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1555 Exchange Avenue, Third Floor
Conway, Arkansas 72032
Telephone: 501-329-1415   Fax: 501-329-2589
E-mail: info@obesity-surgery.net
      
           
        
ASMBS-Bariatric TV
Policies

OFFICE HOURS
Monday - Friday 8:30 - 5:00

REACH US
Phone: 501-329-1415
Fax: 501-329-2589
E-mail: info@obesity-surgery.net

Dietician/Surgery Scheduling Questions: 
Courtney Sutterfield, RH, LD

Appointments: 
Skye Schou

Billing Issues: 
Mattie Morrow, Assistant Office Manager/Patient Accounts, CCS-P

Operational Issues: 
Kim Wilson, Manager

**Notice: Due to an increasing demand in patients who had surgery elsewhere, but now wish to be followed by Dr. Baker, a non-refundable Program Fee of $500 will be required effective June 1, 2011. This Program Fee will be collected prior to treatment and will go towards the additional expense involved in the patient transfer process. Thank you.

NOTICE OF PRIVACY POLICY (.pdf)
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Uses & Disclosure
Our practice collects personal health information on you that may be used for three primary purposes:

1. Treatment – For example, we will prepare a record of information each time we see you in or out of the office while you are under our care. This medical record is used to keep track of changes in your condition as well as remind us of your past care, treatment, allergies and other facts relevant to your overall health. This information may be passed on to other providers as part of a coordinated health care program for you.

2. Payment – We must report elements of your personal health information, such as specific treatments, visits, tests and surgeries along with related diagnoses to third party payers to properly determine benefits payable on your behalf for the services we render. We only report the minimum necessary information to process the claim.

3. Health Care Operations – In order to provide you with high-quality health care we often need to be able to use your personal health information for purposes such as pre-registering you at the hospital if you ever need to be admitted or providing your pharmacy with a prescription so that it is ready to pick up when you arrive. Again, we are committed to using the minimum necessary information to achieve these purposes.

In addition, we will use or disclose your personal health information under the following circumstances:

  • When we receive a valid authorization from you
  • If you give us an oral authorization
  • If we are required by law to disclose your personal health information to others such as public health agencies

 

Required Disclosures
We are required to disclose the information to you if you request it and we are required to disclose the information to the US DHHS for compliance determinations of this practice. We may disclose information about you with out your authorization for the following reasons:

  • When required by law, for judicial proceedings or law enforcement
  • For workers compensation
  • For uses and disclosures about descendents
  • Uses and disclosures for cadaveric tissue donation
  • To avert a serious threat to public health or safety
  • Disclosures about abuse or neglect or domestic violence

Other uses and disclosures will be made only with your written authorization and you may revoke such authorization by writing to us at our practice address or delivering a written revocation to us in person.

We may periodically call you to remind you of appointments and we may advise you of treatment alternatives and benefits that may be of interest to you based on your health condition or status.

 

Your Rights
You have a right to request restrictions on the use and disclosure of your personal health information. Our practice is not obligated to accept your restrictions though. However, if we do accept the restriction it must be complied with fully on our part.

You have a right to inspect and have a copy of your personal health information. If you would like a copy please request the information in writing or use a form available in our office for the request.

You have a right to request amendments to your personal information. We will not amend any information we did not create. We are not obligated to make an amendment to your personal health information but we will include your request for the amendment as part of your personal health information.

You have a right to an accounting for the prior six years (but no earlier than the effective date of this notification) for uses and disclosure for purposes other than treatment, payment and health care operations of our practice.

You have a right to a paper copy of this notification. The current version will be provided to you at your request.

 

Our Duties
We are obligated by law to protect your privacy and we will do our utmost to fulfill that duty to you. We will abide by all the terms in this notification but we reserve the right to change the terms of this notice and the personal health information it protects. You are entitled to a copy of those changes. You may always see the current notice posted on our website at [http://yourmedpractice.com]. We will include updated copies with statements mailed to patients, we will publish the revised notice in our practice newsletter and we will e-mail a copy to any patient with a valid e-mail address on file. If we know the e-mail failed to reach you we will send you a letter with the revised notice.

We will do our very best to make certain your rights are protected and we carry out our responsibilities to you. If you have any complaint we encourage you to contact us. It is our sincere desire to preserve your privacy and fulfill our duties. We will take no retaliatory action against any person for exercising their right to the resolution of a grievance. To the contrary we encourage your comments and criticisms. If we cannot resolve the issue for you, you have the right to file a grievance and make a complaint to the US Department of Health & Human Services.To make a complaint or ask any questions concerning this policy please contact the office manager directly at 501-329-1415

Effective Date - September 23, 2013

Download the Privacy Policy Here

 

CONSENT FORM
Patient Consent for Use and Disclosure of Protected Health Information

In signing this form, you consent to the use and disclosure of your protected health information by [practice], our staff, and our business associates strictly for the purpose of treatment, payment and health care operations.

You acknowledge you have had an opportunity to review our Notice of Privacy Practices prior to signing this consent. We encourage you to review our Notice of Privacy Practices carefully. It provides more detail on how we may use and disclose your information. The Notice of Privacy Practices may change. A current copy may be requested when you are being seen as a patient, by contacting our manager at 501-329-1415 or by visiting our web site at http://WWW.OBESITY-SURGERY.NET

You may request that we restrict how we use and disclose your protected health information for the purposes mentioned above. If you would like to request a restriction, please do so in writing. However, we reserve the right to deny your request. If we grant your request, we are bound by the terms of the agreement.

You may also revoke this consent in writing; however, information on any treatment / service provided using this or prior consents may still be used or disclosed for purposes of treatment, payment, or health care operations. Refer to the Notice of Privacy Practices for further information.

By signing this form, I grant my consent to the medical practice use and disclose my protected health information for the purposes of treatment, payment and health care operations.

Download the consent form here (.pdf)

 

ON CALL
Generally Dr. Baker takes his own calls when the office is closed. His medical exchange number is 501-663-8400. When out of town he checks out to another qualified surgeon. You may also reach the surgeon covering for him at the medical exchange number.

According to HCFA (US Government Health Care Financing Administration), Blue Cross, and other insurers, the following language should be included in any instructions:

"If you think you are dealing with a serious acute medical condition or life threatening emergency, seek immediate care by dialing 911 or going to the nearest emergency room."

"Serious acute medical condition or life threatening emergency" are defined by HCFA as the following:

A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:
Serious jeopardy to the health of the individual, or in the case of a pregnant woman, the health of her unborn child.
Serious impairment of bodily functions, or
Serious dysfunction of any bodily organ or part.

This language is included because in the past some HMO's, insurers, and doctors have told patients that they must go through the triage process sometimes requiring a number of phone calls and quite a bit of time in order to insure that emergency room visits be paid.

 

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