Outpatient Therapy Orientation
v3.0
Franciscan Health Pediatric Therapy
POLICIES FOR TREATMENT AND SCHEDULING
Patients are responsible to know their insurance benefits. Each provider has differences in coverage.
Verify your insurance coverage includes
FRANCISCAN St. James Health
as a service provider.
Please notify the front desk staff of any changes to your insurance. This should be checked each month to ensure proper coverage.
NO CELLULAR PHONE USE IS ALLOWED IN OUR FACILITY- PLEASE TURN THEM
OFF
Proper attire is required for therapy treatment. You will need to be able to expose the area of injury for treatment.
Proper footwear is required for therapy treatment.
No high heels.
Patients only
will be allowed in the treatment area.
Guests
will wait in the lobby during the time of treatment.
Appointment times are important to effectively treat your condition by our therapy staff. Please arrive 15 mins. before your appointment time to ensure a full treatment can be provided.
Please sign-in for each visit you attend.
Please check-in with the front desk if you arrive late or very early for your visit, so they can notify the therapist.
Appointment scheduling at the front desk is the responsibility of the patient. Appointments can be scheduled after the time of the initial evaluation and a plan of care is established with the treating therapist.
We require
24-HOUR NOTICE
for any cancellation of an appointment. A fee will be charged for failure to comply. $50.00 for an evaluation. $25.00 for a missed appointment.
If you must cancel appointments, please attempt to reschedule the appointment the same week or add a visit to the following week to make up the missed appointment.
Attendance is needed to effectively treat your condition.
3 cancellations, no shows or any combination within 30 days will result in termination of your therapy program.
Your appointments will be cancelled and you must return to your physician to restart your therapy.
Worker's compensation patients, who fail to comply with the physician's recommended appointments, will have their governing parties notified for each appointment cancelled or not attended.
Please inform your therapist of all return visits to your physician.
My signature below indicates my willingness to comply with these policies and procedures.
Patient Signature
*
I have read and agree to comply with the above policies and procedures of FRANCISCAN St. James Health.
Date
*
-
Month
-
Day
Year
Date
FOR PATIENTS UNDER THE AGE OF 18
Parent or Guardian Name
*
First Name
Last Name
Patient or Guardian Email
example@example.com
Guardian Signature
I have read and agree to comply with and my child will the above policies and procedures of FRANCISCAN St. James Health.
Date
-
Month
-
Day
Year
Date
Submit
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