bon sain

complete women's healthcare
"All the technology you need, all the compassion you deserve."

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Patient Info

Before arriving, please download the applicable forms here and on the policies page and take a moment to fill them out. If possible, after your forms are filled out please scan and email (or fax them to us) several days prior to your appointment.

Please note there are a total of 7 forms that are part of our new patient registration process. If you are coming to Bon Sain for a hormone consultation, you will need to replace item #4 Patient Medical History with our Hormone Questionnaire (listed below the complete list).

1) Bon Sain Financial

2) Check In Sheet

3) HIPAA Bon Sain

4) Patient Medical History

5) Release Records Bon Sain

6) Office Policies

7) Contraception/Bladder Questionnaire

HORMONE CONSULTATION PATIENTS ONLY (please fill out document below instead of item #4 patient medical history)

Hormone Questionnaire

Office and Payment Policies

Please also read and understand the below policies and bring them signed to our office at your next appointment. If you have any questions, please call us.

Office Policies

Payment Policy Form

Fax: 843-706-0792

Please plan on arriving 15 minutes prior to your appointment. Thank you!

SC Code of Laws, Title 44 – Health
Chapter 115

SECTION 44-115-80. Fees physician may charge for search and duplication of records.

A physician, or other owner of medical records as provided for in Section 44-115-130, may charge a fee for the search and duplication of a medical record, but the fee may not exceed sixty-five cents per page for the first thirty pages and fifty cents per page for all other pages, and a clerical fee for searching and handling not to exceed fifteen dollars per request plus actual postage and applicable sales tax. A physician, health care provider, or other owner of medical records must provide a patient's medical records at no charge when the patient is referred by the physician, health care provider, or an employee, agent, or contractor of the owner of the record to another physician or health care provider for continuation of treatment for a specific condition or conditions. The physician may charge a patient or the patient's representative no more than the actual cost of reproduction of an X-ray. Actual cost means the cost of materials and supplies used to duplicate the X-ray and the labor and overhead costs associated with the duplication.

For more information please visit:

http://headaches.about.com/od/advocacyissues/a/MedRecordsHIPAA.htm

29 Plantation Business Park
Suite 204
Bluffton, SC
phone: 843-715-0570
fax: 843-706-0792

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