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Self Pay PatientsPatient: ___DOB:___I, ___ understand that I am paying $200 today as a new patient ($100 for established patients) for my office visit and all additional charges that are incurred
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Refresher how to determine is a process of reviewing and updating information to ensure accuracy.
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All individuals or organizations who have previously submitted a determination of any kind are required to file a refresher determination.
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To fill out a refresher determination, update any changes to the previously submitted information and submit it by the deadline.
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The purpose of refresher how to determine is to ensure that the information on file is current and accurate.
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