• Our Code of Conduct for our practice outlines what we can all do to keep our patients, staff, and visitors safe while in the clinic and being care for by this practice. In order to provide the best environment for patient care, we expect: Everyone to create a safe, inclusive, equitable and healing environment. By doing so the prohibited of guns, weapons of any sort, use of force, profanity, harassment, physical abuse, verbal abuse via in person, email, phone, text, and etc. These types of threats and/or violations are enforced for all patients, family, or any association with patient (s).

• Respect and Dignity: You have the right to be treated with respect, courtesy, and consideration at all times, regardless of your age, race, gender, religion, national origin, sexual orientation, or any other characteristic.

• Privacy and Confidentiality: Your medical information will be kept confidential and will not be disclosed without your written consent, except as required by law. You have the right to review and request a copy of your medical records. 

• Informed Consent: You have the right to be informed about your medical condition, treatment options, potential risks, and expected outcomes. You can make decisions about your care after understanding all relevant information.

•  A fee of $85 (follow up) for each missed appointment, or if there is failure to give at least a 24-hour notice of a cancellation, regardless of whether the appointment is covered by your insurance plan, or self-pay. Your insurance plan will not cover missed appointment fees. If there are three (3) missed appointments termination from practice will occur.

• Account balances may prevent services from being continued and should be discussed with your provider as needed. In some instances, it may be possible to utilize a payment plan to address concerns related to outstanding balance, however this is not always possible or guaranteed. Self-termination or termination of care by the practice does not exempt debt that is owed.

• It is important to promptly inform the front office staff and/or provider of any changes in insurance coverage, including changes in policy, coverage termination, or a change in the primary insurance holder. 

• Additional Charges: These services and their related charges are not covered by insurance and could include but are not limited to: • FMLA Paperwork: $55.00, Disability Paperwork: $50.00, Copying of Records: $0.30 per page, Letters (1-3 pages): $55.00.

• Controlled substance: All patients will undergo medical tests and examinations before and during treatment at Advanced Clinicians Specialty Services. Those tests will include random unannounced checks for drugs on less than 24-hour notice and psychological evaluations if and when it is deemed necessary. When establishing care informed consent is given (by patient) to perform the tests or/ and if refusal to sign at the time of establishing care or give sample or undergo evaluation this may lead to not being able to establish care or termination of treatment once refusal is made. The presence of unauthorized substances or the absence of authorized medication(s) may result in my being discharged from Advanced Clinicians Specialty Services. 

• Refills: There is a $35 fee for medication refills necessary in between scheduled appointments that will be automatically charged to the credit card on file. 

• Identification: All patients are required a valid ID before services are rendered.

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