Thank you for choosing Southeast Connecticut Eye Care, LLC for your eye care. We appreciate the trust you have placed in us to take care of your eyes and your vision. In order to become and continue as a patient with us, you must agree to the following terms and conditions. If you do not agree to these terms and conditions, we would be happy to refer you to another eye care practice.
By becoming our patient, you authorize the physician(s), staff, consultants, and contractors of Southeast Connecticut Eye Care, LLC, to render appropriate medical and surgical eye care to you. You understand that the practice of medicine and surgery involves risk, and although we endeavor to minimize this risk, it can not be eliminated. Examinations, dilation, medications, surgical procedures, testing, imaging, and many of the other things we do here have potential danger to your comfort, vision, health, and even life. In consenting to care, you understand this risk and accept it.
We often use dilating drops to allow your doctor to adequately examine your eyes, and to properly screen for, diagnose, and treat eye diseases. These drops cause the pupil (the black circle in the center of your eye) to become enlarged. This allows your physician to see the inside of the eye, for a better view of the important structures in it.
Dilation may cause blurred vision and sensitivity to bright lights. This effect varies from person to person, and may be much more severe in some than others. It may interfere with your activities, and may make it difficult or unsafe to drive. The decision to drive or not is yours alone, and you take responsibility for your decision if you do drive. We recommend that you bring a driver with you the first time you are dilated, so you see the effect of the dilation. Based on this experience, you can decide whether or not it will be safe for you to drive the next time you are dilated.
Dilating drops may require up to thirty minutes to work. This can sometimes prolong the time needed for your visit with us. Please plan accordingly. In most cases, the effects of dilation last less than four hours, but some may last for days, or even weeks.
Unless you are seeing us for a complete eye exam, we may perform a limited exam. Limited exams are based on certain problems you have, or problems another doctor or care provider asked us to evaluate. Some examples of this include a new patient seeing us for pink eye, or a patient referred to us for evaluation of droopy eyelids. In cases such as these, we may chose to limit our examination to the issue at hand, and not perform a full eye exam. With a limited exam, we may not screen for conditions such as diabetic eye disease, macular degeneration, or glaucoma. By agreeing to be our patient, you agree that you will schedule a complete eye examination with either us or your usual eye doctor, and follow your doctor's recommendations for regular follow-ups. Failure to adhere to a regular schedule of eye examinations can result in important diagnoses being missed, and the potential for preventable visual disability.
Many medications in the United States are used "off-label." This means that a medication is used to treat a condition for which it did not receive approval from the US Food and Drug Administration. An example of this is using antibiotic drops that were approved to treat pink eye to prevent infection after cataract surgery. This is a common, legal, and appropriate practice. Medications may be used off-label if, in the judgment of your physician, it would be beneficial to you to do so. Because so many of our medications are used off-label, we will generally not tell you whether a medication is being used according to its FDA approved indication or not. If you would like to know, please ask your physician.
The most current notice of our privacy practices is provided to you on our website (see-care.com). If you would like a paper copy we would be happy to print one for you, or you can print it yourself directly from our website.
By becoming a patient at Southeast Connecticut Eye Care, LLC you understand that you are entering into a contractual relationship with our physician(s) ("Physician") for professional care. You further understand that meritless and frivolous claims for medical malpractice have an adverse effect upon the cost and availability of medical care to patients, and may result in irreparable harm to a medical provider. As additional consideration for professional care provided to you by Physician, you, the Patient/Guardian, agree not to initiate or advance, directly or indirectly, any meritless or frivolous claims of medical malpractice against Physician.
Should you initiate or pursue a meritorious medical malpractice claim against Physician, you agree to use as expert witnesses (with respect to issues concerning the standard of care), only physicians who are board certified by the American Board of Ophthalmology, and whose primary source of income is from the practice of medicine. Further, you agree that these physicians retained by you or on your behalf to be expert witnesses will be members in good standing of the American Academy of Ophthalmology. You agree the expert will be obligated to adhere to the Code of Ethics defined by the American Academy of Ophthalmology (copy available at www.aao.org).
You agree to require any attorney you hire and any physician hired by you or on your behalf as an expert witness to agree to these provisions.
In further consideration, Physician also agrees to exactly the same above-referenced stipulations.
Each party agrees that a conclusion by a specialty society affording due process to an expert will be treated as supporting or refuting evidence of a frivolous or meritless claim.
Patient/guardian and Physician agree that this Agreement is binding upon them individually and their respective successors, assigns, representatives, personal representatives, spouses, and other dependents. Physician and Patient/Guardian agree that these provisions apply to any claim for medical malpractice whether based on a theory of contract, negligence, battery, or any other theory of recovery. Patient/Guardian acknowledges that he/she has been given ample opportunity to read this agreement and to ask questions about it, and to consult with an attorney if needed.
You request that payment of authorized Medicare benefits to be made either to you or on your behalf be paid to Southeast Connecticut Eye Care, LLC for any services furnished to you by our physician(s). You authorize any holder of medical information about yourself to release to the Centers for Medicare Services, your Medigap insurer if applicable, and its agents any information needed to determine benefits for related services.
By becoming a patient of Southeast Connecticut Eye Care, LLC you agree to assign payments for services rendered to be paid by your insurance company to your clinician, and that Southeast Connecticut Eye Care, LLC may release medical information to your insurance company in accordance with applicable law.
It is your responsibility to obtain an insurance referral if required by your plan. You also agree to pay any co-pay, deductible or coinsurance due. You agree to pay any fees and charges due that are not covered by your insurance, and that you will be responsible for collection fees if collection proceedings become necessary.
In consideration of other patients of Southeast Connecticut Eye Care, LLC, please be on time to your appointments. Being late can delay our entire schedule for the day, and inconvenience other patients. If you are late to your appointment, we will attempt to see you if doing so would not interfere with the care of other patients. If we are unable to see you, we may need to reschedule your appointment to another time or day. If we need to reschedule your appointment, we treat the incident as a missed appointment.
We devote considerable resources to seeing you for eye care. Missed appointments deny other patients the availability of these resources and impose costs on our practice. While we endeavor to remind you of appointments by various means, it is your responsibility to report for your appointment as scheduled. If you miss an appointment the following policy applies.
We understand there may be circumstances beyond your control that prevent you from coming to your appointments. If there are exceptional circumstances that interfere with your visit, please let us know as soon as possible. We may forgive missed appointments at our discretion.
If you wish to cancel an appointment, you must do so no later than twenty-four (24) hours prior to its scheduled time. Canceling later than this is treated as a missed appointment, except in exceptional circumstances.
We try to take care of all patients who seek our care. If you are unable to afford the costs of your care, please ask for an appointment with our office manager for financial counseling. We may be able to offer you payment plans, reduced price care, or other accomodations as needed. We may ask for documentation of financial need (such as tax forms) to determine eligibility.
You may use cell phones in our office, but please be discrete and considerate of other patients. We ask that you not use a cell phone in the clinical area when a technician or physician is present.
Because of the presence of precision optical and digital equipment, food and drinks are not permitted in the clinical area. You may leave food and drink at the front desk reception area if needed.
Use of tobacco or tobacco products (including electronic cigarettes, snuff, and chewing tobacco) is not permitted anywhere in buildings occupied by Southeast Connecticut Eye Care, LLC.
Weapons, illicit drugs (including marijuana), and alcoholic beverages are not permitted anywhere in buildings occupied by Southeast Connecticut Eye Care, LLC.
Because marijuana continues to be classified as an illicit drug by the US Government, we do not provide prescriptions for its use, regardless of any scientific evidence regarding clinical efficacy.
These Terms and Conditions of Care may be amended, updated, and changed at any time and without notice by Southeast Connecticut Eye Care, LLC. You agree to comply with the current version. The current version of these Terms and Conditions of Care is available at see-care.com. We are happy to provide you with a paper copy at no charge upon demand.
Effective date: July 19, 2017