By signing and/or receiving medical services from Nephrology Associates, you agree to the following:

I request payment of authorized Medicare, Medigap, or other insurance benefits to Nephrology Associates, M.D., P.A. for any services provided to me by those physicians and or nurse practitioners; I understand that I will be responsible for any coinsurance, deductible amounts, and any non-covered services.

I hereby authorize Nephrology Associates, M.D., P.A. to release medical or other necessary information required by my private insurance carrier, Medicare, Medigap and its agents to determine benefits for services provided.

This authorization will also permit Nephrology Associates, M.D., P.A. to provide requested information or excerpts from the patients record to any physician, hospital, laboratory, radiological facility, or other health care provider from which the patient has been referred or being referred to support continuity of care.

I understand that I am required to give a 24-hour notice if I wish to cancel my appointment so that my time can be given to another patient. Nephrology Associates, M.D., P.A. reserves the right to charge a $50.00 “no show” fee if I fail to provide this notice.

Additionally, I understand that I have a contract with my insurance company that governs co-payments for office visits. Co-payments must be paid prior to being seen by the physician/nurse practitioner. If co-payment is not received, I may be required to re-schedule my appointment.

This authorization shall remain in effect until revoked by me in writing. A photocopy of this authorization is considered as valid as the original. I certify that I have read and understand the “Financial Policies” and agree to all terms and conditions stated above.

I acknowledge that I have received Nephrology Associates, M.D., P.A. Notice of Privacy Practices, and a personal copy was made available for me.
 

Dear Patients and Families,

We thank you for choosing Nephrology Associate M.D., P.A., and look forward to working with you. We strive to provide the very best care and in order to do so we would like to take this opportunity to acquaint you with our office policies. Please take a few moments to read over the following information. In addition, we suggest you review your health insurance policy and familiarize yourself with the coverage and limitations that it provides.

APPOINTMENTS
We ask that you try to schedule your follow-up appointments as soon as possible - hopefully after each office visit - as routine follow-up time slots are typically booked for several weeks into the future at any given point in time. If you are unable to keep your appointment, please notify our office two working days (48 hours) in advance, so the appointment time can be given to another patient who needs to be seen. Nephrology Associates, M.D., P.A. reserves the right to charge a $50 “No Show” fee if you fail to provide this notice. As insurance does not pay for missed appointments, the patient/guarantor is responsible. Please note that two consecutive missed appointments may result in being discharged from care.

We will try to contact you to confirm each appointment five to ten working days ahead of time. This text/email is a courtesy, and our failure to reach you will not relieve you of your responsibility for any missed appointment charges.

Please make sure our office has the most up-to-date phone number and/or email address, so you receive these notifications. If you are running late for your appointment, please call our office immediately to let our staff know.

CONTINUITY OF CARE
Please provide us with a list of physicians that should receive copies of your chart notes, labs, and other medical records. We want to make your healthcare journey as smooth as possible and keep everyone on the same page.

PRESCRIPTIONS
If you are on medication, please request any needed renewal prescriptions at the time of your appointment. In general, you will be provided with enough refills to last until your next expected appointment. If you do require refills between appointments, please contact us during regular phone hours 8:30 AM to 4PM Monday through Thursday and 8:30AM to 11:30AM on Friday.

Please notify our office of the need for a prescription three business days in advance, as we do not provide “emergency fills.”

Please bring a list of all of your current prescriptions and over-the-counter medications you take to each appointment.

LABS
When you have your follow-up appointment, you must complete labs 2 weeks prior, and some patients may have regular interval labs scheduled. Three of our offices have partnered with Quest labs and provide the ability to get your labs completed at the same place you have your appointment. The offices are: Olathe, Shawnee/Georgetown, and NKC. Please call our office for lab hours of operation.

You may also go to any lab of your choosing. If you go to an outside lab, please tell us what lab you have gone to so we can track the results and provide them at your appointment. We will also fax the lab order to any lab of your choosing. Before you go or while you are at the lab, please alert our office, and we will fax the lab order right over, if you do not have a copy of it.

Our nurses give you a call 2 weeks before your appointment to remind you to do your labs. This is a courtesy they provide. If they leave a message, please call back and let us know where the labs were done.

For 24-hour urine collection, please make sure to turn these in at least 2 weeks before your appointment as some of these tests take longer to process.

LETTERS AND FORM COMPLETION
We require a minimum of 48 hours for all letters and form completion. Any information that you would like forwarded to another provider, school, attorney, employer, etc. requires a signed release of information. In some cases, we may require you to schedule an appointment for the completion of these forms. Please contact our office to inquire whether a scheduled appointment will be necessary. There may be a fee associated.