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Chest Medicine of Cullman



NEW PATIENT FORM


ALL PATIENTS

Complete this online NEW PATIENT REGISTRATION FORM before you come. Allow 20 minutes to answer the questions which are key to us knowing all about your health so we can make accurate diagnosis and treatment. No, your doctor did not send us everything we need.



If you arrive for your appointment with less than 20 minutes before your scheduled appointment 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 complete this online CMED SLEEP QUESTIONNAIRE... in addition to the NEW PATIENT REGISTRATION FORM.


Allow yourself a total of 37 minutes for both forms to be answered. If you arrive for your appointment with less than 37 minutes before your scheduled appointment 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. Many insurances will require us to repeat testing if we cannot provide the original sleep study to them. We are trying to keep you from having unnecessary testing which will delay your treatment.


Please complete the online form by clicking the above icon. Fill out the form to the best of your knowledge (even if you don't remember the details) and we will do the rest. This needs to be completed at least 7 days before your appointment. Otherwise, you can fax a request yourself to the outside sleep center before you come and bring the paper copy of the report with you when you come.


WHAT TO BRING WITH YOU



1.Before you come please log on to your Patient Portal. You will receive an invitation via email.


2. You will also receive a message from Clearwave which will assist you in pre-registering. You will find a Clearwave kiosk in our lobby when you arrive. Please check-in there.


3. Please complete all online forms or bring all completed paperwork including new patient registration (and sleep questionnaire if applicable). If you do not have the opportunity to complete the paperwork before your first appointment, plan on arriving at least 20 minutes (37 min for new sleep patients) before your appointment.


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

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Appointments





Where do I go?
Although some of the automated messages that you received by text or email may be confusing- please follow these instructions (and not necessarily those that you receive electronically from Cullman Internal Medicine).

Our office is located in Cullman Regional professional office building #2, 4th floor Suite 420

If you are scheduled for an office visit with the doctor or nurse practitioner, go to 4th floor
If you're here to get your CPAP set up or supplies, go to 4th floor
If you are scheduled for lab work or a chest x-ray, go to 3rd floor first
If you're here to get your pulmonary function test (PFT) , go to 4th floor
If you're scheduled for an echocardiogram, go to 2nd floor first

NEW PULMONARY PATIENTS:
REGRETFULLY, WE ARE NO LONGER ACCEPTING NEW PULMONARY PATIENTS AT THIS TIME


NEW SLEEP PATIENTS:
WE LOOK FORWARD TO HELPING YOU!
PLEASE CONNECT WITH US BY SCHEDULING YOUR VISIT ON OUR WEBSITE
SLEEPCULLMAN.COM


EXISTING PULMONARY AND SLEEP PATIENTS:
YOUR APPOINTMENTS ARE SECURE. IF YOU NEED TO RESCHEDULE PLEASE CALL 256-737-8000.




OFFICE POLICIES




LIMIT ONE (1) CAREGIVER WHO HAS BEEN VACCINATED AGAINST COVID-19 IN THE EXAM ROOM WITH EACH PATIENT. WE CANNOT ACCOMODATE MULTIPLE FAMILY MEMBERS OR FRIENDS SO PLEASE DO NOT COME INTO THE LOBBY AS WE WILL MAINTAIN SOCIAL DISTANCING AND WILL ASK EXTRA PERSONS TO WAIT IN THEIR VEHICLE.

ALL PERSONS MUST WEAR A MASK. THE PATIENT ONLY MAY BE ALLOWED TO REMOVE YOUR MASK ONCE INSIDE THE EXAM ROOM IF YOU HAVE BEEN COVID-VACCINATED.

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



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. please do not leave multiple messages as that only delays our response to you.

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) 737-8000 option 1.
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 at256-737-8000 option 9.


*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.