NEW PATIENT APPOINTMENT FOR A NURSING HOME OR EXTENDED CARE FACILITY RESIDENT


 

Hello, this is Dr. Polley.  Thanks for choosing Polley Clinic.

MAKING AN APPOINTMENT FOR A NURSING HOME OR EXTENDED CARE FACILITY PATIENT

If you need to make an appointment for a nursing home or extended care facility resident, please read this message carefully.

Please have the following information about your resident available when the operator answers your call:

1. All Insurance information.
2. Current demographic information.
3. The CORPORATE FAX NUMBER of the facility to which a complete set of instructions and requirements for your resident’s appointment can be sent.

If you do not have all this information available for the operator, please hang up and call back when you do.

A representative from your institution MUST log on to the Polley Clinic patient portal before your resident’s appointment. Log-in instructions will be sent to your institution’s corporate fax number.

PLEASE BRING THE FOLLOWING REGARDING YOUR RESIDENT TO THE APPOINTMENT:

1. All insurance cards.
2. The patient’s photo ID.
3. Up-to-date medical records.
4. A document stating the problems for which the patient is to be seen, and describing any treatments given.
5. A legible list of the patient’s medications.
6. Money for deductibles, copayments, and any outstanding balance.
7. Any referral forms.

If your resident is governed by a power of attorney because they cannot speak, sign, or make their own medical decisions, the person vested with the power of attorney must accompany the patient to every visit.

THANK YOU FOR PARTNERING WITH US TO PROVIDE THE BEST APPOINTMENT EXPERIENCE.

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