Melanie Chatterji, MD, FACR • Aaron B. Heath, DO • Grant H. Louie, MD, FACR • Rosemarie A. Shaw, CRNP
Robert A. Shaw, MD, FACR

Forms Completion Policy

Patients may require forms to be completed by one of the providers (disability, FMLA, life insurance, MVA, etc). Completion of forms requires administrative time to gather data, physician time to review, and time to complete the form. Some forms are lengthy, complex, and require a physical exam by a licensed health care provider. To expedite processing these forms in a timely manner, we have developed the following Forms Completion Policy. Please note: you must be an established patient. A provider of Carroll Arthritis will not complete any type of form until you have been seen in the office at least 3 times.

  1. Disability, FMLA, Durable Medical Equipment, Insurance policy, (including, but not limited to):
    • Forms cannot be completed on the day presented to the office UNLESS you have scheduled an office visit specifically for forms completion. When you schedule your appointment, inform the receptionist that you have forms.
    • If you have seen the doctor within the past 30 days, then you may choose to leave the forms and the doctor will complete them within 5 business days. There will be a $25 charge to the patient (cash or credit card), payable upon submission of the forms.
  2. Letters on Carroll Arthritis letterhead for medical needs (including, but not limited to):
    • Excuse for Jury Duty for a medical condition
    • Special consideration for needs
    • Other letters requested
      There will be a $10 fee charged to the patient (cash or credit card), payable upon patient receipt of the requested letter.
  3. Handicapped Tags/Parking Permits*
    • There is a $10 charge for completion of this MVA form charged to the patient (cash or credit card) upon receipt of the completed form.
     
    *****Please note that the providers of Carroll Arthritis will consider a handicapped tag ONLY if the patient is wheelchair-bound, on crutches or a walker at all times, or is on continuous oxygen therapy.
 

We are not obligated to complete these forms. We reserve the right to refuse to complete any form. If records are requested, in addition to a completed form, then the form will be sent from our office once payment has been received from the company requesting this information. No forms or records will be sent to a third party without a signed release from the patient.

Rev. 10/13