Streamline Your Care: Essential Forms to Initiate Treatment
We are grateful that you have chosen Mid South Sleep Diagnostic Center as your provider for sleep-related disorders. Recognizing the abundance of options available to you, we assure you that our team of board-certified sleep physicians, office staff, and technologists is committed to delivering a comprehensive diagnosis and tailoring treatment options that best suit your needs.
To facilitate your journey, we kindly request that you download and complete our new patient packet. While it may seem extensive, each component plays a crucial role in enabling us to provide the utmost care and devise a personalized plan for your improved sleep.
Included within this packet, you will find:
- Patient Information: This section allows us to gather your general details, including insurance coverage, to ensure a seamless administrative process.
- Admissions Questionnaire: Your health history is invaluable in assessing how we can enhance your sleep quality. We encourage you to complete this form meticulously to enable accurate evaluation and appropriate treatment recommendations.
- Patient Consent for Use and Disclosure of Protected Health Information: By completing this form, you have the opportunity to designate individuals with whom we can communicate regarding your care or financial matters, granting them access to pertinent information.
- Patient Disclosures and Authorizations: This comprehensive section grants us permission to administer treatment, file insurance claims on your behalf, and highlights our privacy policy, collection policy, and your financial responsibilities associated with the services rendered.
- Release of Medical Records: While optional, this form is essential if you wish for us to share your medical records with a party other than your referring physician. It may also be necessary if we need to obtain additional information about your medical history from another healthcare provider.
- Minor Patient Authorization: This form solely applies to patients under the age of 18 and authorizes their treatment by our facility.
- Notice of Privacy Practices: We have provided you with an overview of our privacy practices, outlining how your protected health information is utilized and disclosed, as well as your rights and our responsibilities concerning this information.
Additionally, we encourage you to download a copy of our Notice of Privacy Practices, which serves as a comprehensive guide to understanding how we safeguard your privacy and comply with regulatory standards.
At Mid South Sleep Diagnostic Center, we prioritize your well-being and are committed to providing a streamlined and confidential experience. By completing these essential forms, you take the first steps towards a better night’s sleep and improved overall health.
If you have not done so Schedule a Consultation: we’ll arrange a consultation with one of our board-certified sleep physicians. You can contact the location nearest to you or call us at +1 901-755-8891 to book an appointment.