Our Policies
Policies
Prescriptions:
Ariel Hurtado, M.D. and Megan Hurtado, N.P., do not prescribe or manage any narcotics or opiates. If you are currently receiving medications from other health care providers we will gladly work closely with them.
Insurance:
Some procedures offered by Warrior Wellness will not be covered by insurance. You will be required to pay for the procedure before it is performed. If necessary, we will submit a claim to insurance after your procedure is performed. It is not guaranteed that your insurance will cover any or all of your medical visit.
Appointment/Procedure Policy:
Please arrive on time to all appointments and procedures.
Arriving late delays not only your appointment, but that of our other patients.
Warrior Wellness has the right to reschedule your appointment if we feel that you would not receive the full value of your appointment that day, or if you arrive later than 15 minutes of your scheduled appointment time.
Furthermore, if you are more than halfway through your appointment time and are barely arriving, your appointment will be cancelled, and our cancellation policy will take effect.
Cancellation-No-Show-Rescheduling Policy
Warrior Wellness Hurtado, M.D. & Hurtado, N.P., has a 48-hour cancellation-no-show-rescheduling policy.
A $125* cancellation-no show-rescheduling fee for a regular appointment and a $250* cancellation-no show-rescheduling fee for any procedure will be charged to the credit card on file.
This policy is in place to respect the time of our clinicians, patients, and staff. Appointments/Procedures that are not cancelled or rescheduled within 48 hours can be difficult to fill.
Any patient that cancels, no shows, or reschedules within 48 hours of his/her appointment/procedure date and time will result in a ($125*/$250*) fee to the credit card on file.
We kindly ask that you respect our medical providers’ time as they schedule out weeks to months in advance.
*Warrior Wellness reserves the right to modify our fees at any time
Refund Policy
We appreciate your understanding of our refund policy. Warrior Wellness does not offer refunds of any services rendered or products or nutraceuticals sold.
Outcomes vary from person to person and our knowledgeable providers do their best to achieve your desired health goals, however, this cannot be guaranteed.
Our retail products and nutraceuticals are final sale. Defective products or those that may cause an allergic reaction must be reported within seven days to assure that Warrior Wellness can take the proper steps in assuring and optimizing resolution.
Gift Certificates are final sale.
Patient Signature: _________________________________________
Date:
HIPAA Policy, Notice of Privacy Practices and Photo Consent
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information.
Please review the following information carefully:
The Health Insurance and Portability & Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used. We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.
How we may use and disclose your health information: • We may create and distribute de-identified health information by removing all references to individually identifiable information. • We may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you. • Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing, and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization. Ariel Hurtado, M.D., and/or Megan Hurtado, N.P. of Warrior Wellness, are required by law to review and sign all patient charts. I, _______________________________ (Patient Name), understand that Ariel Hurtado, M.D., and/or Megan Hurtado, N.P. will be reviewing my personal health records and photographs provided in the medical record.
Initials: ___________ Date:
A consumer fact sheet regarding protection of privacy by the U.S. Department of Health and Human Services can be accessed online at www.hhs.gov/news/facts/privacy.html.
Initials: ___________ Date:
Notice To Patients:
Open Payments Database For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public. You may search this federal database for payments made to physicians and teaching hospitals by visiting this website: https://openpaymentsdata.cms.gov/
Photo and Video Consent:
I consent to have my pictures and/or videos taken and stored in the electronic medical record system of Warrior Wellness. Such photographs and videos will not be used for any purpose except for documentation purposes and internal training without my express permission.
Initials: ___________ Date:
Optional:
Social media and Promotional Release and Consent:
I hereby give permission to Warrior Wellness to use my photos, videos, and/or likeness in all forms of media, for the purpose of advertising, training, and any other lawful purposes.
Initials: ___________
Patient Signature: _____________________________ Date:
Provider Signature: ____________________________ Date:
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