Chest Medicine of Cullman



Appointments



How to schedule your visit,
What forms need to completed BEFORE you arrive,
and What items you must bring with you on the day of your visit.

Instructions for all NEW PATIENTS:

1. All new patients must print and complete
the New Patient Form. Please bring this with
you, along with all your medications and any
medical records you need to show us on your
first appointment. (If you have not been to the
office in more than 3 years, you are
considered a new patient and must also fill out
this form.)

2. Sleep Disorders patients will need to
print and complete the Sleep Disorders
Questionnaire in addition to the New Patient
Form.

3. All Patients who have had a previous
sleep study performed by anyone other than
Dr. Warner must print the Release Form and
send it to the other sleep lab before your
appointment.



NEW PATIENT FORM


ALL PATIENTS

Print and complete this form before you come.

If you have never been seen here or have not been seen as a patient within the last 3 years- bring this form COMPLETED to your first visit.


Allow 30 minutes to complete these forms. If you arrive for your appointment on time and these forms are not completed, we may have to reschedule you to another date.


SLEEP QUESTIONNAIRE


NEW SLEEP PATIENTS


ALL new patients coming for evaluation of a sleep disorder must bring this form.

Print and complete this form before you come.

If you have never been seen here or have not been seen as a patient within the last 3 years- bring this form COMPLETED to your first visit.


Allow 20 minutes to complete these forms. If you arrive for your appointment on time and these forms are not completed, we may have to reschedule you to another date.​


SLEEP STUDY RELEASE


NEW SLEEP PATIENTS


If you have had a previous sleep study provided by another doctor, no matter how long ago or where, we need to get a copy..


Print and sign this form. If you can fax it to the outside sleep center before you come- that would help us tremendously!

If you cannot fax it before your appointment then bring it completed with you when you come.​


WHAT TO BRING WITH YOU



1.Before you come please log on to your patient portal.


2. Please bring all completed paperwork (new patient and sleep questionnaire if applicable).If you have had a previous sleep study performed by any doctor besides Dr Warner YOU must get a copy and bring it with you on the day of your appointment. If you do not have the opportunity to complete the paperwork before your first appointment, plan on arriving at least 30 min before your appointment.


3. Bring bottles or an accurate list of all your current prescription and over-the counter medications including inhalers, eyedrops and "herbal remedies", etc.


4. Bring copies of all recent X-rays, and CAT scans. Your doctor may have sent a copy of the report but we need to see the actual pictures. Only you can get these to us by bringing films on CDs WITH YOU.



OFFICE POLICIES





We attempt to stay on schedule to keep you from waiting. If you are waiting 15 minutes or more past your scheduled appointment time please notify the receptionist immediately.
Please do not be late for appointments. We appreciate your patience for the occasional emergency which may delay your visit.

If you cannot keep an appointment please let us know immediately so others can be seen and keep our waiting time down. If you fail to show up and do not cancel, you may be billed for that time.

Please no perfumes or colognes

Please no cell phones

Limit one guest in the exam room with each patient.

Emergencies:

After hours emergencies should call 911 or 256-737-2000 and ask for the
covering physician. We will not discuss a patient's case with anyone but the patient*.


Phone Calls and Prescription Refills:

Phone calls will be returned by the medical assistant as soon as possible. Telephone lines are open from 8:00 am to 4:30 pm Monday - Thursday.

Regarding refills, we request that first you verify with your pharmacist that there are no more refills available. Telephone requests for refills should be made Monday - Thursday directly to our refill line at (256) 737-8077. Have your pharmacy phone number available.
Because we need your chart to refill most medications, routine refills will not be phoned in after hours or weekends. Refills will not be authorized for patients not seen in the last twelve months.


Hospital Affiliation:
Cullman Regional Medical Center


Insurance and Billing:

Our office will file many insurance claims for your convenience. Copayments are expected at the time of service. Payment plans may be arranged for patients based on need. Questions
regarding insurance we accept or your bill should be directed to the billing office at256-737-8087.


*NOTICE OF PRIVACY PRACTICES:


A. We have a legal duty to protect health information about you.

B. We may use and disclose Protected Health Information (PHI) about you without your
authorization in the following circumstances:
1. We may use and disclose PHI about you to provide health care treatment to you.
2. We may use and disclose PHI about you to obtain payment for services.
3. We may use and disclose PHI about you for health care operations.
4. We may use and disclose PHI under other circumstances without your authorization
or a chance to agree or object.
5. You can object to certain uses and disclosures.
6. We may contact you to provide appointment reminders.
7. We may contact you with information about treatment, services, products or health
care providers.
8. We may contact you for fundraising activities.

C. You have several rights regarding PHI about you.
1. You have the right to request restrictions on uses and disclosures of PHI about you.
2. You have the right to request different ways to be in touch with you.
3. You have the right to see and copy PHI about you.
4. You have the right to request a change to PHI about you.
5. You have the right to a listing of disclosures we have made.
6. You have a right to a copy of this Notice.

D. You may file a complaint about our privacy practices.