EMERGENCY ROOM VISITS Sample Clauses

EMERGENCY ROOM VISITS. I am allowed to receive pain medication in the emergency room, but it is a violation of the PSPC contract to receive narcotic medication to take home and it must be discussed with the on-call doctor prior to receiving medication. A violation includes any prescription and/or samples.
Sample 1
AutoNDA by SimpleDocs
EMERGENCY ROOM VISITS. I am allowed to receive pain medication in the emergency room, but it is a violation of the AA Spine & Pain Clinic contract to receive narcotic medication to take home and it must be discussed with the on-call doctor prior to receiving medication. A violation includes any prescription and/or samples. Have you ever had any medical or legal problems with alcoholism, drug abuse (including marijuana), addiction or drug trafficking? If yes, please explain: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Have you used any illegal drugs (including marijuana) within the past six months? If yes, list the drugs you have used and when: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Have you used any prescription drugs for which you did not have a personal prescription within the past six months? If yes, please explain: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ I HAVE THOROUGHLY READ THIS AGREEMENT BEFORE RECEIVING TREATMENT AT A.A. SPINE & PAIN CLINIC I UNDERSTAND AND AGREE TO THE CONDITIONS OF CARE DESCRIBED ABOVE AND WILL COMPLY WITH THEM. ALL OF MY QUESTIONS ABOUT THE TERMS OF THIS AGREEMENT HAVE BEEN ANSWERED. I KNOW THAT FAILURE TO COMLPY WITH ANY OF THESE TERMS OF THIS AGREEMENT MAY RESULT IN IMMEDIATE TERMINATIONS OF SERVICE. Reviewed contract and answered all patient’s questions (MA): Date: _____________ Patient’s Signature: ___________________________________________Date
Sample 1
EMERGENCY ROOM VISITS. I am allowed to receive pain medication in the emergency room, but it is a violation of the AASPC contract to receive narcotic medication to take home and it must be discussed with the on-call doctor prior to receiving medication. A violation includes any prescription and/or samples.
Sample 1
EMERGENCY ROOM VISITS. I am allowed to receive pain medication in the emergency department or urgent care center, but it is a violation of the Alpine Pain Solutions patient agreement (contract) to receive narcotic medication to take home. The provider may address the issue with the on-call provider for Alpine Pain Solutions of Utah. I HAVE THOROUGHLY READ THIS AGREEMENT BEFORE RECEIVING TREATMENT AT ALPINE PAIN SOLUTIONS OF UTAH AND I UNDERSTAND AND AGREE TO THE CONDITIONS OF CARE DESCRIBED ABOVE AND WILL COMPLY WITH THEM. ALL OF MY QUESTIONS ABOUT THE TERMS OF THIS AGREEMENT HAVE BEEN ANSWERED. I KNOW THAT FAILURE TO COMPLY WITH ANY OF THE TERMS OF THIS AGREEMENT MAY RESULT IN IMMEDIATE DISMISSAL AND TERMINATION OF SERVICE. Reviewed contract and answered all patient’s questions (MA):_ Date:___/ _/ Patient’s Signature: _ _ _ _ _ Date:___/ _/
Sample 1
EMERGENCY ROOM VISITS. I am allowed to receive pain medication in the emergency room, but it is a violation of the A.A. Pain Clinic contract to receive narcotic medication to take home and must be discussed with the on-call doctor prior to receiving medication. A violation includes any prescription and/or samples. Have you ever had any medical or legal problems with alcoholism, drug abuse (including marijuana), addiction or drug trafficking? If yes, please explain: Have you used any illegal drugs (including marijuana) within the past six months? If yes, list the drugs you have used and when: Have you used any prescription drugs for which you did not have a personal prescription within the past six months? If yes, please explain: I HAVE THOROUGHLY READ THIS AGREEMENT BEFORE RECEIVING TREATMENT AT A.A. PAIN CLINIC, INC. I UNDERSTAND AND AGREE TO THE CONDITIONS OF CARE DESCRIBED ABOVE AND WILL COMPLY WITH THEM. ALL OF MY QUESTIONS ABOUT THE TERMS OF THIS AGREEMENT HAVE BEEN ANSWERED. I KNOW THAT FAILURE TO COMLPY WITH ANY OF THESE TERMS OF THIS AGREEMENT MAY RESULT IN IMMEDIATE TERMINATIONS OF SERVICE. Reviewed contract and answered all patients’ questions (MA): Date: Patients’ Signature: Date:
Sample 1

Related to EMERGENCY ROOM VISITS

  • Emergency Room Services This plan covers services received in a hospital emergency room when needed to stabilize or initiate treatment in an emergency. If your condition needs immediate or urgent, but non-emergency care, contact your PCP or use an urgent care center. This plan covers bandages, crutches, canes, collars, and other supplies incidental to your treatment in the emergency room as part of our allowance for the emergency room services. Additional services provided in the emergency room such as radiology or physician consultations are covered separately from emergency room services and may require additional copayments. The amount you pay is based on the type of service being rendered. Follow-up care services, such as suture removal, fracture care or wound care, received at the emergency room will require an additional emergency room copayment. Follow- up care services can be obtained from your primary care provider or a specialist. See Dental Services in Section 3 for information regarding emergency dental care services.

  • Emergency Repairs a) The landlord must post and maintain in a conspicuous place on the residential property, or give to the tenant in writing, the name and telephone number of the designated contact person for emergency repairs.

  • Emergency Alert System The Franchisee shall comply with the applicable requirements of the FCC with respect to the operation of an Emergency Alert System (“EAS”) requirements of the FCC and applicable state and local EAS plans in order that emergency messages may be distributed over the Cable System.

  • Emergency Work Employees who are required to report for emergency work on non- workdays, or outside of their regular hours of work on a scheduled workday or on holidays which they are entitled to have off, shall be paid overtime compensation for the actual work time and for travel time in connection therewith, but such travel time shall not exceed one-half (1/2) hour.

  • Emergency Use In the case of any civil emergency or disaster, the Licensee shall, upon request of the Issuing Authority, make available to the Town a channel for use during the civil emergency or disaster period. The Licensee shall adhere to any new Emergency notification standards as established by the Federal Communications Commission.

  • Emergency Closures A. The University’s inability to make a Room available to me for any reason beyond the University’s control including, but not limited to, natural disaster, fire, flood, earthquake, condemnation, pandemic, quarantine, utility malfunction, infestation, or other emergency or force majeure event shall not constitute a breach of this Agreement by the University. In such circumstances, the University shall have no liability to me in any way for injuries, reimbursement, damages, inconvenience, annoyance or compensation of any kind. The University may attempt to find, but cannot guarantee, an alternative space for me. If the unavailability of my Room or an alternative space persists for more than 72 hours, I may terminate this Agreement and Check out during said unavailability without penalty provided that I shall be responsible for all financial obligations incurred up to the date of such termination. The University agrees to provide me with a pro rata refund, calculated from the date of such termination to the end of the Agreement Period, of any prepaid housing and dining payment made to the University, and to return my Deposit pursuant to this Agreement. Upon resumption of standard operations, Agreement Termination requirements and charges will apply as described in Section XIV.

  • Emergency Situations If the condition is an emergency, this will be communicated to the Contractor with the request that corrections are to be accomplished immediately. The Contractor shall respond to the notice in emergency situations within twenty-four hours. If the Contractor fails to respond within this time limit, the Owner may correct the defect and charge the Contractor for the Work. If it is determined the complaint is not the responsibility of the Contractor, the Contractor shall be promptly paid for the cost of the corrective work. The Contractor shall give notice in writing to the Owner when corrections have been completed.

  • Emergency Calls IP Phones need an additional power supply to operate. In the event of a power failure it is your responsibility to ensure you have the means to make emergency calls. In accordance with paragraph 13.2, we will not be liable for any loss or damage (financial or otherwise) where you fail to do so.

  • Emergency Operations 6:01 In the event of an emergency which could endanger the health or safety of the public, employees shall unite to meet the emergency and shall, until the danger has been brought under control, perform such duties as may be required of them regardless of their occupation.

  • Emergency Replacement SAP may replace a Subprocessor without advance notice where the reason for the change is outside of SAP’s reasonable control and prompt replacement is required for security or other urgent reasons. In this case, SAP will inform Customer of the replacement Subprocessor as soon as possible following its appointment. Section 6.3 applies accordingly.

Time is Money Join Law Insider Premium to draft better contracts faster.