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Patient Information
Office Address
24331 El Toro Road
Suite 200
Laguna Woods, CA 92653
Phone (949) 586-3200
Fax (949) 900-2158
Directions To Our Office
Office Hours
Monday through Friday from 8 a.m. to 5 p.m.
Online Appointment Request Form
Click Here To Request an Appointment
Patient Forms
Patient Profile Form
Confidential Health History Form
Monarch Healthcare Eligibility Waiver Form
Notice of Privacy Practices
SCOS Payment Policy
Point-of-Service (POS) Waiver Form
Dr Tran's Patient Forms
New Patient Questionnaire Form
Dr Brage's Patient Forms
Foot and Ankle Form
Dr Johnson's Patient Forms
New Patient Questionnaire Form
Worker's Compensation Forms
Patient Information
A Message To Our Patients About Arbitration
The attached contract is an arbitration agreement. By signing this agreement we are agreeing that any dispute arising our
of the medical services your receive is to be resolved in binding arbitration rather than a suit in court. Lawsuits are
something that no one anticipates and everyone hopes to avoid. We believe that the method of resolving disputes by
arbitration in one of the fairest systems for both patients and physicians. Arbitration agreements between health care
providers and their patients have long been recognized and approved by California courts.
By signing this agreement you are changing the place where your claim will be presented. You can still call witness and
present evidence. Each party selects an arbitrator (party arbitrators), who then selects a third, neutral arbitrator.
These three arbitrators hear the case. This agreement generally helps to limit the legal costs for both patients and
physicians. This is because the time it takes to conduct an arbitration hearing is far less than for a jury trial further,
both parties are spared some of the rigors of trial and the publicity which may accompany judicial proceedings.
Our goal, of course, is to provide medical care in such a way as to avoid any such dispute. We know that most problems
begin with communication. Therefore, if you have any questions about your care, please ask us.
Sincerely,
South County Orthopedic Specialists, A.P.C.
Your First Visit
We will attempt to verify coverage with your insurance company prior to your first
appointment. This will hopefully, eliminate any surprises concerning your
personal responsibility for payment. To assist in providing the most appropriate
treatment and to eliminate unnecessary visits, you should bring the following
information to your first visit.
- History of your present problem or injury, including date and circumstances of onset.
- Records of other treatment you have received for this condition, including films (the actual x-rays) and reports for
any x-rays or diagnostic tests (CT, NM, bone scan, EMG and nerve conduction studies, etc.).
- The name, address and telephone number of your primary care physician and /or referring physician.
- Your insurance cards and information; name of company, address, policy and/or claim numbers and subscriber's name; any
authorizations from your insurance company.
- Information concerning your insurance company's requirements on preadmission certification and second opinions.
- If your condition is work-related, a copy of the report
Patient Accounts
We participate with many PPO'S, workers' compensation carriers, private insurance's and Monarch HealthCare.
We accept Medicare Assignment.
We will file claims for all services covered under these plans. You will
be asked to pay for any non-covered services, co-payments or deductibles
at the time of your visit. For non-contracted insurance plans, we will
ask for payment of routine services at the time of your visit.
For non-contracted insurance plans, we will ask for payment of routine services at the time of your visit. We accept
ATM debit cards; cash; personal check; Discover, Master, or Visa credit cards. When you make payment, you will be
given a complete and accurate statement that you may file with your insurance company for reimbursement.
For contracted insurance plans, we will file a claim with your insurance
company for any fees related to care, surgery, or hospital services. Payment
of balances remaining after the insurance company's payment is your responsibility.
Billing Error Disclaimer
This office is required by federal compliance laws to report services provided by South County
Orthopedic Specialists based on documentation in the medical record. As a policy, we cannot
improperly alter a claim for the purpose of obtaining payment. If you discover a bona fide
billing error, duplicate charge or other posting errors, we welcome you to bring the matter
to the attention of our business office staff for investigation and proper corrective action.
As you may know, coverage and payment amounts vary greatly by payer (i.e., insurance company).
If you have questions about your particular coverage, it is best to check with the benefits
representative at your company. Our staff will be happy to assist you in claims filing for
prompt adjudication and payment of your insurance claim.
Workers' Compensation
Our physicians have extensive knowledge and experience in the diagnosis and treatment of occupational injuries.
"Qualified Medical Evaluator" status indicates compliance with strict workers' compensation education requirements
and successful completion of a state examination.
Medical-Legal Issues
We do not accept lien cases or new patient personal injury cases involved in litigation. Should you have a personal injury
which ultimately requires that you obtain an attorney to represent you, we will be happy to provide your attorney with
copies of your medical records through a copy service. We do not provide narrative medical-legal reports, depositions or
court testimony.
Medications
Neither initial nor refills of medications will be prescribed after business hours.
After Hours Process
On-call coverage is provided 24/7, including weekends and holidays.
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