New Patient Information, Responsibilities and Medical Release Forms
(NOTE: To submit custom payment amount, complete the Patient Account # and Patient Name and then click Make Payment button to customize your payment amount and enter amount to be submitted.)
- You have the responsibility to participate in decisions regarding your own care and to clarify the consequences of a decision to refuse care. You are responsible for any consequences or adverse effects you may incur as a result of refusing care or not complying with instructions given to you.
- You have the responsibility to provide a complete and accurate health history and to tell your NTIDC provider if you have any changes in medication, procedures and/or your physical condition.
- You have the responsibility to ask your provider what to expect regarding pain and pain management, discuss pain relief options with your provider, work with your provider to develop a pain management plan and ask for pain relief when the pain first begins.
- You have the responsibility to care for the equipment used in your therapy and to report any problems you may have. All equipment is to be returned to NTIDC pharmacy when your therapy is complete. You will be billed for any abuse, loss or theft of equipment.
In most cases your lab results will be available in 5-7 days. The lab tests ordered will determine the actual length of time to complete.If you call the office during normal business hours to discuss your results with a member of our staff:
- Please leave a message for the nurse to contact you.
- Callbacks are not done while waiting patients are in the office.
- You may schedule an appointment with your physician to discuss your results.
For medication refills, simply contact your pharmacy directly and they will make the request for you. Refill requests must come from a pharmacy.
Refill requests may take up to 72 hours for approval. Please monitor your pill bottles and contact the pharmacy at least 5 days prior to running out of your medication. Please note that prescription refill authorizations are dependent upon you maintaining the recommended follow-up appointments with your provider.
For all Class II Controlled Substances, an approved prescription form is required by the Texas State Law. All refills on these medications will be handled directly through the physician.
For Class II Controlled Substances, please notify our offices 5 working days prior to the pharmacy needing to refill the prescription, as your physician may not be in the office. These prescriptions will not be filled again under a 30-day time period. Prescriptions that are misplaced, stolen or lost will not be replaced.
NTIDC offices always have a physician on-call when the offices are closed. If you have an urgent problem, please keep in mind the following:
- Routine medication refills are only filled during office hours
- Class II Controlled Substance refills are only filled during office hours
- Scheduling and/or canceling appointments will not be done after hours. Please contact the offices during normal business hours.
- Antibiotics will not be prescribed without an office visit.
- If you have a life-threatening or medical emergency, please call 911 or go to the nearest emergency medical facility
- In order to contact an on-call physician, please contact our office.
NTIDC participates with the vast majority of insurance plans, including both Medicare and Medicaid. Our knowledgeable and friendly staff will help you understand if our services are covered and if you will be responsible for any unmet deductible, coinsurance or co-pay amounts. These amounts, as well as any service provided by NTIDC that is not covered by your health plan, will be payable at the time of your visit. Please bring your insurance card to your appointment so we may verify your medical coverage.
If you have any additional questions regarding fees or are in need of making special payment arrangements, please speak with one of our Patient Account Managers. As a courtesy to you, our office will file insurance claims. However, patients assume ultimate financial responsibility for payment.
For billing questions, you may contact the Patient Account Manager by calling 214-823-2533.
- To have access to services regardless of race, country of origin, religion, sex, handicap or source of payment.
- To know about your role in treatments and to be an active part of your healthcare treatment.
- To be told how the medicine you have been prescribed is effective.
- To be told about risks and benefits of your treatments.
- On-site placement of intravenous lines for infusion of prescribed medications.
- To be told about your therapy in a way you can understand.
- To expect quality care and treatment.
- To receive appropriate pain assessment and pain management and to know that all reports of pain will be taken seriously and responded to by our healthcare professionals in a quick and caring manner.
- To be given proper information about pain and pain relief measures.
- To stop treatments (with or without your doctor’s approval) and to be told what can happen if you do refuse treatment.
- To have your property treated with respect and to have your privacy and security maintained.
- To be assured of confidentiality of clinical records and to allow or not allow the release of medical information within required regulations.
- To be told the costs related to your medical care.
- To be given a detailed bill that describes charges for professional fees, products and equipment used during your therapy.
- To receive advice about financial assistance or payment plans.
- To be told the names of the people involved in your care, the responsibilities of those people, and the right of choice in the care provided.
- To receive answers to your questions, 24 hours a day, seven days a week.
- To file a complaint or to recommend changes in policies or services to the company without fear of coercion, discrimination, reprisal or service interruption.