MEET OUR STAFF

THE PATIENT - DOCTOR RELATIONSHIP

COVERAGE

NO SMOKING PLEASE

APPOINTMENTS

EMERGENCIES

TELEPHONE CALLS

PATIENT REGISTRATION

LABORATORY REPORTS

BILLING

INSURANCE AND LEGAL FORMS

RELEASE OF MEDICAL RECORDS

SECOND OPINIONS

THE PATIENT - DOCTOR RELATIONSHIP

ADULTS - generally prefer to come to the examing room alone. In this way freedom in the patient-doctor relationship can be established. However, this decision is left up to the parties concerned. Certain procedures, such as hernia or
varcose vein operations can be performed at Northwestern Memorial Hospital or an alternative outpatient surgicenter.

CHILDREN - At Northwestern Memorial Hospital Dr. Vazquez treats only patients older than 16 years of age. Children under ther age of 16 years are referred to physicians at Childrens Memorial Hospital or the Evanston Hospital.

COVERAGE

Surgical care is available 24 hours a day, 7 days a weeks. Attending staff coverage is arranged with other physicians for any time when Dr. Vazquez cannot personally attend to your needs, such as, during a vacation period.

NO SMOKING PLEASE

For good medical reasons, and the comfort of others, you are asked to refrain from smoking while in our office.
 

APPOINTMENTS

OFFICE VISITS ARE ARRANGED BY APPOINTMENT ONLY.

The office telephone number is 312-649-6562. You may call the office Monday through Friday 9.00 am to 4.30 pm to schedule an appointment.

Regular office visits are scheduled for Monday, Wednesday and Thursday 9.00 am to 12 noon and 1.30 pm to 4.30 pm. However, patients do not become ill on schedule, operations may take longer than anticipated, emergencies do
occur, and a delay may result. A sincere attempt is made to adhere to the appointment schedule.

Try to call for an appointment at least two weeks in advance. This should enable us to schedule an appointment time convenient for you.

Please do not ask that other members of the family be examined at the time of your appointment. This would interfere with the schedule of other patients.

If you cannot keep an appointment, at least 24 hours notice would be appreciated.

EMERGENCIES

Seriously ill patients or those patients with emergencies will be seen as soon as they arrive at the office or the hospital. This may necessitate an interruption of the regular schedule. If this occurs, we will attempt to inform scheduled patients
of possible delays.

In the event of an emergency during business hours (Monday through Friday 9.00 am - 4.30 pm) please enlist the help of the office staff to locate Dr. Vazquez. If you have a medical emergency after hours or on the weekend, Dr.
Vazquez is available through the anwswering service at Northwestern Memorial Hospital at (312) 915-8132.

If you are injured or urgently ill and must be seen immediately by a physician, please go to the Emergency Room (ER) at Northwestern Memorial Hospital - Olson Pavillion, 233 East Superior Street. The ER is staffed by specialists in
emergency medicine. Specialty residents from the surgical service are on call for your emergency care. The Emergency Room staff will locate Dr. Vazquez and inform him of your condition. Please inform the staff that Dr. Vazquez is your physician.

TELEPHONE CALLS

The doctor-patient relationship is confidential. For this reason, in most circumstances, we will not give information regarding a patient to others without written authorization from the patient.

If Dr. Vazquez were to leave a patient being examined to answer every phone call to the office, it would obviously be unfair to the patient under treatment. However, please do call the office if you have a question or a concern, or if the
doctor has asked you to call to receive a report on test results or medication. The Office Assistant has been trained to answer many questions by referring to your chart. If you or the Office Assistant require the doctor's opinion, you will
be advised to expect a return telephone call from the doctor. Please leave specific information as to how and when you may be reached by phone.

Please remember that many diseases have similar symptoms. For this reason, most requests for treatment will require an office examination. Also, medications cannot accurately be prescribed for a problem which has not previously been
evaluated.

Requests for prescription refills should be made only during office hours because your chart must be reviewed.

If you need to speak with the doctor directly, he will be available during regular office hours Monday, Wednesday and Thursday 9.00 am to 5.00 pm to accept or return your phone call between patient visits. At other times please leave
your message with the Office Assistant and your call will be returned usually by the end of the day. In case of anemergency the doctor will return your call as soon as possible. If you have not heard from him within one hour please
call again.

PATIENT REGISTRATION

New patients will be asked to fill out a Patient Registration Form. A portion of this information is confidential and will be released only upon your written authorization.

You may be asked to complete a MEDICAL QUESTIONNAIRE related to you medical history. These questionnaires were designed to give the doctor important information regarding the background of your problem and
any previous treatment. Completion of this questionnaire gives you a chance to organize your thoughts and tell the doctor about the symptoms, history and treatment of this complaint and past illnesses, and other pertinent medical
history.

LABORATORY REPORTS

Dr. Vazquez will usually call you to inform you of significant abnormal laboratory results. If you have not been informed of the test results within ten days, please telephone the office. Remember, the secretarial staff is not permitted
to interpret laboratory data.

BILLING

For Office Calls

We expect fees for initial office visits and follow-up office visits to be paid at the time the services are provided. Our office will file claims for those patients who require operative procedures. Those patients who have only office visits
are expected to file their insurance claims themselves, the exceptions being, BCBS, Medicare and I.D.P.A. patients. Also the managed care patients who have a co-pay need only make the co-payment at the time of service delivery.

The fee for examinations is usually between $50 and $100 depending upon the services provided. An additional fee is charged for any laboratory tests performed. Patients who are referred to this office from the Emergency Room for
follow-up care (i.e. suture removal) are expected to pay for the services at the time of the office visit. This office will NOT send out monthly statements to patients for any of the above described professional services. You will be
furnished with one itemized completed universal insurance form and receipt at each office visit. These forms are accepted by all insurance companies. No other forms will be filled out by this office. If you need additional copies of your form please make a photocopy of the original. It is the patient's responsibility to secure payment from ALL third party carriers. Collection of insurance benefits is not the responsibility of the physician or the office personnel.

For Hospital Admissions and Outpatient Surgical Procedures

Should your care require hospitalization, we will make arrangements for admission. Outpatient surgical procedures are also performed in the operating suite or a surgicenter. You will receive charges from the hospital or surgicenter for the use of the facility plus a separate bill from Dr. Vazquez for his professional services.

In the event that you require an operative procedure be performed, the office will bill your insurance company for the operation only. If the insurance company has not made payment within sixty days from the date of operation, the
balance becomes the patients responsibility. For your convenience, the office accepts Visa, Mastercard, and the Discover card. Any balance outstanding after 90 days is automatically forwarded to our collection service unless prior
arrangements have been made.

Questions about your hospital bill should be directed to the hospital billing department. Questions regarding surgicenter bills should first be directed to their billing department and brought to Dr. Vazquez's attention if problems
persist.

INSURANCE AND LEGAL FORMS

PLEASE bring your INSURANCE CARD with you to the office for your first visit. If a decision has been reached that you will be admitted to the Hospital for a surgical procedure, upon discharge an itemized standard Health Insurance Claim Form will be sent to your insurance company. You will be asked to sign a release and assignment of benefits for your insurance company on your first visit. We will also need you to supply us with the mailing address for your claim form. Once again statements are due, paid in full within 60 days of your hospital surgery date. We are happy to assist you with your reimbursement from your insurance company. If you have any questions or would like to make other arrangements this MUST be done before your scheduled procedure or sclerotherapy session.

RELEASE OF MEDICAL RECORDS

No confidential information will be released to any person or agency without prior written authorization of the patient to do so. At times if it should be necessary to mail an entire chart there would be a nominal charge for this service.

SECOND OPINIONS

Some insurance companies require that the patient obtain a second opinion before scheduling a non-emergenecy elective operation. Please check with your employee benefits representative or insurance company to determine if a
second opinion is required to retain full insurance benefits. We can provide the name of a physician to supply a second opinion.

Please feel free to e-mail Dr. Vazquez with any medical questions,

or contact our office with any other questions.

Richard M. Vazquez, M.D., F.A.C.S.

201 East Huron Street

Suite 11-250

Chicago, Illinois 60611

(312) 649-6562