AFM HEALTHCARE OFFICE PROTOCOL
1) Patient’s Rights and Responsibilities – A copy of our “Patient’s Rights and Responsibilities” is included with this package and is available at our website afmhealthcare.com. Please read over these as they address our responsibilities to you as a patient and your responsibilities as a recipient of AFM Healthcare services.
2.1 Telephone Calls- We are very committed in providing you fast and easy communication; however, we need your assistance to make it possible. Always say your “name, telephone numbers where you can be reached, the reason for the call, and convenient times to reach you”. Please be reminded that we will return your phone call within 24-48 hours.
2.2 Healow- We are using Healow as the fastest way to communicate with us. Using this portal, you can send us a message, ask for a reﬁll, check your appointment times and view your progress notes. Please sign up for secure messaging via patient portal. Check with our oﬃce staﬀ for detailed information for this service.
Oﬃce Hours: If there is an emergency during normal working hours (8:30-5:00pm), please contact the oﬃce and tell the staﬀ member the nature of the emergency. You will be assisted in obtaining the services you needed.
After Hours: If you need emergency assistance after hours, please call our oﬃce and follow the prompts. Phone calls to the main oﬃce will be forwarded to our answering service. The on-call physician will be paged for calls requiring immediate attention. All other calls will be directed to our oﬃce during regular oﬃce hours.
Life threatening emergencies: If the situation is life threatening, please call 911 or go to the nearest ER.
4) Cancellation of appointments- We send you reminders 48 hours before your appointment, via text, call and Healow patient portal. We have reserved the time for you and will not be able to oﬀer that time slot to another patient. For this reason, you are asked to contact us 24 hours in advance if you need to cancel a scheduled appointment, to avoid the late cancellation charges of $25.00. A fee of $25.00 will be charged if you miss the appointment.
5) Prescription Reﬁlls
Please make every eﬀort to make and keep timely appointments with your provider.
For routine medication please be reminded to call our oﬃce 1 week before your medication is completely gone.
Please do not go to the pharmacy and wait for your prescription. Please allow 24-48 hours for your request to be processed.
Medications such as Antibiotics or Narcotics will not be refilled by phone and require an office visit unless stated by your provider.
In accordance with our pain policy AFM Healthcare will not prescribe or manage chronic pain with narcotics or opioids until you’ve been seen by your primary care provider. In addition, no narcotics will be maintained on the clinic premises. In accordance with recommendations by the Federation of State Medical Boards, we will direct those patients in need of the use of controlled substances to pain specialists and experts for further evaluation, treatment, and monitoring.
6) Fees – Please make sure that every time you visit our oﬃce you are aware about your insurance beneﬁt and patient due responsibilities. It will be important for us to have that information as well as any changes, so we may assist you in using your beneﬁts appropriately.
Please give your insurance information and changes to oﬃce staﬀ as soon as it is available. Failure to provide updated insurance information may result in non-payment by insurance payors and you will be responsible for the full amount of charges.
Co-payment and co-insurance fees are due and payable in full before seeing the provider. We accept cash, credit cards and checks. Make checks payable to “AFM Healthcare”. We will submit claims to your insurance companies for processing. However, if we do not work with your insurance carrier you can opt for self-pay. We charge a $35 service fee for returned checks.
7) Conﬁdentiality- We comply strictly with your Healthcare records and we by HIPAA No records of your treatment will be released outside AFM Healthcare, without written permission from you. You should know that there are some unusual circumstances under which your clinician may release treatment information without your authorization. These situations are (1) an emergency involving imminent danger or harm to self or another.
(2) court order (3) physical or sexual abuse of a minor, and (4) if a crime is threatened or committed at one of our sites against any of our staﬀ. Our patient care coordinator will discuss these conditions with you if you have any concerns.
8) Referrals- If other specialty care is required your family doctor will:
Refer to another specialist, if it is medically appropriate.
If you are a member of a managed care health plan (or HMO), you are responsible for following the rules of your plan. Generally, an HMO requires that you call our oﬃce for a referral before seeing a specialist. Each plan has its own regulations. so be sure you understand your responsibilities.
Please allow at least ﬁve (5) business days to process a referral. A written referral will be completed for you by the referral coordinator.
9) Forms: We charge the following fees for forms:
1) Animal Support Letter- $25.00 (if ﬁrst copy is displaced and pt need new copy)
2) Sport Physical – $25.00 (if ﬁrst copy is displaced and pt need new copy)
3) Medical Records – Retrieval Fee $25 + (First 25 pages $1.00, $0.25 for the subsequent pages)
AFM Healthcare is required by law to keep the privacy of your health information and to provide individuals with notice of its legal duties and privacy practices with respect to health information. AFM Healthcare must abide by the terms of the Notice currently in effect. AFM Healthcare reserves the right to change the terms of its notice and to make the new notice provisions effective for all PHI (Protected Health Information) that it supports. This Notice of Privacy Practices and Policies outlines our practices, policies and legal duties to maintain confidentiality and protect against prohibited disclosure of protected health information (“PHI”) under the privacy regulations mandated by the Health Insurance Portability and Accountability Act (“HIPAA”) and further expanded by the Health Information Technology for Economic Clinical Health Act (“HITECH”).PHI includes your demographic information such as name, address, telephone number, and family; past, present, or future information about your physical or mental health or condition; and information about the medical services provided to you, including payment information, if any of that information may be used to identify you. Your PHI may be kept by us electronically and/or on paper. We may amend this Notice of Privacy Practices and Policies periodically. The new notice will be effective for all PHI that we keep at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices or you may obtain a copy by accessing our website at www.afmhealthcare.com, by calling the office, 407-657-2111 and asking that a revised copy will be sent to you in the mail or asking for one at the time of your next appointment. We regard the safeguarding of your PHI as an important duty. The elements of this Notice and any authorizations you may sign are required by state and federal law for your protection and to ensure your informed consent to the use and disclosure of PHI. If a representative is a court appointed legal guardian, a copy of court documents must be supplied and kept in medical records. Your health records may be released to the following:
- To other health- care professionals within the organization for the purpose of providing you with quality health care
- To your insurance provider for the purpose of the organization receiving payment for providing you with needed health care services.
- To public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.
- To other health care providers in the event, you need emergency care.
- To a public health organization or federal organization in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication)
Your conﬁdential health-care information may be released only after receiving written authorization from you. The following are your rights:
- You may revoke your permission to release conﬁdential health care information
- You may restrict the disclosure of your protected health information for any services provided whereby you or somebody else pays “out of pocket”, in full, for the
- You may be contacted by AFM Healthcare to remind you of any
- You have the right to opt out of any notiﬁcations regarding healthcare treatment options and marketing that are oﬀered to
- Right to receive conﬁdential communication about your health
- Right to review and photocopy any/all portions of your healthcare information
- Right to make changes to your health care information
- Right to know who has accessed your health care information and to know what
- Right to possess a copy of this privacy notice upon
- Right to complain to AFM Health care if you believe your rights to privacy have been violated. Please mail your complaint to
7221 Aloma Ave, Suite 200-400 B
Winter Park, FL 32792
For further information about this HIPAA Privacy notice please call 407-657-2111.
This notice is eﬀective. 02/18/2020.