Dear New Patient, Sincerely, Staff and Providers at Brown Clinic

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1 Dear New Patient, Thank you for selecting Brown Clinic and its providers for your healthcare needs. It is our desire to provide you with comprehensive care in a family atmosphere. We are here to answer your questions about your health, medical conditions and treatment. In the interest of helping you get off on the right foot, please complete your Request for Records Transfer and forward it to your past provider s office, if you have not already done so. Your previous practitioner has 30 days to respond to your request. Your new doctor will appreciate having that information in order to address your medical needs and be fully informed. In order to simplify and expedite your initial visit with us, please complete the attached forms. If any information does not apply to you, please note N/A for not applicable. Please arrive at least 20 minutes prior to your scheduled appointment and bring all forms in the New Patient Packet along with the documents listed below: Primary Insurance Card Secondary Insurance Card if applicable Photo ID (driver s license, school photo ID, passport) Any prescribed medications you are currently taking We look forward to your visit and hope we can be of continuing service. If you have any questions, please do not hesitate to contact our clinic at (605) Sincerely, Staff and Providers at Brown Clinic Main First Avenue SE, Watertown, SD Nothridge Fourteenth Avenue NE, Watertown, SD (605) Fax (605) Appointments (605) Toll Free

2 Welcome to Brown Clinic; the people you know and trust. We invite you to explore all of the services that Brown Clinic offers. We take a team approach to keeping you and your family healthy. Your needs come first at Brown Clinic. We have been a part of Watertown and the surrounding communities since You can find out more information about Brown Clinic on our website: Your new Patient Packet includes all the forms and information you will need to make your first experience with us a success. You will find an explanation of our financial policy included in your new Patient Packet. Also included is a Patient Health History form to be filled in before your first appointment. Please have your past health records transferred so the physician can review your individual history prior to your initial visit. If you have questions that have not been addressed in your new patient packet, please call us at Thank you for making Brown Clinic your choice for excellent health care. Brown Clinic Administrator Jim Vachal

3 Brown Clinic Financial Policy Brown Clinic is dedicated to providing the best possible care and service to you and your family. Your complete understanding of your financial responsibilities is an essential element of care and treatment. Regarding Insurance We accept most insurance plans and will bill your insurance company directly as a courtesy. When your insurance payor doesn t cover medical care deemed necessary by your physician, you will be 100% responsible for those charges. If we believe your insurance payor may not cover some or all of your services, you will have this explained to you, and you will be asked to sign an Advanced Beneficiary Notice (ABN). The ABN will state what services may not be covered, and you will have the choice whether or not to proceed with the recommended treatment. Non-Covered Services It is your responsibility to know your insurance coverage benefits and to present your card at each visit. You will need to verify coverage for all preventive care such as physicals, routine immunizations, employment screening, Department of Transportation physicals, radiology services and lab tests. We cannot be responsible if services are not a covered benefit on your insurance plan. No Insurance Coverage If you do not have insurance coverage, you are required to pay the estimated charges prior to your appointment or make financial payment arrangements with one of our Financial Counselors prior to the appointment/office visit. Change in Insurance Plans We ask you to update your insurance and demographic record at each visit to our office. It is your responsibility to notify us immediately of any changes. If we are unable to process your claim due to incorrect information, or your claim is denied because of incorrect information, we will bill you directly for our services. Payment is Required at the Time of Service If a co-payment is required by your insurance company, it is payable at the time of service. Minors Under most circumstances we cannot see a minor without an accompanying parent, guardian or adult with written consent from the parent or legal guardian. The adult accompanying the minor, and the parents or guardian, are responsible for any patient balances due at the time of service, including co-payments. WE ACCEPT Cash, checks, Visa, MasterCard, Discover and American Express credit cards. For your convenience, you may also make payments at the Brown Clinic website: Please click on the make a payment link, and follow the instructions. A FEE Will be assessed for lengthy form completion (disability forms, etc.) and letters that you request from the provider. The flat-rate fee is $40. Forms require 3-5 business days to be completed. We charge a $25 fee for any returned checks over and above what your financial institution may charge. Thank YOU For your preparation and attention to these important details. If you have any questions,

4 General Information Appointments and Scheduling When calling to schedule an appointment, call It is our commitment for you to see your primary care physician (PCP) within 48 hours. If your PCP is not available, you will be referred to the next available medical provider. Insurance Cards We will need to see your insurance card(s) and a photo ID every time you are seen in our office. We are unable to process your insurance claim without it; if you cannot provide proof of insurance at the time of service, you will be considered a self-pay patient. Any insurance co-pay s or co-insurance are due when you register. Please Be On Time For Your Appointment New patients: please arrive 20 minutes early to complete any necessary paperwork and to allow for verification of insurance. Established patients: please arrive 15 minutes early to complete your registration. Medications Please bring all medications, including herbal or over-the-counter medications to every appointment. Prescription Refills If you require prescription medication, you should receive enough medication to last until your next appointment. In the event you need to refill a prescription, please call your pharmacy allow hours for an approval. Yearly Physicals Please check your insurance policy carefully before scheduling a physical exam. Your wellness exam is limited to specific insurance guidelines. If you need other health concerns addressed outside of these guidelines, you may be billed for additional services. We have knowledgeable staff to assist you with any insurance issues. Telephone Messages We receive a high volume of telephone calls every day. We will make every effort to return calls as soon as our schedule allows. If you leave a message, please leave a phone number where you can be reached during business hours. Avoid Distractions Please refrain from cell phone use while our staff is assisting you.

5 Brown Clinic offers extended services such as: In-house Specialists OB/GYN Specialist Pediatrics General Surgery Podiatry Pharmacological Services Nutritional Services In-house Services Mammography Osteoporosis Screening Ultrasound CT Laboratory Infusion/Oncology Center outreach provider services Pediatric Pulmonology Ear, Nose and Throat Specialist Cardiology and Pediatric Cardiology Pulmonology Dermatology Oncology and Hematology brownclinic.org