for prescriptions or refills will only be answered during normal office hours in order to access your medical records and to consult with your physician. Please keep in mind that sometimes your physician may not be available immediately to address your request. To request a prescription refill during normal office hours, contact (270) 737-4343, and dial ext. 117.
After Hour Care
- For assistance after normal office hours, contact our office for instructions on how to obtain care. If you have a serious medical emergency, you should go to your nearest hospital’s emergency room.
Billing And Insurance
Billing & Insurance Assistance -
If you have any questions related to your bill or insurance questions, please contact our billing department at 270-737-4343, dial ext. 109 or 110.
Billing Policy -
Payment is expected for office services at the time they are rendered. Please remember that insurance contracts are between you and your insurance company. Often insurance does not provide the full payment of medical costs. Therefore, the balance of your account becomes your responsibility. We will assist you by processing your insurance claims, but you must understand that you are financially responsible for all charges not covered by insurance and that any insurance benefits received by E-town Ortho will be credited to your account.
If you are not covered by health insurance, then you will be expected to prepay a portion of your office visit at the time of service. This will be discussed with you at the time you make your appointment. This policy also applies if you require surgery. You will be asked to prepay a portion of your surgery up front before surgery is scheduled.
Your Copay -
Co-pays are due at the time of service and are collected before going back to see the physician. If your insurance requires a copay, we are required to collect it based on our agreement with your insurance carrier. If we participate with your coverage, we must collect the copay before each visit. Your appointment will need to be rescheduled if you do not pay your co-payment at the time of service.
Prior Balances -
It is the policy of E-town Ortho to collect payment on prior balances at the time of service. If you have a prior collections balance with us, you will be asked to pay this balance up front before an appointment can be scheduled.
- If you do not have insurance or the insurance company does not fully cover your bill, we can work with you to set up a payment plan to keep your payments current. Please contact someone from our billing department to assist you.