Effective April 3, 2023
Based on current health data and in keeping with the major hospital networks in our
area, Beehive Clinic is ending its mandatory universal masking policy for most patients
Masks will continue to be required as follows:
Staff and Patients are expected to wear masks in the following situations:
● Have recently experienced an exposure to COVID-19, RSV, or Influenza
● Were diagnosed with a COVID-19 infection within the last 6-10 days regardless
of symptoms (Days 1-5 should isolate at home.)
● Have had a fever above 100.4° within the last 24 hours.
● Have mild respiratory symptoms but tested negative for COVID-19
○ Mild respiratory symptoms include any eye, nasal, or oral discharge;
sneezing, coughing or wheezing.
● If they are asked by a healthcare provider to put on a mask based on symptoms
or concerns for patient or caregiver safety.
Patients may choose to mask at any time. Patients who may have autoimmune
conditions are encouraged, but not required, to mask.
Additionally, staff are expected to wear masks in the following situations:
● Caring for patients with an infectious condition, potential exposure to blood or
bodily fluids, or caring for immunocompromised patients at the direction of a
Staff members may choose to mask at any time.
We will continue to monitor local health conditions as necessary and make adjustments
to our policy to prevent infection spread.
Our clinic requires patients to agree to cancel appointments at least one business day
in advance, whether cancelled online, by text, phone, or in person.
Patients also must agree to arrive for their appointment within 15 minutes of the
appointment start time for a regular visit. Patients must arrive within 5 minutes for a sick
or same-day visit as sick or same-day visits are only scheduled for 15 minutes total.
Patients who do not arrive on time agree to pay a $50.00 missed appointment fee if we
are unable to accommodate their late arrival.
Consent to Treat forms, which patients must sign before their first visit and annually
thereafter, as follows:
“I agree to pay a $50.00 fee if I do not cancel an appointment at least one
business day in advance, whether cancelled online, by text, phone or in
person; or do not arrive for my appointment within 15 minutes of the
appointment start time for a regular visit or 5 minutes for a sick or
Missing an appointment prevents us from giving the patient the care they need. Late
cancellations and missed appointments are also detrimental to our clinic because they
prevent us from scheduling another patient who needs medical care as well. Unfilled
appointment times impact our ability to remain profitable when we cannot receive
revenue for the appointment time, thus a late cancellation or missed appointment will
result in a fee to the patient to help offset a portion of the business overhead from the
unfilled appointment time.
I agree to the following:
• I understand I am responsible for my medicines.
• I will not share, sell, or trade my medicine.
• I will not take anyone else’s medicine.
• I will not combine alcohol or any narcotic pain medicine with ADHD medicine or anxiety medicine unless I am specifically directed to by my provider.
• I understand if I am being prescribed a controlled substance for anxiety, alprazolam (Xanax) will not be an option for consideration.
• I will check my blood pressure or have it checked prior to each telemedicine visit and report the result to my provider at the time of the visit.
• I will not adjust the dose of my medicine without discussing it with my provider.
• My medicine will not be replaced if it is lost, stolen, spilled, or used up sooner than prescribed.
• I will make every attempt to keep all appointments and understand receiving controlled substance medicine for ADHD requires visits at least every 90 days, or more often if medication or dosing changes are being made.
• I agree to gradually taper controlled substance anxiety medicines or attend regular therapy appointments, if the medicine will be continued long-term.
• I agree to give a blood or urine sample, if asked, to test for the medicine that is being prescribed to me.
• Refills and dose adjustments for my medications will only be made during my provider visits. At each appointment, my provider and I will discuss how well the medication is working.
• Refills will only be made during regular business hours for my medicine or during my provider visits.
• No refills will be sent on nights, holidays, or weekends.
• I must keep track of my medications.
• No early or emergency refills will be sent.
• I agree to schedule my next appointment at the conclusion of each appointment.
• I understand if I do not schedule my appointment 3 months ahead of time, I may not be able to see my preferred provider and may need to schedule with a different provider to avoid interruption of my therapy. I understand Beehive Comprehensive Clinic Inc. does not send in medication “bridges” for controlled substances.
• I understand no exceptions will be made.
• I will only use one pharmacy to get my medicine. If I decide to change pharmacies, I will notify my provider. In the event my pharmacy cannot fill my controlled substance request, I understand it is my responsibility to contact other pharmacies to find one that can fill my prescription, then notify the clinic.
• My provider may talk with the pharmacist about my medicines.
• I understand my provider will access my prescription history on the Utah State Controlled Substance Database.
Prescriptions from Other Providers:
If I see another provider who gives me a controlled substance medicine (for example, a dentist, a doctor from the Emergency Room, a specialist, etc.), I agree to notify my provider within 24 business hours.
While I am taking this medicine, I give my provider permission to contact other doctors to get information about my care and/or use of this medicine, if needed.
Termination of Agreement:
If I break any of the above terms of the agreement, or if my provider decides that this medicine is hurting me more than helping me, this medicine may be stopped by my provider in a safe way.
I have read this agreement, have had any questions answered, and understand the terms above. I agree I will re-read this contract after it is emailed to me to ensure understanding of this Controlled Substance Agreement.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The terms of this Notice of Privacy Practices (“Notice”) apply to Beehive Comprehensive Clinic Inc., its affiliates and its employees. Beehive Comprehensive Clinic Inc. will share protected health information of patients as necessary to carry out treatment, payment, and health care operations as permitted by law.
We are required by law to maintain the privacy of our patients’ protected health information and to provide patients with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this Notice for as long as it remains in effect. We reserve the right to change the terms of this Notice as necessary and to make a new notice of privacy practices effective for all protected health information maintained by Beehive Comprehensive Clinic Inc. We are required to notify you in the event of a breach of your unsecured protected health information. We are also required to inform you that there may be a provision of state law that relates to the privacy of your health information that may be more stringent than a standard or requirement under the Federal Health Insurance Portability and Accountability Act (“HIPAA”). A copy of any revised Notice of Privacy Practices or information pertaining to a specific State law may be obtained by mailing a request to Beehive Comprehensive Clinic Inc. Attn: Office Manager at the address shown at the top of this notice.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION:
Authorization and Consent: Except as outlined below, we will not use or disclose your protected health information for any purpose other than treatment, payment or health care operations unless you have signed a form authorizing such use or disclosure. You have the right to revoke such authorization in writing, with such revocation being effective once we actually receive the revocation notice; however, such revocation shall not be effective to the extent that we have taken any action in reliance on the authorization, or if the authorization was obtained as a condition of obtaining insurance coverage, or other law provides the insurer with the right to contest a claim under the policy or the policy itself.
Uses and Disclosures for Treatment: We will make uses and disclosures of your protected health information as necessary for your treatment. Medical professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to your course of treatment that may include procedures, medications, tests, medical history, etc.
Uses and Disclosures for Payment: We will make uses and disclosures of your protected health information as necessary for payment purposes. During the normal course of business operations, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you. We may also use your information to prepare a bill to send to you or to the person responsible for your payment.
Uses and Disclosures for Health Care Operations: We will make uses and disclosures of your protected health information as necessary, and as permitted by law, for our health care operations, which may include clinical improvement, professional peer review, business management, accreditation and licensing, etc.
Individuals Involved In Your Care: We may from time to time disclose your protected health information to designated family, friends and others who are involved in your care or in payment of your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited protected health information with such individuals without your approval. We may also disclose limited protected health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.
Business Associates: Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, outcomes data collection, legal services, etc. At times it may be necessary for us to provide your protected health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these associates to appropriately safeguard the privacy of your information.
Appointments and Services: We may contact you to provide appointment updates or information about your treatment or other health-related benefits and services that may be of interest to you. You have the right to request and we will accommodate reasonable requests by you to receive communications regarding your protected health information from us by alternative means or at alternative locations. For instance, if you wish appointment reminders to not be left on voice mail or sent to a particular address, we will accommodate reasonable requests. With such request, you must provide an appropriate alternative address or method of contact. You also have the right to request that we not send you any future marketing materials and we will use our best efforts to honor such request. You must make such requests in writing, including your name and address, and send such writing to the Office Manager at the address above.
Other Uses and Disclosures: We are permitted and/or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization for the following:
- Any purpose required by law;
- Public health activities such as required reporting of immunizations, disease, injury, birth and death, or in connection with public health investigations;
- If we suspect child abuse or neglect; if we believe you to be a victim of abuse, neglect or domestic violence;
- To the Food and Drug Administration to report adverse events, product defects, or to participate in product recalls;
- To your employer when we have provided health care to you at the request of your employer;
- To a government oversight agency conducting audits, investigations, civil or criminal proceedings;
- Court or administrative ordered subpoena or discovery request;
- To law enforcement officials as required by law if we believe you have been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law;
- To coroners and/or funeral directors consistent with law;
- If necessary to arrange an organ or tissue donation from you or a transplant for you;
- If you are a member of the military, we may also release your protected health information for national security or intelligence activities; and
- To workers’ compensation agencies for workers’ compensation benefit determination.
DISCLOSURES REQUIRING AUTHORIZATION:
Psychotherapy Notes: We must obtain your specific written authorization prior to disclosing any psychotherapy notes unless otherwise permitted by law. However, there are certain purposes for which we may disclose psychotherapy notes, without obtaining your written authorization, including the following: (1) to carry out certain treatment, payment or healthcare operations (e.g., use for the purposes of your treatment, for our own training, and to defend ourselves in a legal action or other proceeding brought by you), (2) to the Secretary of the Department of Health and Human Services to determine our compliance with the law, (3) as required by law, (4) for health oversight activities authorized by law, (5) to medical examiners or coroners as permitted by state law, or (6) for the purposes of preventing or lessening a serious or imminent threat to the health or safety of a person or the public.
Genetic Information: We must obtain your specific written authorization prior to using or disclosing your genetic information for treatment, payment or health care operations purposes. We may use or disclose your genetic information, or the genetic information of your child, without your written authorization only where it would be permitted by law.
Marketing: We must obtain your authorization for any use or disclosure of your protected health information for marketing, except if the communication is in the form of (1) a face-to-face communication with you, or (2) a promotional gift of nominal value. Sale of Protected Information: We will not sell your protected information and we must obtain your authorization prior to receiving direct or indirect remuneration in exchange for your health information; however, such authorization is not required where the purpose of the exchange is for:
- Public health activities;
- Treatment and payment purposes;
- Health care operations involving the sale, transfer, merger or consolidation of all or part of our business and for related due diligence;
- Payment we provide to a business associate or subcontractor in the course of normal business activities;
- Providing you with a copy of your health information or an accounting of disclosures;
- Disclosures required by law and any other exceptions allowed by the Department of Health and Human Services.
RIGHTS THAT YOU HAVE REGARDING YOUR PROTECTED HEALTH INFORMATION:
Access to Your Protected Health Information: You have the right to copy and/or inspect much of the protected health information that we retain on your behalf. For protected health information that we maintain in any electronic designated record set, you may request a copy of such health information in a reasonable electronic format, if readily producible. Requests for access must be made in writing and signed by you or your legal representative. You may obtain a “Patient Access to Health Information Form” by calling the Office Manager at (801)252-6116. You will be charged a reasonable copying fee and actual postage and supply costs for your protected health information. If you request additional copies you will be charged a fee for copying and postage.
Amendments to Your Protected Health Information: You have the right to request in writing that protected health information that we maintain about you be amended or corrected. We are not obligated to make requested amendments, but we will give each request careful consideration. All amendment requests must be in writing, signed by you or legal representative, and must state the reasons for the amendment/correction request. If an amendment or correction request is made, we may notify others who work with us if we believe that such notification is necessary. You may obtain an “Amendment Request Form” by calling the Office Manager at (801)252-6116.
Accounting for Disclosures of Your Protected Health Information: You have the right to receive an accounting of certain disclosures made by us of your protected health information after September 1, 2020. Requests must be made in writing and signed by you or your legal representative. “Accounting Request Forms” are available from the front office person or individual responsible for medical records. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12-month period. You will be notified of the fee at the time of your request.
Restrictions on Use and Disclosure of Your Protected Health Information: You have the right to request restrictions on uses and disclosures of your protected health information for treatment, payment, or health care operations. We are not required to agree to most restriction requests, but will attempt to accommodate reasonable requests when appropriate. You do, however, have the right to restrict disclosure of your protected health information to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and the protected health information pertains solely to a health care item or service for which you, or someone other than the health plan on your behalf, has paid Beehive Comprehensive Clinic Inc. in full. If we agree to any discretionary restrictions, we reserve the right to remove such restrictions as we appropriate. We will notify you if we remove a restriction imposed in accordance with this paragraph. You also have the right to withdraw, in writing or orally, any restriction by communicating your desire to do so to the individual responsible for medical records.
Right to Notice of Breach: We take very seriously the confidentiality of our patients’ information, and we are required by law to protect the privacy and security of your protected health information through appropriate safeguards. We will notify you in the event a breach occurs involving or potentially involving your unsecured health information and inform you of what steps you may need to take to protect yourself.
Paper Copy of this Notice: You have a right, even if you have agreed to receive notices electronically, to obtain a paper copy of this Notice. To do so, please submit a request to the Office Manager at the address shown at the bottom of this notice.
Complaints: If you believe your privacy rights have been violated, you can file a complaint in writing with the Office Manager. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services at the US Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, Washington, D.C. 20201, calling 1-877-696-6775 or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. There will be no retaliation for filing a complaint.
For Further Information: If you have questions, need further assistance regarding or would like to submit a request pursuant to this Notice, you may contact the Beehive Comprehensive Clinic Inc. Office Manager by phone at (801) 252-6116 or at the following address: Beehive Comprehensive Clinic Inc., 3409 W 12600 S Ste 230, Riverton UT 84065.
This Notice of Privacy Practices is also available on our web page at www.beehiveclinic.com.
Thank you for choosing Beehive Comprehensive Clinic Inc. as your healthcare provider. We are committed to providing you with quality and affordable health care.
- Insurance. We participate in most insurance plans, including Medicaid and Medicare. If you are not insured by a plan we do business with, payment in full at our self-pay rates, including additional charges for procedures or in-office labs, is expected at each visit. If you are insured by a plan we do business with but don’t have an up-to-date insurance card, payment in full for each visit is required until we can verify your coverage. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage.
- Co-payments and deductibles. All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company.
- Non-covered services. Please be aware that some – and perhaps all – of the services you receive may be noncovered or not considered reasonable or necessary by Medicare or other insurers. You must pay for these services in full at the time of visit. Insurance company policies vary greatly; it is impossible for our staff to know what services will be covered. It is your responsibility to contact your insurance company prior to the rendering of services to verify what they will cover and consider reasonable or necessary.
- Proof of insurance. All patients must complete our patient information form before seeing the provider. We must obtain a copy of your driver’s license and current valid insurance to provide proof of insurance. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of a claim.
- Claims submission. We contract with The Central Billing Office to submit your claims and we and they will assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract.
- Coverage changes. If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. I f your insurance company does not pay your claim in 45 days, the balance will automatically be billed to you.
- Laboratory Tests and Charges. Any laboratory tests which are sent out of the office and do not have immediate results are billed by third party laboratory companies based on a contract between the insurance company and the laboratory company. Beehive Comprehensive Clinic Inc. cannot guarantee insurance company payment for lab tests. Patients may self-pay in advance for lab tests at a potentially discounted rate, but they must advise their provider of this request.
- Nonpayment. The Central Billing Office will issue statements on our behalf. You agree to pay your account in full. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency and you and your immediate family members may be discharged from this practice. If this is to occur, you will be notified by regular and certified mail that you have 30 days to find alternative medical care. During that 30-day period, our provider will only be able to treat you on an emergency basis.
- Missed appointments. Our policy is to charge $50.00 for missed appointments not canceled at least one business day in advance, or any appointment not cancelled with at least one business day* notice, whether cancelled online, by text, phone or in person. We also charge $50.00 if patients do not arrive for their appointment within 15 minutes of the appointment start time for a regular visit or 5 minutes of the appointment start time for a sick or same-day visit. These charges will be the patient’s responsibility and billed directly to you. Please help us to serve you better by keeping your regularly scheduled appointment.
*Business days do not include Federal or Utah State Holidays. We observe all major U.S. Holidays and Utah State Holidays and will not be open to accept next-day cancellations on holidays.
Our practice is committed to providing the best treatment to our patients. Our prices are representative of the usual and customary charges for our area.
Thank you for understanding our payment policy. Please let us know if you have any questions or concerns.