Credit Policy  (information)
The primary goal of Family Practice Medical Center of Willmar, P.A. (FPMC) is to insure that each patient receives the highest quality of medical care at a fee that is representative of that care. When you receive services from FPMC, you assume the financial obligation of paying for the services rendered. We will be happy to bill your insurance company for you, but the obligation to pay for services remains with you. All insurance co-pays must be paid at the time of services. A copy of our Credit Policy is available for you to view.
Release of Information (form)
Should you require copies of your medical records please fill out the attached form and return it to the Medical Records Department. Copies will be released only with the signed consent of the patient or authorized agent. A copy of the Release of Information form is available for you to print.
Notice of Privacy Practices (form)
The staff at Family Practice Medical Center, P.A. works hard to ensure the privacy of every patient. As a result, the facility is in compliance with the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). This major piece of federal legislation protects patient privacy and defines the type of information that must be kept private.
The Notice of Privacy Practices describes the type of medical information we collect and how we use or disclose that information. It also describes you rights as they relate to medical information. View the entire Notice of Privacy Practice.
Consent to Treatment of a Minor
(form)
Although we take pleasure in providing care for the whole family, it is our policy not to treat minors without the attendance and/or consent of a parent of legal guardian. A copy of our Consent to Treatment of a Minor is available for you to view or print.
Contribution Policy (information) Contribution Request (form)
Charitable giving is a priority of our organization through cash contributions, volunteer time, and non-cash donations. We know that sharing our resources with other non-profit organizations and agencies that are doing important work in our county is the right thing to do. It is when we join together as a community - We can truly make a difference.
Medical History Questionnaire
(form)
As a new patient at Family Practice Medical Center we will use the medical history questionnaire to gather information regarding your past medical history. You may complete this form prior to a visit and bring it along to review with your provider.
|
