FLOURISH Integrative Medicine, LLC (“Flourish”) includes all services at the Flourish Integrative Medicine Clinic.
PRACTICE POLICIES
BUSINESS HOURS:
By appointment only. Same day sick visits are available on most days. Please call the office if you need to be seen quickly.
SCHEDULING:
Please use the online scheduler on our website to schedule all of your appointments. Same-day sick visits are often available; call or email for availability. All test results will be discussed in-person at an appointment. Please schedule the standard follow-up (50 minutes) for all lab reviews. Scheduling is available only through the website and is not available through the patient portal.
LATE ARRIVAL FOR APPOINTMENTS:
We try very hard to be on time for my appointments and we ask the same of you. If we are running late, please know that it is likely because another patient needed more help that day. We promise to give you the time for your needs. If you are more than 10 minutes late, we may not be able to give you your entire appointment time if there is someone scheduled after you.
NO-SHOW POLICY:
We do not pack our schedule with appointments, so when someone misses an appointment, it affects our small business. Therefore, we charge a $100 fee when you no-show without prior notice. Please allow us a 24-hour notice for cancellations and rescheduling whenever possible, and we will do our best to do the same for you.
PHONE CALLS:
We do not respond to non-urgent phone calls. Please use the messaging system in the patient portal for non-urgent issues. If you need to speak with Jen urgently, see below.
If you are ill or hurt and need to be seen on the same-day, please make that clear on your voice mail message. If you have several questions, please schedule an appointment to discuss.
URGENT NEEDS:
If you need immediate medical attention, including after-hour urgencies, press option 2 on the voice mail and you will be taken to our emergency response line. You can expect a call back on this line within two hours. If you’re experiencing symptoms like chest pain, severe shortness of breath, heavy bleeding, or any other true emergency, please call 911 or go to the emergency room and don’t wait for our emergency service.
WEATHER:
For all of our safety and yours, we will likely reschedule your appointment with me on days of inclement weather. Please check with the office to see if we are open.
FORMS:
We are likely able to complete forms for you at your appointments for no extra charge. Should you require a form completion outside of an appointment, there will be a fee of $50/15-minute increment spent on this for you. We do not complete disability paperwork.
MEDICAL RECORDS:
Should you need a copy of your medical records, there will be a $50 processing fee. You will be given copies of your test results each time testing is reviewed at an appointment. Additional copies of test results will be charged $1.00/page if needed separate from entire record.
REFILL REQUESTS:
Because of the rules imposed upon licensure and for your safety, we may need you to have an appointment or lab work in order to receive refills on medications. If a refill is authorized, this will be called into or faxed to your pharmacy, or you may schedule a time to come by the office for a handwritten prescription. The most helpful thing you can do is to ask your pharmacy to fax a refill request to the office. Please allow 48 business hours for refill requests to be called in or faxed to your pharmacy.
PATIENT PROVIDER RELATIONSHIP:
Flourish and Jen Owen, N.P. reserve the right to terminate the provider patient relationship for reasons including, but not limited to: patient noncompliance, frequently missed or cancelled appointments, behavioral issues and nonpayment of bills.
ACTIVE/INACTIVE PATIENTS:
Patients are considered active if they have been seen within one calendar year. After that, their status becomes inactive. Inactive patients will have to re-register as new patients as well as have a medical appointment to regain “active” status.
CONSENT FOR SERVICES AND TREATMENTS
INTEGRATIVE MEDICINE:
Integrative Medicine practice includes the use of conventional medicine, including prescription medications, functional medicine, herbal medicine, nutrition counseling, pelvic floor therapy, mind-body medicine, and other therapies, as appropriate. All options will be presented to you and discussed in detail.
By signing this agreement, you agree to take full responsibility for the option you choose for your health and well-being and willingly consent to receive the treatment appropriate for you. You also understand that modalities and treatment options change over time with the ever-changing research available to us and agree to be flexible with the options we present to you as we learn more and receive new information.
PRIMARY CARE:
Jen Owen, N.P. is happy and able to serve as your primary care provider. This means that in most cases, you should contact her first with any concerns about your health, unless you are experiencing an emergency that needs immediate medical attention. Jen or a trusted colleague will be on-call for you 24/7 365 days/year.
That said, please only call our emergency number after hours if you are experiencing symptoms that absolutely cannot wait until the next business day and call during daytime hours whenever possible.
PELVIC EVALUATION/TREATMENT:
If you are receiving a pelvic floor assessment, this assessment includes an internal vaginal exam to assess pelvic musculature health. Appointments for treatment of findings may include internal vaginal work, instruction in pelvic muscle and breathing exercises, rectal assessment, internal herbal formulas, and other techniques as needed.
By signing below, you understand and consent to these services, to be provided at the discretion of our practitioner. You also understand there is no guarantee of outcome of any treatment. Patients may experience a range of effects as a result of treatment including many benefits, but also physical effects such as soreness or bleeding, as well as emotional responses to the treatment. You understand and agree that if at any time you experience symptoms that concern you or difficulty integrating a pelvic session, you will promptly consult emergency services or your treatment provider, as needed.
You must have a symptom in order for me to bill your insurance for pelvic care treatment. If you are not having a symptom, your care will be cash-pay.
If you are paying cash for a package of 2 visits, the 2nd visit must be completed within 60 days of the first visit. You understand that if the 2nd visit is not within 60 days of the first, you forfeit all time and credit for this appointment.
HERBS AND SUPPLEMENTS:
Herbs and/or supplements may be prescribed as part of your care. These products are for sale through the office or a website service. Patients receive a 5-10% discount off the usual retail price.
All herbs are from reputable companies that take great care in the harvesting and processing of the plants. All supplements are “pharmaceutical grade”. This means that they are of the upmost quality. We prefer that you use the herbs and supplements recommended by our practitioner, as we have observed their effectiveness in practice. You are always welcome to purchase products wherever you would like. We, unfortunately, do not have time to research all the supplements you may be taking.
You may purchase products at your appointment times or online. If you require products between appointments, simply let us know by email or phone and we will coordinate a pick-up for you or choose “Supply Pick-Up” on the online scheduler.
We do not bill insurance carriers, health savings plans, or any other like entities for any supplements, herbs, formulas, or supplies. It is your full responsibility to submit the required information to these entities for possible reimbursement. We will provide you with receipts or letters of medical necessity as requested.
TESTING:
Much of the testing ordered will be routine lab testing that is customarily covered by many insurance plans. Specialty testing may also be ordered. It is your decision which testing to undergo. Please verify with your insurance plan regarding coverage for testing. We cannot guarantee coverage or reimbursement for any testing ordered. If you are ever in doubt of coverage, please contact your insurance agency prior to undergoing any testing.
Every effort will be made to order testing that is affordable to you. If you are having trouble covering anything ordered by us, please let us know. We have access to less expensive labs in many cases, so please ask. We work with a phlebotomy company who will come to your home for your blood draws. This company charges extremely reasonable fees and is very knowledgeable about the specialty testing we offer. You will pay this company directly for blood draw fees. If you wish to have your blood drawn at a different location, please communicate this to us upfront to avoid unnecessary paperwork.
While lab tests are often a covered service, you remain responsible for fees associated with these tests if your insurance does not pay, or if the laboratory used will not bill your insurance. Testing is always reviewed at an appointment. Please do not request results without coming in. We don’t discuss results over the phone, unless we receive a critical result.
EMAIL/MESSAGING CONSENT:
Please use the patient portal inside the Charm Health Electronic Medical system for online communication. You were sent an invitation when your chart was opened. Please check your email and use this link to sign-up for your account. If you don’t see the invitation, please let us know as this is the only way to sign-up.
We are happy to answer a follow-up question by message, however if you have several questions, you will be asked to schedule an appointment.
We generally do not respond to messages on weekends and national holidays. If your message is received on a weekday before 12pm PST, we will do our best to respond that same day. If your email is received after 12pm PST, we will do our best to respond before 12pm PST on the following weekday.
If you are experiencing new health issues, want changes in your treatment plan, add new prescriptions or refill a prescription that is outdated please schedule an appointment. These are issues that cannot be answered in any message.
Please be aware that all messages will become part of the patient’s permanent chart.
Each patient is automatically added to our email newsletter list. This is a list for sharing health information and updates. You may unsubscribe at any time.
BILLING, PAYMENTS AND INSURANCE:
All fees for practitioner services and lab fees (except those verified as payable by your insurance company), supplements, and uninsured/non-covered procedures are due at the time of service. We do NOT collect your co-pay or co-insurance at your appointment. This will be added to your billing statement, which will be mailed to you by our billing department.
It is each patient’s responsibility to be aware of their insurance coverage, including co-pays, co-insurance, deductible, and yearly maximums. We do NOT verify your insurance benefits for you. We will provide you with any needed information to verify your own benefits.
*Please be aware that a verification of benefits is not a guarantee of payment by your insurance company and you are responsible for fees not covered by your insurance.
Examples of uninsured/non-covered services:
~Extended pelvic care visits that include more time for Holistic Pelvic Energy™
~Vaginal steams
~Appointments that last longer than 60-minutes and use the code 99417 for each additional 15-minutes spent on your care.
~Telephone calls of greater than 5 minutes and any calls requiring medical decision-making or medical record keeping
~Care given outside of your appointment, such as ordering testing or specialty providers, completing forms, and researching supplements, prescriptions, and interactions, billed at $50/15-minute increment spent on your care
~Specialty testing kits and laboratory handling fees of specialty labs
~Specimen handling and lab administrative fees
~Nutritional, functional, and herbal supplements
~Missed appointments without a 24-hour notice (fee is $100)
It is your full financial responsibility to pay for any charges previously covered/paid by your insurance carrier which are later deemed by your insurance carrier to be “not medically necessary” or any charges that resulted in a partial or full refund request by your insurance carrier from Flourish. *Please be aware that the amount per appointment allowed by your insurance may differ from our cash-pay prices. For full information on insurance coverage, please verify your benefits.
UNINSURED OR OUT-OF-NETWORK PATIENTS:
If you do not have insurance coverage or we are not in-network with your insurance plan, you will be responsible for all fees incurred from your appointments. These fees will be due at the time of service. Packages and payment plans are available, so if you are experiencing financial difficulty, please discuss this with us prior to your appointment.
PAYMENT INFORMATION:
Cash, check, credit cards, and Health Savings Accounts are accepted for all services, although check is greatly preferred. Your payment by check helps us avoid large credit card processing fees. There is a $50 fee for returned checks.
We work with a billing agency to handle your insurance claims for us. If you have a question about your bill, you should call our billing department directly at (503) 384-2988. If they need further information from us, they will contact us. Please use the address on your billing statement to remit payment after insurance claims are submitted. Please do NOT send payment directly to our office.
NOTICE OF PRIVACY PRACTICES
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.
Effective Date JANUARY 1, 2021
- PURPOSE OF THIS NOTICE.
Flourish Integrative Medicine, LLC (“Flourish”) is committed to preserving the privacy of your health information. In fact, we are required by law to do so for any health information created or received by us. Flourish is required to provide this Notice of Privacy Practices (“Notice”) to you. The Notice tells you how we can and cannot use and disclose the health information that you have given to us or that we have learned about you when you were a patient in our system. It also tells you about your rights and our legal duties concerning your health information.
Flourish is required to abide by this Notice. This Notice applies to the practices of:
- All Flourish employees, contractors, volunteers, students and service providers, including clinicians, who have access to health information.
- Any health care professional authorized to enter information into your Flourish health record.
For the rest of this Notice, “Flourish” “we” and “us” will refer to all services, service areas, and workers of Flourish. When we use the words “your health information,” we mean any information that you have given us about you and your health, either in written, electronic or spoken words, as well as information that we have received while we have taken care of you (including health information provided to Flourish by those outside of Flourish).
USES AND DISCLOSURES OF HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS AT FLOURISH.
Treatment, Payment and Health Care Operations.
The following section describes different ways that we use and disclose health information for treatment, payment and health care operations. Not every use or disclosure will be noted and there may be incidental disclosures that are a byproduct of the listed uses and disclosures. The ways we use and disclose health information will fall within one of the categories.
- For Treatment. We may use your health information to provide you with health care services. We may disclose your health information to physicians, nurse practitioners, nurses, technicians and other personnel involved in your health care.
- For Payment. We may use and disclose your health information so that we may bill and collect payment from you.
- For Health Care Operations. We may use and disclose your health information in order to run the necessary administrative, educational, quality assurance and business functions at Flourish.
Your Choices Regarding Disclosures.
- Family and Friends. Unless you notify us that you object, we may provide your health information to individuals, such as family and friends, who are involved in your care or who help pay for your care. We may do this if you tell us we can do so, or if you know we are sharing your health information with these people and you don’t stop us from doing so. There may also be circumstances when we can assume, based on our professional judgment, that you would not object. For example, we may assume you agree to our disclosure of your information to your spouse if your spouse comes with you into the room during a consultation or visit. Also, if you are not able to approve or object to disclosures, we may make disclosures to a particular individual (such as a family member or friend), that we feel are in your best interest and that relate to that person’s involvement in your care.
- Disaster Relief Situation: You may choose to tell us to share your information in a disaster relief situation
- Fundraising Efforts: We may contact you for fundraising efforts, but you can tell us to not contact you again.
OTHER PERMITTED USES AND DISCLOSURES OF HEALTH CARE INFORMATION.
We may use or disclose your health information without your permission in the following circumstances, subject to all applicable legal requirements and limitations:
- Required By Law. As required by federal, state, or local law.
- Victims of Abuse, Neglect or Domestic Violence. To a government authority authorized by law to receive reports of abuse, neglect or domestic violence or when we reasonably believe you are the victim of abuse, neglect or domestic violence and other criteria are met.
- Health Oversight Activities. To a health oversight agency for audits, investigations, inspections, licensing purposes, or as necessary for certain government agencies to monitor the health care system, government programs, and compliance with civil rights laws.
- Lawsuits and Disputes. In response to a subpoena, discovery request or a court or administrative order, if certain criteria are met.
- Law Enforcement. To a law enforcement official for law enforcement purposes as required by law; in response to a court order, subpoena, warrant, summons or similar process; for identification and location purposes if requested; to respond to a request for information on an actual or suspected crime victim; to report a crime in an emergency; or to report a death if the death is suspected to be the result of criminal conduct.
- Serious Threat to Health or Safety. To appropriate individual(s) when necessary to prevent a serious threat to your health and safety or that of the public or another person.
- We can use or share your information for health research.
- Respond to Organ and Tissue Donation Requests. We can share information about you with organ procurement organizations.
- Medical Examiner. We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
- Public Health and Safety.We can share health information about you for certain situations such as: preventing disease, helping with product recalls, and/or reporting adverse reactions to medications.
WHEN WRITTEN AUTHORIZATION IS REQUIRED.
Other than for those purposes identified above in Sections B and C, we will not use or disclose your health information for any purpose unless you give us your specific written authorization to do so. You can withdraw this written authorization at any time. To withdraw your authorization, deliver or fax a written revocation to Jen Owen, N.P. 2505 SW Spring Garden St. Suite 200, Portland, OR 97219; Fax: 503-432-8025. If you revoke your authorization, we will no longer use or disclose your health information as allowed by your written authorization, except to the extent that we have already relied on your authorization.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION.
You have certain rights regarding your health information, which we list below. In each of these cases, if you want to exercise your rights, you must do so in writing by completing a form that you can obtain from Flourish. In some cases, we may charge you for the costs of providing materials to you.
- Right to Inspect and Copy. With some exceptions, you have the right to inspect and get a copy of the health information that we use to make decisions about your care. For the portion of your health record maintained in our electronic health record, you may request we provide that information to or for you in an electronic format. If you make such a request, we are required to provide that information for you electronically (unless we deny your request for other reasons). We may deny your request to inspect and/or copy in certain limited circumstances, and if we do this, you may ask that the denial be reviewed.
- Right to Amend. You have the right to amend your health information maintained by or for Flourish or used by Flourish to make decisions about you. We will require that you provide a reason for the request, and we may deny your request for an amendment if the request is not properly submitted, or if it asks us to amend information that (a) we did not create (unless the source of the information is no longer available to make the amendment); (b) is not part of the health information that we keep; (c) is of a type that you would not be permitted to inspect and copy; or (d) is already accurate and complete.
- Right to an Accounting of Disclosures. You have the right to request a list and description of certain disclosures by Flourish of your health information for six years prior to the date you ask.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use.
- Right to Copy of this Notice. You have the right to request a copy of this Notice.
- Right to Choose Someone to Act For You. If you have a medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
- File a Complaint If You Feel Your Rights Are Violated. You can complain if you feel we have violated your rights by contacting us using the information on page 1. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr
CHANGES TO THE TERMS OF THIS NOTICE. We can change the terms of this Notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office and on our website.
Updated 1/14/2021
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