Policies

To best serve your healthcare needs and to make your experience at Premier Family Medical as pleasant as possible, we have compiled the following information.

Patient Responsibilities: (click on + to read more)

• Specific appointment times are made for the convenience of both you and the providers. Patients should arrive 15 minutes prior to their scheduled appointment to allow receptionists to update insurance, address, and telephone information. Late arrivals (in excess of 15 minutes past appointment time) may be asked to reschedule the appointment. If you must cancel an appointment, please call in advance, preferably at least 24 hours, so that we may release that time to another patient. For missed appointments without providing at least 24 hours notice a charge of $50 will be applied. We know that your time is valuable and we will make every effort to honor all of our commitments. However, the nature of medical practice is such that unexpected emergencies do occur, causing occasional delays. We will keep you informed when these delays happen. Rest assured, should you become acutely ill, we will also make time for you.
• Your insurance company requires you to present your insurance card at each visit. Some insurance companies require that you officially change your primary care physician when switching to a different practice. This is your responsibility and must be done before you schedule an appointment with our office.
• It is vital that you keep our office informed of any changes that affect your insurance coverage. Please notify us of any changes in:
• Name, address or telephone number
• Insurance provider
• Number of family members
• Medical condition(s)

Incomplete or incorrect insurance information can lead to your having to pay more for your visit. Also, please inform us of any Emergency Room evaluation or Hospital admission since your last visit..

• Co-pays are to be paid at the time of service, before seeing the provider. The co-pay is part of the payment that Premier Family Medical receives for the service provided to you. It is to be paid for each visit, regardless if you scheduled your appointment upon the provider’s request of a follow-up exam, upon you own request for a new problem, or any other service provided by a health care professional.
• Please bring an updated list of all medications you are taking or the bottles of these medications with you to each appointment.
• Your insurance policy may not cover the medications, procedures or lab work your provider feels are necessary. Every insurance plan is different. Please take time to educate yourself on the terms of your insurance policy before your appointment.
• Scheduled appointments are preferred. Walk-in patients will be evaluated and worked into the schedule if an appointment is necessary and a provider is available.
• We will make every effort to make certain that the services we recommend are covered by your insurance policy. Questions regarding your insurance coverage should be directed to your insurance carrier or your employer’s human resources department.
• If you have any forms that need to be completed for school, work, or insurance purposes, please remember to bring them to your provider at the time of your visit. You will be charged $45 for the completion of a form if it is not presented during an office visit. You will be charged $10 for the completion of a form presented during an office visit.
• All patients under 18 years of age must be accompanied by a parent, legal guardian, or have signed parental/legal guardian consent for treatment.

Refills: (click on + to read more)

Refills of existing prescriptions will be filled within 2 business days of receipt of the request. You may need to see your provider prior to a full refill being given. To request refills, call the office at (973) 403-3200, 24 hours a day. Talk to the receptionist or leave a clear message with your name, date of birth, name of the medication, dosage, frequency of administration. We also need your prescription number and pharmacy phone number. Patients are asked to call us with their refill request during regular weekday office hours and to call ahead of time before the medication supply runs out to avoid gaps in the treatment. When the medication needs to be filled on regular basis for the treatment of a chronic condition (e.g. diabetes, hypertension, osteoporosis, hypercholesterolemia, etc.), we require regular office visits to insure proper treatment and follow up. If you did not return to the office within the requested time frame, we will provide supply for a few days only, so that you will have enough time to schedule your follow up visit and then get your full refill.

Refill of controlled drugs: (click on + to read more)

Refill of controlled drug prescriptions (narcotics, sedatives) will be limited to those originated at Premier Family Medical until we review copies of your prior physician’s records. Formal, written and signed medication plans or referral to a pain management specialist may be required for ongoing controlled drug use.

Telephone calls to the office: (click on + to read more)

When calling our office, the receptionist, the secretary or the medical assistant will be able to handle your request most of the times (e.g. need to schedule an appointment, need a referral, need the report of a test, etc.). Please do not ask to talk personally to the health care professional unless you have an immediate, serious necessity related to a change in your health condition that requires immediate medical attention. Personal interactions with the health care professional are, in general, much better handled during a scheduled visit at the office. If the ancillary personnel cannot handle your request for some reasons, please leave a message for the provider. When a call-back from a provider is necessary, this will be done as time allows, usually after clinic hours are complete.

Email: (click on + to read more)

Email correspondence is accepted, but may not be secure on your end. We do not check email messages often enough to assure prompt response in regards to immediate/urgent problems you may be experiencing. Urgent issues should only be communicated either in person or by phone. For emergencies, call 911. All email messages and responses will be posted in the patient’s chart for documentation purposes.

Patient ID: (click on + to read more)

A copy of your picture ID is required at your first visit for identification purposes. This is a safeguard for you and for us. The copy will be kept in your medical record in a confidential manner. The picture ID must be an official document currently valid. We will need a new copy of your picture ID in case you change your address or your name. Please notify us if such a change occurs.

Referrals: (click on + to read more)

For more specialized care, your primary care provider may refer you to another physician. Most insurance companies require an official referral from your doctor in order for their charges to be covered. In order to ensure insurance coverage, please discuss referrals to other physicians or ancillary services with your primary care provider before scheduling an appointment. Each insurance company has different policies regarding referrals for specialist visits and ancillary services. Please review your insurance booklet so you will know the requirements of your insurance company. When your primary care provider refers you to a specialist or for an ancillary service, our referral office will notify your insurance company if a referral is required. A copy of the referral will also be faxed to the specialist. If you call our office to request a referral, you will be asked to see your primary care provider to discuss your referral and ensure insurance coverage. If the referral is authorized, our office will follow your insurance company requirements and will also notify the specialist. If the referral is not authorized, you will be notified. Our office needs at least 72 business hours to process referral requests. Our office cannot authorize or process retroactive referrals. If you see another physician outside of our office, you go to the Emergency Room for evaluation, or you get admitted to a hospital where your family doctor has no admitting privileges, please notify us so that we can keep your records current and provide appropriate follow-up care.

Reports of tests and blood work: (click on + to read more)

You are required to schedule a follow up exam in a reasonable amount of time after a test or blood work has been ordered, so that the report can be discussed with the provider. If you did not schedule your follow up appointment, you will be asked to return to the office for a follow up exam upon communicating the test report over the phone. Reports of tests and blood work, especially if abnormal, can be briefly summarized on the phone, but cannot be discussed over the phone. For correct provider/ patient relationship a personal face to face interaction is deemed necessary, to insure privacy, documentation, better understanding and explanation, adequate follow up, accurate and thorough planning if further action needs to be taken, etc. In special occasions, and especially when the test does not show any abnormal findings, the provider may waive the follow up exam. Premier Family Medical will interact directly with the patient when the test or the blood work has been ordered by one of the providers working in this practice. When you see an outside physician in consultation, we may have a copy of tests or blood work reports forwarded to us as, but is much more appropriate to discuss the report with the physician who ordered or performed the test.

Care after hours, weekends, and holidays: (click on + to read more)

For life-threatening emergencies, please call 911. A provider is on-call at all times in the event that a serious illness develops or you have a very urgent matter that cannot wait until regular office hours. When a patient calls the office at (973) 403-3200 after hours, the answering machine will provide the dispatch service’s telephone number. When you call the dispatch service, the operator will take your name, phone number, and the message you want to convey to the provider. The on-call provider will respond as quickly as possible to assist you with your problem. Please make sure you give a correct call back number to the operator and you answer your phone when the on-call provider returns your call. If you don’t receive a call back within the hour, check the correct functioning of your phone, call the dispatch service again and specify that this is your second call, providing again your name, phone number and reason for your call. Please use after hours calls for emergencies only. The on-call physician will not schedule appointments, provide test results, prescribe medications or authorize refills, including refills for pain medications and antibiotics. Routine requests are handled only during office hours.

Emergency care: (click on + to read more)

Dial 9-1-1 in a life-threatening emergency. Otherwise, call us before going to the Emergency Department. Many urgent care services can be provided right in our office, including stitches, acute asthmatic conditions, strains, sprains and other minor emergencies. Most insurance companies require prior approval for reimbursement of emergency visits, ambulance and other emergency services.

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

OUR PROMISE TO YOU, OUR PATIENTS:

Your information is important and confidential. Our ethics and policies require that your information be held in strict confidence.

We maintain protocols to ensure the security and confidentiality of your personal information. We have physical security in our building, passwords to protect databases, compliance audits, and virus/intrusion detection software. Within our practice, access to your information is limited to those who need it to perform their jobs.At Premier Family Medical, PC, we are committed to treating and using protected health information about you responsibly.

This Notice of Privacy Policies describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective April 14, 2003, and applies to all protected health information as defined by federal regulations.

Although your health record is the physical property of Premier Family Medical, PC, the information belongs to you.

You have the right to:

• Obtain a paper copy of this Notice of Privacy Policies upon request,
• Inspect and obtain a copy of your health record as provided by 45 CFR 164.524 (reasonable copy fees apply in accordance with state law),
• Amend your health record as provided by 45 CFR 164.526, obtain an accounting of disclosures of your health information as provided by 45 CFR 164.528,
• Request confidential communications of your health information as provided by 45 CFR 164.522(b), and
• Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522(a) (however, we are not required by law to agree to a requested restriction).

If you have questions and would like additional information, you may contact our practice’s Privacy Officer, Vito Mazzoccoli, MD, at (973) 403-3200.

If you believe your privacy rights have been violated, you can either file a complaint with Vito Mazzoccoli, MD, or with the Office for Civil Rights, U.S. Department of Health and Human Services (OCR). There will be no retaliation for filing a complaint with either our practice or the OCR. The address for the OCR is as follows:

Office for Civil Rights

U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, D.C. 20201

Each time you visit Premier Family Medical, PC, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

• Basis for planning your care and treatment,
• Means of communication among the many health professionals who contribute to your care,
• Legal document describing the care you received,
• Means by which you or a third-party payer can verify that services billed were actually provided,
• Tool in educating heath professionals,

• Source of data for medical research,
• Source of information for public health officials charged to improve the health of the state and nation,
• Source of data for our planning and marketing, and
• Tool by which we can assess and continually work to improve the care we render and outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy: better understand who, what, when, where, and why others may access your health information; and make more informed decisions when authorizing disclosure to others.

Our Practice is Required to:

• Maintain the privacy of your health information,
• Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you,
• Abide by the terms of this notice,

• Notify you if we are unable to agree to a requested restriction, and
• Accommodate reasonable requests you may have to communicate your health information. We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain.

We will keep a posted copy of the most current notice in our facility containing the effective date in the top, right-hand corner. In addition, each time you visit our facility for treatment, you may obtain a copy of the current notice in effect upon request.

We will not use or disclose your health information in a manner other than described in the section regarding Examples Of Disclosures For Treatment, Payment, And Health Operations, without your written authorization, which you may revoke as provided by 45 CFR 164.508(b)(5), except to the extent that action has already been taken.

We will use your health information for treatment. (click on + to read more)

For example:

Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.

We will also provide your other physician(s) or subsequent health care provider(s) (when applicable) with copies of various reports that should assist them in treating you.

We will use your health information for payment. (click on + to read more)

For example:

A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

We will use your health information for regular health operations. (click on + to read more)

For example:

Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

Business Associates (click on + to read more)

There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department and radiology, certain laboratory tests, and a transcription service we use to transfer dictated patient care into the medical record. Due to the nature of the business associates’ services, they must receive your health information in order to perform the jobs we’ve asked them to do. To protect your health information, however, when these services are contracted we require the business associate to appropriately safeguard your information.

Research (click on + to read more)

We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Funeral directors (click on + to read more)

We may disclose health information to funeral directors to carry out their duties consistent with applicable law.
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Organ Procurement Organizations (click on + to read more)