Teresa A. Marlino MD, LLC
OFFICE INFORMATION AND ACKNOWLEDGEMENT
Welcome to Our Practice!
Thank you for choosing Teresa A. Marlino MD, LLC as your women’s healthcare providers. We are committed to providing you with quality health care and to building a successful physician-patient relationship. Below is some important information regarding our office. We ask that you read this carefully, ask any questions you may have and sign in the space provided. A copy will be provided to you upon request.
PHONES
Telephones are answered Monday through Thursday from 8:30am until 5pm. Friday hours are 8:30am until 3pm. We take a 45 minute break for lunch beginning at 12:15pm.
MEDICAL EMERGENCIES
Our practice has full-coverage for patient emergencies that may occur after hours. If an emergency arises during a time when the office is closed, call 610-647-5111 to receive further instructions. Your call will be returned in a timely manner.
PRESCRIPTIONS
All prescription refill requests will be processed in 48 hours. Prescriptions will not be called in after hours or on weekends.
PRE-CERTIFICATIONS
Pre-certifications and referrals for diagnostic facilities can take up to 72 hours for our office and your insurance to process. These will not be done after hours or on weekends. You are required to notify us at least 72 hours in advance of an appointment requiring a referral or precertification.
TEST RESULTS
Should you have any laboratory or diagnostic testing done through our practice, you will be notified of the results as soon as they are available. (usually within 5 working days from the test date). Pap tests can take up to three weeks for results. All results must first be reviewed by the ordering provider. You will then receive a call from the doctor’s assistant with results and/or instructions.
PRIVACY PRACTICES
Notice of Privacy Practices is posted at the check – in area and on our website. Hard copies are also available for all patients upon request. In accordance with HIPAA Privacy Rule, all patients are required to acknowledge receipt of the Notice of Privacy Practices.
By signing this form, I acknowledge receipt of Office Policies and Notice of Privacy Practices. I understand that the Notice of Privacy Practices contains information on the uses and disclosures of any personal health information and I have been given the opportunity to review the Notice. I understand that the terms of the Notice may change and I will be give a revised notice if changes occur. I understand that I may request restrictions on the uses and disclosures of information for the purpose of treatment, payment or healthcare operations. I also understand that Teresa A. Marlino MD, LLC is not required to agree to such requests, but that if it does agree, restrictions are binding.
Patient/Responsible Party Signature______Date______
Print Patient Name______Date of Birth______