Post by Admin on Sept 30, 2021 11:49:12 GMT
***consent to treat Form***
Patient Record -
Physician of SCMV-
I (patient name) give permission for San Carlo Memorial Clinic to give me medical treatment. I allow San Carlo Memorial Clinic to file for insurance benefits to pay for the care I receive.
I understand that: San Carlo Memorial Clinic will have to send my medical record information to confirm medical plan coverage via citizen individual contract.
I must pay my share of the costs.I must pay for the cost of these services if no plan is on file.
(insurance is always assumed to be functional within RP scenarios we wish to make the form as realistic as possible to give a full immerse experience)
I understand:
I have the right to refuse any procedure or treatment.
I have the right to discuss all medical treatments with my clinician.
Patient's Signature Date
Patient Record -
Physician of SCMV-
I (patient name) give permission for San Carlo Memorial Clinic to give me medical treatment. I allow San Carlo Memorial Clinic to file for insurance benefits to pay for the care I receive.
I understand that: San Carlo Memorial Clinic will have to send my medical record information to confirm medical plan coverage via citizen individual contract.
I must pay my share of the costs.I must pay for the cost of these services if no plan is on file.
(insurance is always assumed to be functional within RP scenarios we wish to make the form as realistic as possible to give a full immerse experience)
I understand:
I have the right to refuse any procedure or treatment.
I have the right to discuss all medical treatments with my clinician.
Patient's Signature Date