Urological Associates of Western Colorado
 
Patient Information
 
Following is information regarding our general office policy to help our staff and patients understand their mutual needs and  responsibilities. Please discuss any potential conflicts with our office staff.
 

Appointments
 Please call 970/243-3061 to make an appointment. When a patient is first seen or if a patient has not been seen for over one year, we need the following:
* Completed patient demographic information form.
* Completed medical history form.
* Insurance cards.
* Referral from primary care physician.
* Medical record copies from your referring physician, if indicated.
* Recent x-rays to be brought to the appointment.
These can be checked out at the appropriate hospital or clinic.

Office Hours:
Routine office hours are 8:00 AM to 5:00 PM Monday through Friday. If you have an urgent problem or an emergency, day or night, call our office number. One of our physicians is available 24 hours a day, including holidays and weekends. Routine phone calls are returned by the office nurse in consultation with the physician in the office that day. Non-urgent phone calls to a particular doctor will be returned on his next scheduled day in the office.

Payment Terms
We depend on prompt payment. It is our policy that fees due from patients, including insurance co-pay and deductible, are due at the time of service.  Please call 970/243-3061 with any questions.

Insurance
We participate in several insurance programs such as Medicare, Rocky Mountain Health Plans, Mountain Medical Associates, Great West Life and PacifiCare. If we do not participate with your insurance company, we will assist you in filing your insurance claim as a courtesy. If your insurance company does not pay your bill within 45 days, we will expect payment from you directly. Please call our billing office 970/241-4444 with any questions.

Overdue Accounts
Statements are sent monthly. If you are experiencing a financial hardship, contact our bookkeeping department immediately to discuss payment arrangements. Unless overdue payment arrangements have been made, overdue accounts may be released to an outside agency for collection.

Prescription Renewal
Call your pharmacy for prescription refills. Please allow 48 hours for prescription renewals to be phoned from our office to your pharmacy. No renewals over the weekend. Please call by 4:00 PM Friday.
If you need a 90 day mail order renewal, please obtain a written prescription from your physician and mail it to your pharmacy.

Patient Responsibility
We rely on our patients for their cooperation in their care and treatment. Please ask if you have a question about your condition, medications, or a possible medication allergy.
Be informed about the specifics of your insurance plan. There may be special requirements regarding primary care physician referral, the need for a second opinion, or the use of certain facilities or laboratories. Failure to inform us of these requirements may lead to denial of part or all of a payment by your insurance company which will then become your responsibility.

Notice Of Privacy Practices
The Urological Associates of Western Colorado is required to abide by the United States Department of Heath & Human Services and their Health Insurance Portability and Accountability Act (HIPAA) rules and regulations regarding patient medical records and patient medical information. The HIPAA requirements cover all aspects of your medical information as it relates to you as a patient of the Urological Associates of Western Colorado. You will be provided with a copy of the Notice Of Privacy Practices at your initial office visit. Additionally, for your use we are providing an Internet link to the HHS Office for Civil Rights web site and the pages that explain your rights and our obligations to protect your medical privacy under HIPAA.
http://www.hhs.gov/ocr/hipaa/

Patient Forms
Patient forms are included for your information and to be printed out and returned completed to the Urological Associates offices for inclusion in your Patient file. A list with a link to the specific forms in the Adobe Acrobat print format follows: (To print and view our forms you will need an Adobe Acrobat Reader. If you do not have the free Acrobat Reader it can be downloaded directly from Adobe. Click on the link below.)

New Patient Forms
Patient Orientation
Patient Information
Medical Records Disclosure Authorization

Patient Medical History Forms
Medical History
Current Medications
Male Urological Work Up
Female Medical Work Up
Dr. Pitt's Work Up History
Pediatric Medical History
Pediatric Urological Work Up Form

Surgical Procedure Forms
Vasectomy (3 Pages)
Circumcision (2 Pages)