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Telemedicine Practice Polices

APPOINTMENTS AND CANCELLATIONS

  • The standard meeting time for the initial visit is 45-60 minutes and follow up visits are 15-30 minutes.

  • Payment is due within 24 hours of your appointment. You may lose your appointment if payment is not received within 24 hours of your scheduled time.

  • Cancellations and re-scheduled visits will be subject to a full charge if NOT RECEIVED AT LEAST 48 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for an appointment, you may lose some of the allotted time for that appointment. Your card will automatically be billed 24 hours prior to your appointment if payment is not received.

 

TELEPHONE ACCESSIBILITY

  • If you need to contact Revive Health & Wellness between sessions, please call our main number or send us a message through the website. We are often not immediately available; however, we will attempt to return your call or message within 24 hours. Please note that Face-to-face video visits are highly preferable to phone visits. However, in the event that you are out of town, sick or need additional support, phone sessions are available. If a true emergency situation arises, please call 911 or go to your local emergency room.

 

ELECTRONIC COMMUNICATION

  • We cannot ensure the confidentiality of any form of communication through electronic media, including, but not limited to, text messages, telephone communication, the Internet, facsimile machines, and e-mail. Telemedicine is broadly defined as the use of information technology to deliver medical services and information between two parties that are at different locations. The above electronic means of communication are considered telemedicine. Utilizing telemedicine services through is voluntary in nature and you need to understand:

  • You have the right withhold or withdraw your consent for telemedicine services at any time. If this occurs, you need to understand that we cannot provide care for you any longer as Revive Health & Wellness. 

  • We will protect your protected health information in the same fashion as a brick and mortar practice. You need to understand though that data breaches can happen, and we cannot assure your information is 100% protected.

  • We will not use your protected health information for research purposes unless you give us consent to do so.

  • There are potential benefits, risks and subsequent consequences of telemedicine. Potential benefits include, but are not limited to improved access to care, reducing costs, improving the quality of visits, and reduction of travel time associated with medical visits. The medical provider will make assessments, diagnoses, and treatment plans based off all the visual and auditory information provided during the video conference. You must understand that this is limited and posts potential risks including, but not limited to the provider’s inability to make complete diagnostic assessments that might require a physical exam and to see the patient in person. During an in-person encounter, a medical provider has the ability to see the entire patient including but not limited to their gait, smell, general appearance, and demeanor. Potential consequences thus include the provider not being aware of clinically significant information that you may not recognize as significant to present verbally to the provider.

 

MINORS

  • We require parental consent for all visits done through telemedicine. We require your parents to be present during a portion of the visit to ensure that they are consenting to treatment.

  • If you are a minor, your parents may be legally entitled to some information about your treatment. We will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.

 

TERMINATION

  • We can terminate treatment with you at any time. We will not terminate the medical relationship with you without first discussing and exploring the reasons and purpose of terminating. If treatment is terminated for any reason, we will provide you with a list of qualified providers to continue your care. You may also choose someone on your own or from another referral source. Should you fail to not show up for your follow up appointments, not obtain lab work in a timely fashion or are non-compliant with treatment, unless other arrangements have been made in advance, for legal and ethical reasons, we must consider the professional relationship discontinued.

Appointment Cancellation and No-Show Policy

Revive Health and Wellness is committed to providing exceptional care. To ensure fairness and availability for all patients, we require timely notice for appointment cancellations or rescheduling. Repeated no-shows or last-minute cancellations may result in limited access to services.

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CANCELLATION GUIDELINES

  1. Notice Requirement:
    Patients must provide at least 24 hours' notice if they cannot attend their scheduled appointment.

  2. Rescheduling:
    If a patient needs to reschedule, they are encouraged to do so at least 24 hours before the original appointment time.

  3. Late Cancellations:
    Cancellations made less than 24 hours before the appointment will be considered a "late cancellation" and may be subject to fees.

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NO-SHOW POLICY

Definition:

  1. A "no-show" occurs when a patient fails to attend a scheduled appointment without prior notice.

  2. Consequences:

    • First No-Show: Patients will receive a courtesy reminder of this policy.

    • Second No-Show: A fee of $50.00 may be charged to the patient’s account.

    • Third No-Show: The patient may be required to prepay for future appointments or may be dismissed from the practice, depending on the clinic’s discretion.

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FEES

  • Late cancellation or no-show fees are non-refundable and are not billable to insurance.

  • Fee Amounts:

    • Late Cancellation Fee: $[Insert Fee Amount]

    • No-Show Fee:

      • 1st Offense: $50.00​

      • 2nd Offense: $100.00

      • 3rd Offense: Patient may be referred to another clinic for continuation of care.

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EMERGENCY EXCEPTIONS

We understand that emergencies happen. Patients experiencing unforeseen circumstances (e.g., medical emergencies, severe weather) should contact the clinic as soon as possible. These situations may be exempt from fees at the clinic’s discretion.

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APPOINTMENT REMINDERS

To help patients keep their appointments, our clinic provides reminders via:

  • Phone calls

  • Text messages

  • Emails

Patients are encouraged to confirm or cancel their appointment upon receiving the reminder.

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HOW TO CANCEL OR RESCHEDULE

Patients can cancel or reschedule appointments by:

  • Phone: Call us at (501) 382-1577.

Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

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YOUR RIGHTS

When it comes to your health information, you have certain rights. This section explains your rights and how you can exercise them.

  • Get a copy of your medical records
    You can ask to see or get a copy of your medical records and other health information. We will provide a copy or a summary of your health information, usually within 30 days of your request. A reasonable fee may apply.

  • Ask us to correct your medical records
    If you believe your health information is incorrect or incomplete, you can ask us to correct it. We may deny your request, but we will provide a written explanation within 60 days.

  • Request confidential communications
    You can ask us to contact you in a specific way (e.g., home or office phone) or to send mail to a different address.

  • Ask us to limit what we use or share
    You can request restrictions on the use or sharing of your information for treatment, payment, or operations. We may not be able to agree to all requests, especially when required by law.

  • Get a list of those with whom we’ve shared information
    You can request an accounting of disclosures for the last six years, excluding those made for treatment, payment, and healthcare operations.

  • Get a copy of this privacy notice
    You can request a paper copy of this notice at any time.

  • Choose someone to act for you
    If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.

  • File a complaint if you believe your privacy rights have been violated
    You can file a complaint with our office or with the U.S. Department of Health and Human Services. Filing a complaint will not affect your care.

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YOUR CHOICES

You can make choices about how we share your information in certain cases. For example:

  • You can allow or restrict sharing with family, friends, or others involved in your care.

  • You can opt out of fundraising communications.

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OUR USES AND DISCLOSURES

We typically use or share your health information to:

  • Treat you
    Example: A doctor treating you asks another provider about your condition.

  • Run our organization
    Example: We use your information to manage your treatment and services.

  • Bill for your services
    Example: We share your information with your insurance company to bill for the care you receive.

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OTHER WAYS WE MAY USE OR SHARE YOUR INFORMATION INCLUDE:

  • Public health and safety purposes

  • Research (with appropriate approvals)

  • Responding to lawsuits and legal actions

  • Complying with laws (e.g., reporting abuse or neglect)

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OUR RESPONSIBILITES

  • We are required by law to maintain the privacy and security of your health information.

  • We will inform you promptly if a breach occurs that compromises your privacy or security.

  • We must follow the practices described in this notice and will not use or share your information except as outlined here unless you give written permission.

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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.

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Contact Information:
If you have questions about this notice or need to file a complaint, please contact:
Revive Health and Wellness

1003 Schneider Drive

Malvern, Arkansas 72104

Office: (501) 382-1577

Fax: (501) 397-9068
Email: courtney@health-revived.com

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