IMPROVING YOUR ODDS IN THE FIGHT AGAINST DISEASE... PATIENT Mission Statement GUIDE TO JBN MEDICAL • We strive for excellence in medical care and all the SERVICES services we provide. D I A G N O S T I C • We further our knowledge through research and con- tinuing education. I N C . • We place ourselves on the S E R V I C E S leading edge of informa- M E D I C A L J B N M E D I C A L tion technology. D I A G N O S T I C 2951 Walkers Line Suite #301 • We provide compassion- Burlington, Ontario ate care to our patients L7M 4Y1 905.331.3101 J B N and their families. Phone: 905-331-3101 Fax: 905-319-2499 Email: firstname.lastname@example.org SERVICES PROVIDED Full fee schedules are posted in all exam rooms and a copy is also available at the OTHER INFORMATION reception desk. We accept cash, Visa, • Please allow 2 weeks for completion Master Card and personal cheques (NSF of any dropped off forms (3rd party cheques subject to an additional charge). charges may apply). • Access to information: as a patient you HOURS OF OPERATION have the right to request information Covered by OHIP – services covered by OHIP from your chart (administrative charges Clinic hours are Monday to Friday 9AM to may apply). are provided to patients with valid Health 4PM. We do not close for lunch. Card. It is patient’s responsibility to obtain • Protection of Personal Information and coverage and provide proof of insurance with CONTACTING US Electronic Document Act (PIPEDA) – each visit. Patients without valid OHIP cover- your personal information is always Please call 905-331-3101 for all your age who are residents of Canada will be kept confidential. We require your inquiries. Our telephone line is answered billed OHIP rates and an administrative fee signed consent to share the information by an auto attendant, offering simple with each visit. Foreigners will be billed OMA with other professionals. Exception to choices. If you are unable to make a se- rates for all services provided. this rule can be made in case of medi- lection press ZERO or stay on the line and Covered by WSIB – for WSIB related services an operator will assist you. In the event cal emergency. JBN PIPEDA policy is patient is required to provide all appropriate your call is directed to a voice mail please displayed at Reception A and B. claim documentation. leave your name and phone # and your call will be returned promptly. 3rd party services (requests made by another ALLERGY INJECTIONS party) – fees apply for medical and non- In case of emergency call 911 or go to the medical services provided. The requesting nearest Hospital Emergency. Our clinic is Current allergy injection schedule is party may pay directly or the patient maybe not a walk-in urgent care centre. How- available at Reception B and at responsible for the payment and seek reim- ever, if possible, our physicians will make www.jbnmedical.com. We reserve the bursement. themselves available to other doctors right to make last minute changes. Insurance reports treating you for any medical emergency. Please call 905-331-3978 before Employer reports coming out. Government reports PLEASE NOTE you have to make an ap- Medical legal assessments pointment to discuss test results or to obtain prescription repeats. Drivers medical APPOINTMENT CANCELLATION POLICY Personal uninsured services – requests for J B N M E D I C A L health care not insured by any of the above An appointment can be cancelled up to D I A G N O S T I C categories. Examples: 24hrs prior to the scheduled time (Monday appointments have to be cancelled by 2951 Walkers Line Diagnostics: ABPM, BNP testing Friday, early morning). If an appointment Suite #301 letters and notes is missed without a valid reason, we re- Burlington, Ontario chart review and transfer serve the right to charge a no show fee L7M 4Y1 before rescheduling. Patients who fail to telephone advise show for 2 consecutive confirmed appoint- Phone: 905-331-3101 missed appointment fee ments can be deemed non-compliant and Fax: 905-319-2499 Additional charges may include fees for long will be returned to the care of family phy- Email: email@example.com distance calls, faxing and photocopying. sician.