Heart House Patient Information
For your convenience, we have made available online some patient forms that you may complete prior to your office visit. If you wish, print out and complete these forms and then, bring them with you when visiting our office. (You may want to print a second copy of these forms if you want to keep a record of this information.)
- New Patient Information Record [pdf file format]
- Medical Record Questionnaire [pdf file format]
- HIPAA Statement [pdf file format]
- Assurance of Privacy Practices [pdf file format]
- Patient Records Release [pdf file format]
- Financial Policy [pdf file format]
Heart House Privacy Statement
- Heart House HIPAA Policies and Procedures [pdf file format]
- Heart House Notice of Privacy Information Practices [pdf file format]
Please bring your current insurance card with you every time you visit a Heart House office. Insurance coverage will be verified at every visit. As insurance policies often change, we must have up-to-date information. Also, please verify that our office is participating with your insurance plan by contacting your insurance company directly or by speaking to an account representative in our office.
The Heart House participates with Medicare and Medicaid patients, as well as those individuals with private insurance. We also participate in most HMO and PPO Plans. Please contact our office or your insurance company directly to verify our participation in your plan. Please bring your current insurance card with you every time you visit a Heart House office. Insurance coverage will be verified at every visit. As insurance policies often change, we must have up-to-date information or by speaking to an account representative in our office.
Statements are sent out on a monthly basis and payment is due upon receipt. For your convenience, the Heart House offers the option of payment by credit card or, if you prefer, you may mail your payment directly to our office. Questions regarding billing should be directed to our Business Office at 856-547-0539.
Many plans require patients to pay a co-payment for each office visit. Co-payments are due when services are rendered.
In order to see a specialist, many managed care plans require a referral from your primary care physician. It is your responsibility to obtain this referral prior to your visit. If a referral has not been approved by your insurance plan, your insurance may not pay for the visit. Without prior approval, you may be responsible for the charges associated with the visit.
Medical Records and HIPAA Privacy Rules
All requests for medical records must be received in writing. You will be notified by phone when the records are available to be picked up. Our office maintains medical records confidentiality in compliance with Federal HIPAA rules and regulations. Please follow this link to our HIPAA statement.