Forms
Forms You Can Download
Patient Provider Agreement (PPA)
The health and wellness of our patients is a top concern of this office. Providing the best possible care to every patient is our primary goal. The only way we can meet this goal is if I, your doctor, and you, my patient, work together. This concept is called the Patient Centered Medical Home.
Read more: Patient Provider Agreement (PPA)
Notice of Privacy Practices
This notice describes how health information about you (as a patient of this practice) may be used and disclosed, and how you can get access to your personal health information.
Read more: Notice of Privacy Practices
HIV Testing & Information
The Human Immunodeficiency Virus (HIV) is the virus that causes Acquired Immune Deficiency Syndrome (AIDS). An HIV test will tell you whether you have been infected with the HIV virus.
We offer a rapid test which is performed on a specimen of blood. The results are available to you in about one hour. If you test negative on this test no further testing is necessary and you are negative.
Read more: HIV Testing & InformationConsent Form For HIV Test
The HIV test looks for infection with the AIDS virus.
I understand that if this test shows that I have the HIV virus, I am most probably infected and could spread this to someone else. I could pass the virus to someone I am having sex with, someone I am sharing a needle with, or to my unborn baby if I am pregnant. If the test results are negative for the HIV virus, I understand I might still have the virus but that it is too early to tell by the HIV test.
Transitioning of Medical Care Policy
Prescription Refill Policy
BE WELL MEDICAL CENTER
PRESCRIPTION REFILL POLICY
Date: October 21, 2010
Background: To maintain an efficient office, provide quality medical care, and avoid any possible prescription abuses, an office policy should be maintained and followed for prescription refills. This policy needs to be clearly communicated to the entire staff and all patients.
Policy: All prescription refill requests should originate from the patient by contacting their pharmacist asking to request the refill electronically. All refill requests should be approved or disapproved by our office in 24 hours or less. The reason for any disapproval should be given electronically through RxNT. Routine prescription refills may not be fulfilled during the weekends, so patients need to plan ahead.
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