*Required fields are marked with an asterisk.
Below is a copy of our patient handbook. If you would like to download a copy of the handbook including a copy of our "Notice of Privacy Practices", please click here.
ALLERGY CENTER AT BROOKSTONE OFFICE HOURS
Mon, Tues, Thurs, Fri: 8:30 a.m. – 5:00 p.m.
Wed: 7:30 – 4:30 p.m.
Closed for Lunch: 12:00 p.m. – 1:00 p.m.
Thurs: 8:30 – 5:00 p.m.
Closed for Lunch: 12:00 p.m. – 1:30 p.m.
This office is not open every Thursday.
Patients are seen in the office by appointment. To schedule an appointment for our Columbus office, please call us during office hours at 706-324-4012.
To schedule an appointment for our LaGrange office, call 706-324-4012 or 706-885-0070. When you call, please specify to the receptionist that you are making an appointment for our office in LaGrange.
If you are receiving an allergy injection only, you do not need an appointment but should arrive within the posted injection schedule hours. Please check with the allergy shot room to verify the injection hours. Allergy injections are not given in
the LaGrange office.
Because of the nature of our specialty, we ask that you refrain from wearing perfume or other fragrances to the clinic. These odors may trigger asthma, rhinitis or migraines for some of our patients.
HOURS CARE ANSWERING SERVICE
In the event you need to speak with a physician after regular office hours, call our primary number at 706-324-4012. The answering service will contact the physician on call, and your call will be returned within the hour. If you have an emergency
situation, call 911 or go to the Emergency Room immediately. Patients should not call the answering service after hours for medication refills. Patients with upper respiratory infections or flu like illness should contact their primary care physician
or seek medical care at an afterhours clinic. If you call after hours, you may receive service by a Board Certified Allergist outside of the Columbus area.
Prescriptions can be refilled by calling our office at 706-324-4012, ext. 13. Appointments are not always necessary to receive refills, but patients must be seen annually or more regularly as required by their physician.
APPOINTMENTS OR LATE CANCELATIONS
If you are unable to keep your appointment, you are expected to cancel your appointment with at least a 24 hour notice. Failure to cancel the appointment without a 24 hour notice is considered a “No Show” and will result in a $25.00 missed appointment
fee. Appointments for Mondays must be canceled by 2:00 p.m. on Friday to avoid being considered a no show.
To assist you in keeping appointments, we have implemented various reminder systems; however, keeping up with scheduled appointments is the responsibility of the patient. Not getting a reminder call is not an acceptable excuse for failing to show
for your appointment.
Patients who consistently fail to present themselves for scheduled appointments or fail to cancel their appointments 24 hours prior to scheduled appointments will be considered chronic no-show patients. Chronic no-show patients may be discharged from
BILL OF RIGHTS
It is the policy of The Allergy Center at Brookstone to recognize and respect the rights and responsibilities of all patients. The following specific policies will be observed by the staff:
Considerate and respectful care in a safe and pleasant environment.
Be free from all forms of abuse, neglect, harassment, and exploitation.
Privacy concerning their medical care.
Receive complete current information concerning their diagnosis, treatment and prognosis from their physician in terms they can reasonably be expected to understand.
Know the identity and professional status of individuals providing service to you, and to know which physician or other practitioner is primarily responsible for your care.
Receive from their physician all information needed in order to give informed consent, as required by the laws of the State of Georgia, prior to the start of any procedure or treatment. Except in emergencies, such information should include –
but not be limited to – the specific procedure or treatment and risks considered medically significant by the physician.
Be involved in all decisions about their care. Discussions with patients will include the necessity, appropriateness, and risks of proposed care or procedure as well as discussions of treatment alternatives. You have the right to ask questions.
Have your personal and religious beliefs honored. You have the right to discuss all treatment options and refuse any or all treatment recommendations.
Obtain a second opinion regarding recommendations. Expenses associated with second opinions are your responsibility.
Refuse treatment to the extent permitted by law and to be informed of the medical consequences of their actions.
An interpreter. Interpreters should be requested at least 1 week in advance of office visit.
Be informed of the facility rules that apply to their conduct as a patient.
Confidential medical care and record maintenance. Information will not be released without your consent unless authorized by law. You have the right to information in your medical record and you may request a copy of your records.
Have the opportunity to participate in decisions involving your health care, unless contraindicated by concerns of your health.
Be able to participate or refuse to participate in any research without compromising your access to treatment and services.
Refuse participation in experimental treatment and procedures. Should any experimental treatment or procedures be considered, they should be fully explained to the patient prior to commencement.
Information regarding emergency and after-hours service.
Impartial access to treatment regardless of race, color, gender, ethnicity, national origin, religious affiliation, sexual orientation, handicap or disability.
Request information on the financial aspects of services. To estimated fee and payment information prior to any procedures.
A fair and efficient process for resolving differences with their healthcare provider.
The patient has the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the actions of
health care personnel, and the adequacy of health care facilities.
INFORMATION ON FINANCIAL INTEREST
Dr. Robert Chrzanowski and Dr. Robert Cartwright do have a financial interest and ownership in The Allergy Center at Brookstone. Dr. Tracy Bridges does not have financial interest or ownership in this practice. All physicians are compensated by salary.
TO FILE A COMPLAINT OR GRIEVANCE
General complaints or grievances will be reviewed by the office manager who will address the issues and forward to the medical director as needed. If you believe your privacy rights have been violated by our practice or an employee of our practice,
you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. Because we are always interested in improving the quality of services provided to you, we would encourage you to contact us first.
All complaints must be in writing. You will not be penalized for filing a complaint.
COMPLAINTS CAN BE SUBMITTED TO THE FOLLOWING
Department of Community Health – Healthcare Facility Regulation
2 Peachtree Street, Suite 31-447
Atlanta, GA 30303
Composite Board of Medical Examiners
2 Peachtree Street NW, 36th Floor
Atlanta, GA 30303
AGAINST NURSING STAFF
Professional Licensing Boards Division
Georgia Board of Nursing
237 Coliseum Drive, Macon, GA 31217-3858
OF PATIENTS’ RIGHTS
The patient has the right to file a grievance with the Georgia Composite Medical Board, concerning the physician, staff, office and treatment received. The patient should send a written complaint to the board. The patient should be able to provide
the physician or practice name, the address and the specific nature of the complaint. Complaints or grievances may be reported to the Board at the following address or telephone number:
Georgia Composite Medical Board - Complaints Unit
No.2 Peachtree Street, N.W. 36th Floor
Atlanta, GA 30303
PATIENT IS RESPONSIBLE FOR
Providing accurate and complete health information concerning their past illnesses, medications, including over-the-counter products and dietary supplements, and any allergies or sensitivities.
Keeping all scheduled appointments and complying with treatment plans to ensure appropriate care.
Taking responsibility for maximizing healthy habits, such as exercising, not smoking and eating a healthy diet.
Respecting healthcare providers, staff, other patients and the Allergy Center’s property.
Arriving at the Allergy Center in a non-altered state. No patients will be seen under the influence of drugs or alcohol.
Voicing concerns or problems to the facility staff.
Requesting further information about anything they do not understand.
Accepting personal financial responsibility for any charges not covered by their insurance.
Having a responsible adult come with a minor child for an appointment or procedure.
Their own actions if they refuse treatment or do not follow medical advice.
Informing their provider about any advance directive, including a living will and/or medical power of attorney affecting care.
Becoming involved in specific health care decisions.
Working alongside of your health care provider in developing and carrying out agreed-upon treatment plans.
Disclose relevant information and clearly communicate wants and needs.
Use the health plan’s internal complaint and appeal processes to address concerns that may arise.
Avoid knowingly spreading disease.
Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional.
Be aware of a health care provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
Become knowledgeable about his or her health plan coverage and health plan options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate
processes to secure additional information, and the process to appeal coverage decisions.
Show respect for other patients and health workers.
Make a good-faith effort to meet financial obligations.
Abide by administrative and operational procedures of health plans, health care providers, and government benefit programs.
Report wrong doing and fraud to appropriate resources or legal authorities.
You are required to present all insurance cards in which you are active at the time of service. In the event you fail to notify us about other health insurance, or changes to your insurance, you will be personally responsible for the fees incurred
for that date of service.
As a courtesy, we verify all insurance coverage possible in advance of the first visit with our Physician. Your insurance coverage is a contract between you and the insurance company and as such, you are responsible for obtaining necessary referrals
and following plan guidelines. If a referral is required for your policy and it is not received by our office at the time of your appointment, we will be forced to reschedule your appointment. Any discrepancies that are discovered during the verification
process may result in a delay or rescheduling of the appointment. Failure to notify us of insurance changes may result in the patient/guarantor receiving the bills for all rendered services. If a referral is needed, it is the patient’s
responsibility to assure that the referral is obtained and kept up to date.
Payment for services is expected at the time of service. With most insurance plans, there is a portion of fees that are the patient’s responsibility. Depending on the type of insurance you have, you may have an annual deductible to meet. Co-payments,
co-insurance, and deductibles are collected at the time you check-in for your appointment. We will file your claim with your insurance in a timely fashion. Prompt payment of any fees not collected at the time of service is expected and appreciated.
Our office will make every effort to verify your insurance benefits prior to your visit and notify you in advance.
The Allergy Center at Brookstone understands that some blended family situations are complicated; however, we cannot, and will not become entangled with various arrangements set forth in Divorce Decrees and the like. Therefore, payment for any and
all services rendered will be expected from the guardian that escorts the patient to their appointments. It is your responsibility to ensure that the appropriate and responsible party is present. The party responsible for the account is that person
that signed the authorization for treatment prior to the divorce or separation. After a divorce or separation, the parent that authorizes treatment for the child will be the parent responsible for subsequent charges. If the divorce decree requires
the other parent to pay all or part of the treatment cost, it will be the authorizing parent’s responsibility to collect from the other parent.
OF NETWORK SERVICES
We participate through a contract with most insurance companies and are considered “in network” for those insurance companies. If we do not participate with your particular insurance company or plan, we may be able to provide care under your “out
of network” benefits. When receiving medical care from an out of network provider, you would be responsible for the difference between what your plan pays and our fee schedule. This payment would be due at the time of service. If insurance coverage
cannot be verified at the time of your visit, you have the option of paying for the visit in advance and filing for your own reimbursement or rescheduling your appointment until such verification can be made.
Outstanding charges that are found to be the patient’s responsibility will be mailed to you on a detailed monthly statement. We allow 90 days or three statements to be mailed for a balance to be paid in full. If the account is not paid in full
after 90 days of a balance entering your responsibility, your account will be turned over to our collections agency. Failure to notify our office of address changes or the submission of incorrect information does not constitute an excuse for undelivered
statements or missed payments. Also, in the event that your private insurance has not reimbursed our facility for services rendered after sixty days from the date we file your claim, the patient or their Guarantor will be responsible for the payment
of the full charges resulting from services rendered. In the event you feel there is a discrepancy in your account, contact the billing department as soon as possible. The Allergy Center at Brookstone, P.C. will take all the necessary steps allowed
by law to collect on past due accounts. Any patient who has been placed in collections must pay any balance owed to the practice in full before the practice will see them again.
The Allergy Center at Brookstone accepts cash, credit cards, debit cards, and CareCredit. We do not accept checks.
AND FORM COMPLETION POLICY
We will complete required forms for disability, insurance, FMLA or others following a scheduled office visit to evaluate the patients’ current condition or need for the form. There will be a fee of $5 - $25 when applicable. Forms may take up to 7
business days for completion. No forms are completed on a rush or emergency basis so please plan accordingly.
In the State of Georgia, all patients have the right to participate in their
own health care decisions and to make Advance Directives or to execute
Powers of Attorney that authorize others to make decisions on their
behalf based on the patient’s expressed wishes when the patient is unable
to make decisions or unable to communicate decisions. The Allergy
Center at Brookstone upholds those rights. However, unlike in an acute care hospital setting, we do not routinely
perform “high risk” procedures. Most procedures performed in this
practice/facility are considered to be of minimal risk. You will discuss
the specifics of your procedure with your physician who can answer your
questions as to its risks. Therefore, it is our policy, regardless of the contents of any Advance Directive or instructions from a health care surrogate or attorney-in-fact,
that if an adverse event occurs during the course of your treatment at this
practice/facility, we will initiate resuscitative or other stabilizing
measures and transfer you to an acute care hospital for further evaluation.
At the acute care hospital, further treatments or withdrawal of treatment
measures already begun will be ordered in accordance with your wishes,
Advance Directive, or health care Power of Attorney. Your agreement
with the practice/facility’s policy will not revoke or invalidate any
current healthcare directive or healthcare power of attorney.
At your request, our practice/facility can provide you with the necessary
forms to complete your advance directive in accordance with Georgia
YOU HAVE QUESTIONS ABOUT THIS NOTICE PLEASE CONTACT
Teresa Heath, Office Manager
1220 Brookstone Centre Parkway
Columbus, Georgia 31904
706-324-4012 or Fax 706-324-0396
you do not agree with this practice/facility’s policies, we will be pleased to
assist you in rescheduling your appointment.