New Patient Forms
Welcome to Women's Comprehensive Clinic for Internal Medicine. We appreciate you as our patient and value your time. Registration and disclosure forms are availabel for download to expedite your appoint. If you are unable to fill out the forms prior to your arrival we recommend you arrive 10 minutes before your appointment time
Office Practices and Policies
To better serve our patients, we have established the following practice guidelines. Questions regarding any office policy can be directed to any of our office staff.
Our contracts and agreements with commercial insurance companies and health plans require us to collect all co-payments and deductible amounts at the time of service. Therefore, payment is expected at the time of arrival. If payment is not made at the time of the scheduled appointment, a $10.00 administrative fee will be assessed. This fee will not be billed to your insurance company. A $25.00 fee is assessed for all checks returned by your bank (e.g., NSF, stop payment).
Missed Appointments ("No Shows") and Cancellations
Women’s Comprehensive Clinic for Internal Medicine understands that there are times when you must miss an appointment due to emergencies or obligations for work or family. However, when you do not call to cancel an appointment, you may be preventing another patient from getting much
needed treatment. Conversely, the situation may arise where another patient fails to cancel and we are unable to schedule you for a visit, due to a seemingly “full” appointment schedule.
A “no show” is defined as a scheduled appointment that the patient does not keep. Patients are expected to call to cancel if they cannot make a scheduled appointment.
First occurrence: Patient will be charged a $20 fee.
Second occurrence: Patient will be charged a $30 fee.
Third occurrence: Patient will be charged a $50 fee. Patient will be discharged from the care of Women’s Comprehensive Clinic for Internal Medicine, PLLC and assisted in the transfer of their records to another doctor.
All scheduled appointments require and should be cancelled at least 24 hours prior to the appointment time. Any appointments cancelled less than 24 hours prior to the scheduled appointment time will be charged a $20 fee.
Test Results Policy
Managing test results effectively is vital to quality patient care, failure to follow up on test results can lead to patient harm. When ordering a test, physicians are expected to explain the significance of the test to their patients. When in receipt of a normal result, physicians should communicate the result to their patient. When in receipt of a clinically significant result, physicians are expected to communicate that result to their patient in a timely fashion, and ensure the patient understands the significance of the tests. It is important to provide the patient an opportunity to ask questions, and demonstrate understanding, thus he /she can be involved in the management of their own test results and be an active participant in their own care. When a physician receives a clinically significant result for a test that he or she has ordered, the physician is expected to take appropriate action and follow-up with the patient.
We do not follow “no news is good news” policy. You will receive notification of your labs. In the event there are clinical significant results you will be given a recommendation to make a follow up appointment to discuss your results in detail with Dr. Castoreno. If you are unable to follow up, or choose not to follow up we cannot release test results to you as we cannot ensure accurate interpretation or follow up. We can forward these to your primary care physician or specialist. In the event your labs are normal or not clinically significant you will be notified, and copies will be provided for your records. If you have any questions regarding any test result we encourage you to set up an appointment with Dr. Castoreno for detailed discussion.
Abnormal Test Result: is a term used by medical laboratories and other diagnostic centers to refer to a result that falls outside of a pre-determined normal range. Abnormal test results are not always necessarily clinically significant.
Clinically Significant Test Result: is a result determined by a physician based on his or her clinical judgment to be one which requires follow-up with appropriate urgency and or recommended schedule. A physician will determine clinical significance based on his or her knowledge of the patient’s symptoms, previous test results, and/or diagnosis.
Discontinuation of Treatment
Discontinuation of the services provided by our professional staff will be addressed should one of the following reasons occur: a) non-adherence with treatment recommendations, b) repeated cancelations or late arrivals to your scheduled appointments, c) not meeting your financial obligation for services rendered, and/or d) violating an appropriate code of conduct. You can discontinue treatment with any of the providers at any time in person, by phone, or in writing. We ask that you please inform us so that we may forward your records to your new physician.
Copy of Records
If you would like your physician or other professional to obtain a copy of your record, a release of information must be signed. The requesting party will be responsible for any fees. When applicable, the charge for copies of your medical records is $25.00 for the first 20 pages and .50 cents for each additional page in excess of 20 pages. All fees must be paid in advance.
Physician Certifications / FMLA
There will be a $25.00 charge for the first page and $5.00 for each additional page for the completion of forms or reports for someone other than your health insurance. This charge must be paid in advance. If the form can be completed as part of your visit, there may be no charge.
Our Doctor do not participate in disability certifications or evaluations. This consists of individuals pursuing long-term disability and who have been out of work because of medical conditions.
Prescriptions are generally written in a quantity to last until the next scheduled appointment. It is our policy not to refill prescriptions outside of scheduled appointments. If it does become necessary for a refill to be written or called in to your pharmacy due to you not keeping a scheduled appointment, a charge of $20.00 may be assessed. A $30.00 charge will be applied if a prescription for a controlled substance must be rewritten due to the loss or expiration of that prescription. Requests for prescription refills may be called in during business hours, requested via patient portal or faxed by your pharmacy. A minimum of 48-72 hours is typically required for the prescription refill to be approved. Urgent prescription refills can be issued for a $30.00 fee. In general, prescription refills cannot be ordered or approved after business hours because your physician and chart may not be available.
Controlled Substance disclosure.
Due to the increase abuse and addiction of prescription drugs categorized as schedule I-V controlled substances, Women’s Comprehensive Clinic for Internal Medicine, PLLC does not provide any long term narcotic painkillers, sedatives, tranquilizers or stimulants. We apologize for the inconvenience and will assist in appropriate referrals whenever possible. Additionally no refills will be provided on above stated medications. Administrative fees applied to triplicates if required.