Bay West Family Health Care_6992  
Frequently Asked Questions
Frequently Asked Questions


We want to make your visit as timely and helpful as possible. To that end, we have developed the following policies and procedures:

1) Check-in: Please bring your insurance card to each appointment. Insurance companies often will change your card, membership number or insurance address, which must be accurate for you to obtain care.
2) Update your contact information: On every visit our receptionist will ask if your contact information has changed. Please make sure that we have your current address and phone numbers, so that we may reach you in case of emergency, to confirm your appointment or give you test results.
3) Appointment no-shows: Please remember your appointments; you are responsible whether or not we call to confirm. If you do not arrive or call to cancel at least one hour before your scheduled appointment, you may be charged $25. If you miss three or more appointments, you may be asked to find another practitioner. If you are more than 15 minutes late for your appointment, you may be asked to reschedule. Missed or late appointments mean that other patients cannot be seen or are delayed.
4) Billing: Bills for medical services are payable on receipt. If your bill has not been paid within 90 days, your account will be sent to collection. You are responsible to provide us with correct information about your health insurance, and to pay any balance not covered by your insurance.
5) Filling out forms: You may be charged $15 per form for the physician to fill out personal forms not directly related to your health care. We will not charge for forms for state and federal disability and forms for public education and other public agencies.
6) Conduct in the office: We care about providing a healing environment, as we care for many sick people every day. Behavior that is rude, disruptive or inappropriate to the physicians, staff or other patients will not be tolerated and may result in such a patient being asked to find another practitioner. Please alert our office manager if you feel there is an issue.
7) Prescription refills: Please ask your practitioner to refill your medications at your appointment if needed. If you run out before your next appointment, ask your pharmacist to contact our office for a refill. We do not refill certain prescriptions (such as narcotics, tranquilizers and sleeping pills) over the phone on nights and weekends.
8) Advice Nurse: We have an advice nurse available from 9PM-7AM weekdays and all day Saturdays and Sundays. In addition, there is always a doctor on call, who can be paged by our answering service for urgent matters. If you have a life-threatening emergency, you should call 911.
9) Website: Check our website at for articles on common medical conditions, ways to maintain good health, and complementary approaches that you may find useful.
10) Online consultations: Online consultations are available through our website. Users must have prior approval from their practitioner; there is a charge to use this service, which is not covered by most insurance.

Flexible Sigmoidoscopy

Procedure Description:
Flexible sigmoidoscopy is a visual examination of

What To Expect:
The procedure takes about 30 minutes. You will be lying on your side and have some discomfort at certain points in the exam. You are usually awake and can return home immediately after the procedure.


1) Buy 2 Fleets enemas and 1 box of Dulcolax tablets; these can be bought over the counter at the drugstore.

2) NIGHT BEFORE EXAM: Use 1 Fleets enema as directed, and take 4 Dulcolax tablets. You will likely be going to the bathroom frequently after this.

3) MORNING OF EXAM: Use 1 Fleets enema 1 hour before you leave home. Please eat a light breakfast, juice, coffee or tea.

You may have some cramping and gas that day. Occasionally there may be slight rectal bleeding. You may eat whatever you want after the procedure.

Request for Access to Patient Health Information

Request for Patient Access to Health Information
BayWest Family Health Care, 1580 Valencia St., Suite 201, San Francisco, CA 94110
Practice Administrator, (415) 550-0811
As required by the Health Information Portability and Accountability Act of 1996 and California law, you have a right to request the opportunity to inspect and copy health information that pertains to you. We will evaluate your request and will either grant it or explain the reason why the request will not be granted. Your right to access does not extend to information compiled in reasonable participation of, or for use in, a civil, criminal or administrative action or proceeding, or to information we received in confidence from someone other than another health care provider.
I hereby request access to health information for:
(Print Patient?s name and address)
If known: Year of birth: _________
I would like access to: ¨ All the records or
¨ The portion of the records concerning:

(Specify type of disease, accident, dates of treatment, or other portion of records you are interested in.)
¨ Inspection. Please let me know when I may come to inspect the records, and the amount of the charge, if any. I understand that an employee of this medical practice may be present and that I may not make any marks or alter the records in any way.
¨ Copies. I would like copies of ¨ All records requested or
¨ All records other than X-rays or tracings
¨ Transfer. Please transfer ¨ Copies of all records requested or
¨ Original X-rays or tracings only
(Name and address of health care provider to whom the records are to be delivered)
¨ I would like the information in the following form or format if it is readily produceable in this form: _________________________________________________.
Inspection. I understand that you may charge me for reasonable clerical costs incurred in making the records available for inspection at a rate of [$6.00] per quarter hour and I may be required to pay these costs before I may inspect the records.

Copies or Transfer. I understand that you may charge me a reasonable charge of up to twenty-five cents ($0.25) per page, or fifty cents ($0.50) per page for copies from microfilm, plus any additional reasonable clerical costs incurred in making the records available.
¨ I hereby agree to pay the charges specified above.
¨ Please call me to let me know how much these copies will cost.
¨ I am requesting these records be provided without charge to appeal the denial of eligibility for Medi-Cal, SSDI or SSI/SSP benefits. A copy of the program's denial notice is attached. I applied for these benefits on ___________ (date).

Signed: __________________________ Date: __________________________
Print Name: ______________________ Telephone: _____________________
If not signed by the patient, please indicate:
¨ parent or guardian of minor patient
¨ guardian or conservator of an incompetent patient
¨ beneficiary or personal representative of deceased patient
Name of Patient: _________________________________________