PATIENT FORMS

We are accepting new patients including all Oregon Health Plan patients. We are currently covered with most private insurers, accepting Motor Vehicle and Workers Compensation Claims as well.

NEW PATIENT PAPERWORK:

  1. Complete and sign ONLINE

  2. Download and bring into your appointment OR upload completed forms to our HIPAA compliant Business DropBox.

  3. Please arrive to your scheduled appointment time 10 minutes before if we may have any questions on the information provided, and please bring with you a picture ID and insurance card.

    ***New Patient’s must call to schedule their initial visit (for insurance and availability reasons), online requests will be denied for New Patients.

 

RELEASE OF INFORMATION

 

  1. Download and print the authorization form and bring it to your next appointment OR submit the form electronically.

  2. Once the authorization has been verified, the OIH Records Department will fulfill your request. Requests for your personal records will be completed within 72 hours on business days.

  3. If fees apply, OIH Records Department will send you an invoice by email. Once payment has been received, records will be sent by your chosen delivery method.

  4. Your medical records will either be emailed to you by secure messaging or will be mailed on a USB drive. We do not mail paper due to sensitive HIPAA protected information.

  5. If another doctor’s office requests records from our clinic we will process these requests within 30 business days or sooner, no fees apply to you.

  6. We do not process requests for Records to be sent to another facility on patient’s behalf due to HIPAA requirements. If you want records transferred to another facility, please contact that facility directly to request transfer.

FEE SCHEDULE

There may be fees for the release of records as permitted by state law (ORS 192.563).

1 Years of Records Emailed, Faxed: Free

More than 1 Years of Records or More than 10 Pages of Records Printed, Mailed or Added to a USB:* Processing fee of $30

*All records are mailed on a USB to protect your health information.

No fee will be charged to release your records to another physician’s office. A completed authorization will be required.
 

TO REQUEST INFORMATION FROM OTHER FACILITIES:

Download and print the authorization form OR submit the form electronically.
 

AUTHORIZATION FOR THE RELEASE OF MEDICAL
INFORMATION FROM OTHER HEALTHCARE FACILITIES

To give OIH access to outside medical records, you will need to authorize release from your current medical provider(s). Please complete the form and we will send it to your current provider for processing. It may take up to 30 business days for OIH to receive your medical records.

CONTACT US

For questions regarding your medical records request, please contact us below:

Phone:503.972.0235 x 2150
Fax:971.244.5372
Email:records@oregonih.com
Website:www.oregonih.com

 

BILLING INFORMATION

Obtaining payment for health care services can sometimes be a daunting task. The “system” is extremely complex, with numerous health plan requirements, layers of government regulation, coverage issues, coinsurance amounts and rules about coordination of benefits. Navigating this web of requirements takes a partnership between you, your insurance company and Oregon Integrated Health.
 

OUR COMMITMENT TO YOU

We will:

  • Verify your eligibility for any services you request at Oregon Integrated Health.

  • Bill your health plan, automobile or workers’ compensation insurer for covered services before billing you (except for copays, coinsurance or deductibles known at the time of treatment).

  • Make reasonable efforts to obtain referrals, authorizations and pre-certifications from your health plan.

  • Communicate with you the information we have gathered on your health plan coverage and out-of-pocket responsibility.

  • Provide a payment plan – if you are uninsured or have large balances after insurance.

  • Conduct business with respect, care, teamwork, excellence and commitment to personal best.

YOUR RESPONSIBILITY AS OUR PATIENT

We ask you to:

  • Provide us with your health plan information.

  • Know your insurance coverage and what your out-of-pocket expenses are.

  • Tell us when a service is to be covered by a party other than your health plan (for example, by automobile insurance or workers’ compensation).

  • Keep us and your insurer up-to-date with your choice of primary care doctor.

  • Keep us up-to-date with your personal information, including home address, employer information and telephone numbers or if your insurance plan changes.

  • Pay your copay when you check in for your appointment.

  • Promptly pay your coinsurance, deductible or other out-of-pocket responsibility.

Patients are responsible for paying charges that are not covered by insurance. Payment is due 30 days from the bill date indicated on the statement. We accept MasterCard, Visa, credit cards. You may pay online, in person at your appointment or by calling our billing office 503.972.0235 x 2103.

Payment plans are available for patients who have large balances not covered by please visit one of our clinic offices or call 503.972.0235 x 2103. Charges not covered by insurance that remain unpaid for more than four months will be considered for referral to a collection agency.
 

YOUR APPOINTMENT

When making your appointment, please remember to provide the following information:

  • Your health, automobile or workers compensation insurer information.

  • Your home address and telephone number.

For new patient appointments, you will have the option to be emailed a New Patient Packet. Our forms are also available here online and can be printed and presented at your appointment. You will receive a Reminder Phone Message prior to your appointment.

For your first appointment, please arrive 10 minutes prior to your appointment time:

  • Present your insurance card and Identification.

  • Provide the front desk with any updates to your personal information.

  • Pay your co-payment.

 

MEDICAL INTERPRETATION

Oregon Integrated Health strongly encourages the use of interpreters for medical translation. Patients, however, may decline the use of free-of-charge interpreter services and choose to use family members or friends. If this occurs, the provider will document that the interpreter services were declined.

Please note that federal law prohibits the use of minor children as interpreters.

When you are registering or calling for an appointment, please make sure OIH staff are aware of your need for an interpreter and have record of your primary language. They will then coordinate efforts to ensure that a competent medical interpreter, fluent in English and your primary language, will be present for your appointment(s).

Generally, requests for appointments require 72 hours notice but may be expedited based on interpreter availability.

 

LATE OR MISSED APPOINTMENTS

LATE TO APPOINTMENT POLICY

Late Appointments are considered if you arrive 5 minutes or more past your appointment. You will likely be asked to reschedule unless the provider’s schedule can still accommodate you. Priority will be given to the patients who arrive on time and you may have to be worked in between them. This may mean you will have a considerable wait. If this is not convenient for you, you may choose to reschedule. We strive to see every patient as close to their appointment time as possible.

We ask that you please be courteous of your provider’s valuable time and attention. The providers, office staff, as well as your fellow patients will thank you.
 

MISSED APPOINTMENT OR “NO-SHOW” POLICY

Our office requires 24 hour notice if an appointment cannot be kept or needs to be cancelled. You can call our main office number between 8am and 5pm. If before 8am or after 5pm, please leave a message on our voicemail.

We make every effort to provide reminder calls, text messages and emails 48hr and 24hr before your scheduled appointment.

All “No Show” appointments are tracked within the patient’s medical record. There is a $50.00 fee attached to all “No Show” appointments subsequent to the first offense. Every patient receives a text message at the end of day reminding them they missed an appointment at the clinic that day. Each patient is called the following business day and provided an opportunity to reschedule. If you have pending future appointments these will be cancelled unless you confirm that you will be attending these appointments. After three (3) missed appointments, the practice may at its discretion choose to discontinue your care.

If inclement weather is effecting your travel to the clinic for your appointment, please call the clinic ahead of time to reschedule – we will do our best to call you as well if our clinic is closed.