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DIVULGACION DE INFORMACION

Autorizo a CHCI a usar y divulgar mi informacion de salud para los siguientes propositos: (1) para proveer, arreglar o coordinar mi tratamiento de salud; (2) para permitir a CHCI obtener el pago por los servicios que me provee; Y (3) para permitir que CHCI lleve a cabo la atencion medica ordinaria y operaciones comerciales tales como garantia de calidad, planificacion de servicios y administracion general.

Soy consciente de que esta autorizacion para usar y divulgar informacion puede incluir informacion sobre: (1) VIH o SIDA; (2) abuso de alcohol o drogas; (3) enfermedad mental o cualquier condicion de salud conductual; (4) enfermedades de transmision sexual; (5) planificacion familiar, embarazo y aborto. Soy consciente de que CHCI puede compartir informacion con mis otros proveedores medicos para tratamiento medico o con un tercero para pago financiero a traves de medios electronicos.

Autorizo a CHCI a solicitar y usar mi historial de medicamentos recetados de otros proveedores de atencion medica y/o pagadores de beneficios de farmacia de terceros para propositos de tratamiento. Este formulario de consentimiento permanecera en vigor hasta el dia en que revoque el consentimiento. Para denegar el consentimiento en cualquier momento, hable con un asociado de servicios al paciente, que le ayudara con este proceso de exclusion voluntaria.

Asignacion de beneficios

Yo asigno a CHCI todos los beneficios a los que pueda tener derecho de Medicare, Medicaid, otras agencias gubernamentales, companias de seguros y otros terceros que son financieramente responsables por la atencion medica y el tratamiento proporcionado por CHCI. Autorizo la divulgacion de informacion requerida por la compania de seguros para propositos de facturacion y me doy cuenta de que la prueba de cobertura de seguro necesita ser proporcionada para que CHCI pueda presentar una reclamacion de seguro en mi nombre. Estoy de acuerdo en que cualquier beneficio pagado por mi seguro ca

OBLIGACIONES FINANCIERAS

Estoy de acuerdo en que, excepto en los casos en que pueda estar limitado por la ley o los acuerdos de CHCI con terceros pagadores, en caso de que un tercero (es decir, mi seguro) no haya pagado por el que he proporcionado una asignacion de beneficios, Estoy obligado a pagar todas las cantidades adeudadas por los servicios prestados en las localidades de CHCI de acuerdo con las tarifas y terminos de CHCI en vigor en la fecha del servicio. Tambien estoy de acuerdo en que soy responsable de cualquier copago, coseguro o deducibles aplicables. Entiendo que no debo proporcionar

Intercambio de informacion de salud

CHCI utiliza un intercambio electronico de salud que nos permite compartir informacion clĂ­nica con otros medicos, enfermeras, hospitales y centros de salud. El programa ayuda a proporcionar la mejor atencion posible al permitir que los proveedores fuera de CHCI vean su informacion clĂ­nica. Esto incluye registros medicos, de salud del comportamiento y dentales actuales y pasados en CHCI. Entiendo que esta autorizacion permitira a CHCI inscribirme en este programa. Lo entiendo inscribiendo en este programa

COMUNICADO DE CONTACTO

CHCI se pone en contacto rutinariamente con los pacientes por teléfono, correo electrónico (si se proporciona la dirección de correo electrónico), texto (si se proporciona el número de teléfono celular) y/o correo para recordarles sobre citas, preguntar sobre facturas y notificarles de otros programas y servicios de CHCI. Los pacientes o representantes legales que no deseen ser contactados por teléfono, correo y/o correo electrónico, deben hablar con un Asociado de Servicios al Paciente.

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Can I annotate fields to indicate their intended use?

Yes. You can provide "Help" to your users for any field:

1. On any page in your application, click "Customize" then "Fields". If it is a multi-table application, select the table.

2. Click the "Edit" button next to the field for which you want to add an annotation.

3. In the "Help" text input box, enter text that will assist your users, and click "Save".

Your text will appear when the user hovers over or clicks on the question mark icon next to that field on the Add Record and Edit Record pages.
 
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    When you bring additional fields into a conversion, Quickbase often finds inconsistencies. For example, say you're converting your Companies column into its own table. One company, Acme Corporation, has offices in New York, Dallas and Portland. So, when you add the City column to the conversion, Quickbase finds three different locations for Acme. A single value in the column you're converting can only match one value in any additional field. Quickbase needs you to clean up the extra cities before it can create your new table. To do so, you have one of two choices:

    • If you want to create three separate Acme records (Acme-New York, Acme-Dallas and Acme-Portland) click the Conform link at the top of the column.
    • If the dissimilar entries are mistakes (say Acme only has one office in New York and the other locations are data-entry errors) go back into your table and correct the inconsistencies—in this case, changing all locations to New York. Then try the conversion again.

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