RALEIGH ENDOCRINE ASSOCIATES

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Document Library

NameDescription
DocumentGlucose Sugar LogUse this form to track and communicate sugars to your physician.
DocumentAuthorization to request medical records.Please fill out, sign and fax to our office if you would like us to request your medical records from another provider.
DocumentAuthorization to release medical recordsPlease fill out, sign and fax to our office if you would like your medical records sent to another provider.
DocumentPatient Registration FormAll new patients must fill this out and bring to their first appointment.
DocumentHIPAA FORMAll patients must have this form signed and on file to be treated in our office.
DocumentREA Financial PolicyAll patients must have this form signed and on file to be treated in our office.
DocumentMedication HistoryAll new patients must fill out this form wth a complete history of all current medications and bring to your first visit.
DocumentReferral Request FormUSe this form to request a referral from your physician.

OFFICE HOURS
Our office is open Monday-Friday 8:00 AM to 5:00 PM. We are closed on most major Holidays.

MAKING AN APPOINTMENT
Patients are seen by appointment only. To make an appointment, please call our office between the hours of 8:00AM and 4:30 PM Monday through Friday.

NEW PATIENTS must fill out a PATIENT REGISTRATION PACKET. Please download the following forms by clicking on the link above and bring them to our office: 

Patient Registration Form
Medication History Form
REA Financial Policy Form
HIPAA Form

Please bring the completed and signed forms to your appointment. Completing these forms prior to your arrival will help expedite your care. Please arrive at least 15 minutes prior to your scheduled appointment to allow time for updating information. NEW PATIENTS MUST ARRIVE 30 MINUTES PRIOR TO YOUR APPOINTMENT TIME TO ENSURE ALL DOCUMENTATION IS COMPLETE OR RISK LOSING YOUR APPOINTMENT.

Please remember to bring your Insurance Card and a valid Driver's License or government-issued photo ID.

REFERRALS
If you have been referred by another provider, please download the form above and have your referring provider's office complete it and fax to (919) 954-3365.

CANCELLATION POLICY
As a courtesy, we attempt to contact every patient to remind them of their appointment. However, it is the responsibility of the patient to arrive on time. If you arrive more than 15 minutes past the scheduled appointment time, you may be asked to reschedule. ALL CANCELLATIONS MUST BE RECEIVED 24 HOURS IN ADVANCE. Patients who do not cancel their appointments at least 24 hours in advance will be charged a "No-Show" fee.  Monday appointments must be canceled by noon the preceding Friday to avoid the cancellation fee.

CO-PAYS AND COLLECTIONS
All Co-pays are due at the time of service. We are unable to discount or waive this fee due to our contract with your insurance. Payment is due in full at the time of service for any self-pay patients, for services that are considered "non-covered" and for patients who have an annual deductible that must be met before their carrier will pay benefits. If you are not able to make a payment, you may be asked to reschedule your appointment. Returned checks are subject to a $30 service fee. Accounts more than 90 days past due will be turned over for collection.

PRESCRIPTION REFILLS
Raleigh Endocrine Associates is now using electronic prescription. Please contact your pharmacy and ask them to send us an electronic refill request. This will be the fastest way to get your prescrition refilled. If your pharmacy is not set up for electronic prescription, please provide your pharmacy with our fax number: (919) 954-3365. They will fax the necessary information directly to us. Please allow 48 hours for all requests to be handled. If you have an emergency, please call the office and let them know the nature of the emergency. Do not leave voicemails for any emergency.

TEST RESULTS
Test results may take up to 10 business days. You will be contacted by phone or mail after your results are reviewed by your provider. If you have not heard from our office within two weeks of your test, you may call the office for assistance.

REQUEST FOR MEDICAL RECORDS
We will release Medical records with a written authorization only. There may be a charge for each request according to North Carolina statute. Medical records fees are $35.00. Medical forms that require a provider signature are subject to a $25 to $50 fee.

Please download one of the following documents above, complete, sign, and mail or fax to our office at (919) 954-3365.

Please note, there are two forms for Medical Records: One for the Patient to request records for personal use or for another Provider, and one for Raleigh Endocrine Associates to request Patient files from another Provider. Both forms require the patient signature.

INSURANCE
Raleigh Endocrine Associates is contracted with the following carriers: BCBS-NC, Cigna, Medcost, Medicare and Supplements (Secure Horizons, Aetna Medicare, Anthem BCBS), Aetna, United Healthcare, Great West, and Wellpath. We are not acceping any new Medicaid patients.

We will accept all insurances, but may be considered "out-of-network" for any non-contracted carriers. All patients will need to review their out-of-network benefits. If you have an HMO, you will be responsible for getting the proper authorization prior to your appointment.