Terms & Conditions
Patients hereby consent to the following:
- Administration and performance of all treatments
- Administration of any needed anesthetics
- Performance of such procedures as may be deemed necessary or advisable in the treatment of this patient
- Use of prescribed medication
- Performance of diagnostic procedures/tests
- Taking and utilization of cultures
- Performance of other medically accepted laboratory tests that may be considered medically necessary or advisable based on the judgment of the attending Podiatrist or their assigned designees I fully understand that this is given in advance of any specific diagnosis or treatment. Patient’s consent to be continuing in nature even after a specific diagnosis has been made and treatment recommended.
The consent will remain in full force until revoked in writing. Patient’s that Alexander and Farrell Podiatry Associates, may use my information for the purposes of treatment, payment and healthcare operations.
Treatment includes but is not limited to: the administration and performance of all treatments; the administration of any needed anesthetics; the use of prescribed medications; the performance of such procedures as may be deemed necessary or advisable in the treatment of this patient, such as diagnostic procedures, the taking and utilization of cultures and of other medically accepted laboratory tests, all of which the judgment of the attending physician or their assigned designees, may be considered medically necessary or advisable.
Payment includes but is not limited to: the authorization of payment directly to Alexander & Farrell Podiatry Associates, patients hereby authorize the release of my medical records to third party insurers or authorized persons to whom disclosure is necessary to establish or collect a fee for the services provided, such as billing and collection services, insurance payers, auto accident insurers, or for work related injury to my employer or designee. I understand that I am financially responsible for charges not covered by this authorization. I acknowledge that patient records may be stored electronically and made available through computer networks.
Healthcare Operations include but are not limited to: release of my medical information to any of my physicians and their offices or insurance companies participating in my care or treatment. I fully understand that this is given in advance of any specific diagnosis or treatment. I intend this consent to be continuing in nature even after a specific diagnosis has been made and treatment recommended.
The consent will remain in full force until revoked in writing. This consent specifically includes the release of medical information concerning drug-related conditions, alcoholism, psychological conditions, psychiatric conditions, and/or infectious diseases including but not limited to blood borne diseases.
Medical Aid Patient’s: patient’s authorize to release medical information to the Administration or its intermediaries for Medical Aid claims and payments.