If you have any questions regarding the Patient Forms feel free to contact our office at (516)487-2444.
Patient
Registration Form
Consent
for Use and Disclosure of Protected Health Information
Patient
Financial Responsibility Statement
Card on File
Agreement
Notice of
Privacy Practices
HIPAA
Consent
Office Policies
Medical Procedure
Billing Form
Medical
Records Release Form
Your first visit to our office will be in the form of a consultation. The physician will meet with you to discuss your gastrointestinal issues, medical and social history, and to perform a physical examination. They will then discuss with you a treatment plan and course of action.
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North Shore Gastroenterology Associates, participates with most major insurance carriers. As a courtesy to our patients, we will file claims for those insurances with which we participate. Please note that any amount not covered by your insurance company is ultimately your responsibility. While a list of insurance companies we participate with is available on our website, it is strongly recommended that you contact your insurance company prior to your visit to confirm that we are still participating.
Payment will be requested and is required at the time of service for all services that are non‐covered or determined to be the patient’s responsibility, including co‐payments. Payment may be made by check or credit/debit card. If you have any questions regarding insurance, billing or our fees, please call our billing department.
Below is a list of Insurance Companies that North Shore Gastroenterology Associates, P.C. participates with. Please note that this may not be a complete list, and is subject to change without notice. You should contact your insurance carrier for verification of benefits.
Allied Digestive Health has partnered with HealthMark Group to ensure the accurate and timely completion of medical record requests.
Once you enter your email, you will receive an email with HealthMark to log in (no username or password required!). Click on the “submit request” button and follow the prompts from there. You will receive an email as soon as your records are available for download.
Do I have to remember another username and password?
Nope! HealthMark’s Request Manager uses email verification and secure links to get you your records quickly, efficiently and securely – and without yet another username and password to remember!
How long does it take to process requests?
Most record requests are processed within 8 business hours. So, one or two business days after you submit your request, your records will be delivered electronically – right to your inbox.
Is there a cost associated with obtaining my medical records?
HealthMark Group fulfills all requests for personal copies at no charge. If paper copies are requested a fee to cover delivery costs will be charged and must be paid before the records will be shipped.
About
Our GI Care
For Your Visit
Great Neck Office
233 East Shore Road,
Suite 101,
Great Neck, NY 11023
P: 516-487-2444
Mon – Fri: 9:00 AM – 4:00 PM
Sat & Sun: Closed
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