Midwestern University Clinics | Arizona And Illinois Affordable Healthcare

Time 2020-10-27 20:04:09

Web Name: Midwestern University Clinics | Arizona And Illinois Affordable Healthcare

WebSite: http://www.mwuclinics.com

ID:96394

Keywords:

Clinics,Arizona,Midwestern,

Description:

Welcome to Midwestern University Clinics The Midwestern University clinics offer a wide-range of health services for the whole family. At our clinics, graduate-level students and expert clinical faculty work side-by-side to provide exceptional care. Patients of all ages benefit from state-of-the-art facilities, comprehensive treatment options, and a collegiate atmosphere where they play an important role in the education of the next generation of healthcare professionals. At our clinics, we offer patient services with convenient centralized scheduling, easy inter-specialty referrals, and several specialty areas in one central location.This authorization will expire 1 year from 10/27/2020.I understand I may withdraw my authorization at any time by submitting a written request to the HIPAA Privacy Officer. I understand any revocation is not effective to the extent action has already been taken in reliance on this authorization. I understand information used or disclosed pursuant to this authorization may be subject to re-disclosure and may no longer be protected by federal or state law. This authorization is not intended to affect a patient's ability to receive medical care.Alcohol and Drug Abuse Treatment.To the extent my medical record contains information regarding alcohol or drug treatment that is protected by federal law, I authorize the disclosure of such information or record.HIV / AIDS InformationTo the extent my medical record contains information regarding my HIV/AIDS status, treatment or testing, I authorize the disclosure of such information or record.Behavioral Health Notes / RecordI authorize the disclosure of any behavioral health notes or information in my medical record.With my digital signature below, I consent to the release of the above listed information / documents.Community Partner site to email this completed form to communitypartners@midwestern.edu. Midwestern willcontact the patient to schedule an appointment within 48 business hours of receipt.Midwestern will reserve an appointment time for the patient. The length of time to complete your agreed upontreatment depends on the individual needs of each patient. As a teaching facility, care will require longerappointments than you may be accustomed to in a private dental office. Additionally, procedure completion mayrequire more than one appointment. Valid ID is required for patient registration.Patient referral is valid for 30 days from date of referral on form and patient must be seen within those 30 days.If patient is taking medications, please remind them to bring a list to their appointment.Patient must be screened and accepted into the dental program prior to any treatment. For the no charge endodonticCommunity Partner therapy program, the patient will be provided with a limited exam and radiograph.Retreatments are not a covered benefit under the Community Partners endodontic therapy program.Some complex cases may be determined to be a non‐teaching case and outside the scope of the program.If patient does not require endodontic therapy, patient will be referred back to referring dentist for treatment.If patient is provided with endodontic therapy, the patient understands that treatment will include a restoration [core] totemporarily protect the tooth, at no charge to the Community Partner patient. Please note the tooth may still need additionaldefinitive treatment.Patient understands that this referral is for potential limited treatment only for the listed tooth on the referral and thepatient may choose to return for comprehensive care at our clinic.Patient must provide a current valid government issued photo ID.With my digital signature below, I consent to the release of the above listed information / documents.

TAGS:Clinics Arizona Midwestern 

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The Midwestern University Clinics conveniently located in Glendale, Arizona and Downers Grove, Illinois provide high quality affordable healthcare.

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