ST. CLARE HEALTH CLINIC PATIENT HANDBOOK

Transcription

1 ST. CLARE HEALTH CLINIC PATIENT HANDBOOK Important Information For You! 1121 South Indiana Avenue Crown Point In (219) FAX (219) PN REV. 3/19/15 3/STAPLE Affiliated with Franciscan St. Anthony Health Crown Point

2 St. Clare Health Clinic Patient Brochure Who qualifies for our clinic? Residents of Northwest Indiana that are: o Un-insured o Those that meet our income guidelines o Those that do not live closer to another free/sliding scale clinic Who does NOT qualify? People with insurance, Medicaid, Medicare, workman s compensation claims, or those able to receive health services from Veteran s Administration do not qualify. Children should sign up for Hoosier Healthwise at Why do we need financial information? This information is needed in order to get funding for the clinic and continue caring for our patients. Many pharmaceutical companies offer reduced or free medicines with required financial information to participate in the Medication Assistance Program (MAP). What do you need to bring at the first appointment? The first appointment is a scheduled financial screening it will be to determine whether you qualify for St. Clare Health Clinic. This is not an exam and will not provide refills of meds. You will need the following for all in household: o Photo identification of patient o Financial information of the most current month/year such as: Federal tax return W-2 forms/1099 forms/schedule C/SE Proof of income (how you pay rent, utilities, food), pay stubs/profit and loss statement for one month. Social Security letter of current amount and deductions Benefit statements=child Support, pensions, TANF, energy assistance Food stamp letter of monthly amount Birth certificate and HIP application or denial Medicaid denial letter Proof of inability to obtain health insurance through employer or through healthcare.gov Please Note!! Do not leave or mail us original documents. Please retrieve all original documents provided to St. Clare Health Clinic. All documents will be shredded once the appointment is completed, to ensure patient privacy and confidentiality. After the completion of the financial screening all patients will be provided with a letter from St. Clare Health Clinic stating if the patient qualified for services. You will need to provide the above information again to Requalify Annually by May 31 st

3 What does the St. Clare Health Clinic provide? The St. Clare Health Clinic is a primary care provider offering non-emergency services which include: o Physician exams o Basic labs and x-rays o Some sample medications o Medication assistance program through the pharmaceutical company o Referrals to community social services Is there a fee to see the doctor at the clinic? The services at the St. Clare Health Clinic are provided without charge. A $5.00 donation per visit is encouraged. Practitioners may order tests that are not covered. When scheduling be sure to check if covered first as well as the process for testing coverage. Bills for services will be sent to your home and must be brought in for review and if non-covered service you will be responsible. All emergency room, hospitalizations, surgeries and urgent care visits are NOT covered. Contact St. Anthony Health Crown Point billing department to inquire about Charity Care applications for those services at phone # What if I need a referral to a specialist? All referrals must be ordered by a St. Clare provider. Patients must take St. Clare Health Clinic referral letter to the specialist If you fail to show up for your scheduled specialist appointment it will not be re-scheduled and it will be included in your record as a no call no show. Patient is responsible to make payment arrangements with specialist office staff prior to appointment as deemed necessary by specialist. What if I need a letter for my attorney regarding disability? If the request is for an attorney or their office, the request must be on official letter head from the law firm. Patients must sign release of information to the law office with understanding that the request may take up to 7 days to complete. Provider will complete disability and Medicaid physicals only if provider finds patient has adequate qualifications. What happens if I need surgery or hospitalization? If you should need surgery, St. Clare can assist with pre-operation testing such as labs and x-rays (must be St. Clare Health Clinic order). You will be responsible for the hospital bills, anesthesia, physician, radiology and any additional services. Please contact the hospital billing department that can assist you with payment arrangements and/or any other financial assistance programs that you may qualify for.

4 Are medications provided? There are three ways that you can receive your medications. o The practitioner provides a prescription to take to the pharmacy of your choice. (Check Medication Assistance Options flyer) o Refills need 1 week notice to be processed or called to pharmacy. o Certain medications can be provided through pharmaceutical companies when you meet the guidelines (if we have the necessary financial information such as current tax returns and proof of income). Refills need 3 weeks. o Limited controlled substances are prescribed according to the clinic policy and patients must follow the medication agreement. Failure to follow the agreement will result in termination of services. Chronic conditions will be referred to specialty services for assistance. Medication and Prescription Pick-Up Policy: Pick-up hours are: Monday-Thursday 10am-11am & 3pm-4pm & Friday 10am-12pm o If you cannot pick up your medication or prescription during these times, then you can have someone pick them up for you. The person picking up medication or prescription for you is required to show a photo ID. What are St. Clare Clinic s office hours? All of the doctors and nurses at the clinic volunteer their time to treat our patients. Because our physicians are volunteers, hours that our patients can be seen are limited. Monday-Friday 8:00-4:30. Closed for lunch 12pm-1pm daily. What if I cannot come to my appointment? If you are unable to make your appointment please give 24-hour notice to the clinic. We may be able to fill your appointment with another patient in need. If you make an appointment and fail to show up without notice 3 times it will result in termination of services from the clinic. Our mission at St. Clare Clinic is to provide access to primary healthcare, health maintenance and health information to those who may otherwise endure hardship in order to obtain quality health care.

5 Helpful Phone Numbers St. Clare Health Clinic Regional Mental Health Center 24 hour crisis line: Call for a new patient appointment Domestic Violence Shelter and Domestic Violence Counseling Center St. Jude House: Crown Point (219) Housing and Community Services- Northwest Indiana Community Action Corporation (NWICA) or dial Help for Seniors- may help with in home services, wellness services, meals, nursing home pre-admission, caregiver support, advocate support, and Medicaid waivers. Help with Housing- Housing Choice Voucher Program (Section 8) Rental assistance vouchers in a seven-county region of Northwest Indiana Tax Prep Mortgage Assistance:1-877-GET-HELP Help with Utilities and Home Weatherization Legal Services of NWI Al-Anon Hoosier Healthwise & Healthy Indiana Plan- (HIP) Medicaid and Foodstamp office Trustee s Office o Calumet Township Gary o Center Township Crown Point o Hanover Township Cedar Lake o North Township East Chicago o North Township Hammond Other Low Income Health Clinics o Hammond Area - Catherine McAuley Clinic o Porter County/Valparaiso - Hilltop Clinic Northshore Health Centers- o Northshore Health Center- Portage: o Northshore Health Center- Lake Station: o Northshore Health Center- Merrillville: o Gary / Merrillville Community Health Net Dental Clinic o Merrillville Northshore Dental Center: o Valparaiso Community Health Dental Clinic (219) o Gary Dental Clinic: o Indiana University Dental Clinic: o Portage Community Dental Clinic: