Introduction and Welcome:
WELCOME TO OUR FACILITY. OUR PATIENT SRVICES HOURS ARE FROM 9:00AM TO 7:00 PM MONDAY THROUGH THURSDAY WITH OUR LAST APPOINTMENT BEING AT 6:00 PM FOR 1 HOUR SESSION AND 6:30 PM FOR ½ HOUR SESSION.
Our Mission is to provide innovative, multidisciplinary services dedicated to injury prevention and rehabilitation for the community.
As a qualified team of professionals, we promote and provide excellence in rehabilitation services through our commitment to patient’s rights, advance education and professional ethics.
We believe that our services are optimized when we work as a team with our patients/clients, his/her caregivers, family and our professional colleagues. We additionally believe that we demonstrate social responsibility by providing services in a cost effective, proficient manner.
The management team has evaluated administrative, technical, and physical safeguards to protect the privacy of protected health information, and per our risk analysis, safe & responsible measures have been implemented
As part of our Mission, we make every effort to see our patients on a timely basis. This requires certain patient responsibility and we ask your cooperation.
Patient Responsibility:
PROMPTNESS – please make every effort to arrive on time
CANCELLATIONS – please call 281-344-1808 if you are unable to keep your scheduled appointment
LATE ARRIVALS – Will be seen as the therapist’s schedule permits. Please understand that if you arrive late, you may not receive all or any of your treatment.
EARLY ARRIVALS – Will be seen as the therapist’s schedule permits. The therapists are obligated to other appointments, so you may be required to wait until your schedule time.
RESCHEDULING – Please consult your front office to schedule future appointments
GOODS AND SUPPLIES – Please ask the Business Office Receptionist or your therapist if you are eligible for supply/equipment reimbursement by a third party payer
NON-COVERED SERVICES – At times services that could be important to your rehabilitation are not considered “covered services” by your health plan; should this occur you will be advised prior to treatment administration and will be given the opportunity to choose to sign a waiver and accept personal payment responsibility or you may choose to decline to receive the recommended service.
I UNDERSTAND THAT IF WE HAVE TWO CONSECUTIVE NO SHOWS THAT MY CHILD WILL BE REMOVED FROM THE THERAPIST SCHEDULE AND AN APPOINTMENT WILL BE MADE WITH FAITH A. STILEN, OWNER TO CONTINUE SERVICES. IF THE SHOW RATE IS 50% OR LESS, THE PATENT’S SERVICES WILL BE DECREASED OR CANCELLED AT THE DISCREETION OF FAITH PEDIATRIC REHABILITATION.
If you have any questions or concerns please ask for me, Faith A. Stilen President
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PATIENT NAME (PRINTED) DATE
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PARENT SIGNATURE
CLIENT TERMINATION POLICY AND PROCEDURE
I. Faith Pediatric has the right to “terminate” a client for the following reasons:
1. Profitability. On the surface, this appears to be common sense. However, no one likes to turn away a customer, and depending on the financial stability of your business, sometimes it can be several years before we make the determination that a customer is not profitable. In addition, this analysis can be complicated, as some customers may be “lossleaders” whose value is not directly connected to their bottom line.
2. Alignment. Businesses evolve and sometimes we simply don’t provide —or at least specialize in — the areas that certain clients need. It’s important to be honest with our clients and ourselves when something is simply not the right fit for our business. Otherwise, these customers will end up in category 1 or 4.
3. Culture. In our company, culture is a priority. We treat our employees and clients with respect and integrity. As such, we expect the same from those with whom we do business. This is not to say that sometimes things go wrong and people get upset. This is understandable and we are empathetic. But, some people are simply unkind and disrespectful by nature. Any client who is chronically abusive to you or your staff is usually not worth it in the end.
4. Exposure. Finally, there are clients who create a larger exposure for your business than they generate in revenue. If not addressed appropriately, clients from any of the above three categories can fall into this category. Furthermore, there are a number of specific warning signs that can signify a client exposure that should be evaluated (see sidebar).
Additional details to terminate difficult clients:
· Clients not paying your invoices on time
· Clients not taking your advice
· Clients that consistently cause stress in your office
· Clients that make threats
· Clients that fail to provide paperwork on a timely basis
· Clients that you do not trust
· Clients that do not understand the services you are rendering
· Clients that do not appreciate your expertise
· Clients that challenge the need for documentation
· Clients that are a bad fit for your business model
· Clients that test your bottom line
II. Documentation must be provided and meeting set up with owner of company, operations manager, therapists and client/client’s parents to inform family they have been “fired” from company
III. FPR will see client for 30 days to give ample time for family and client to find services elsewhere
IV. FPR will provide list of clinics within 30 mile radius to help family/client transfer to new clinic
I have read and understand the above mentioned conditions for “termination” of services for my child
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Parents signature Date