Clinic Visit / Patient Forms

Patient Forms

If this is your first time seeing a Louisiana Heart Medical Group provider, please print out our new patient forms below and bring the completed forms to your first appointment. If you prefer to complete the forms at the office, please plan to arrive 15 minutes prior to your appointment.

 Patient Information  Patient Information2036 KB

 E-Prescribing Consent Form  E-Prescribing Consent Form227 KB

 Financial Policy  Financial Policy200 KB

 Release of Protected Information  Release of Protected Information353 KB

 HIPAA Release of Information  HIPAA Release of Information218 KB

 Disclosure of Physician Interest  Disclosure of Physician Interest655 KB

 LHMG Non-discrimination Notice  LHMG Non-discrimination Notice268 KB

Appointments

New patients and first time appointments must be made by calling the physician’s office.  Established patients can make an appointment through the Patient Portal. Please give at least 24-hours notice if you must cancel or reschedule your appointment. This allows us to schedule another patient who may need to see the physician sooner than his scheduled appointment.

Please bring your medications or a list of medications you are currently taking and your insurance information.

Health Insurance

Please bring your health insurance identification card each time you visit your physician. This ensures our office has the most current insurance information in your file. Your insurance may also require prior authorization for lab work, diagnostics, and other care. 

Check with your Insurance Company before Your Visit

It’s always a good idea to contact your insurance company and familiarize yourself with important information before your office visit and/or procedure.  Knowing how your insurance company will pay your claim and if they are a participating provider will help avoid unexpected costs later.  It is each patient’s responsibility to know their insurance contract and which providers participate with their insurance plan.  Should you have any questions or concerns regarding what insurance carriers or networks Louisiana Heart Medical Group has entered into a contractual relationship with please call your physician’s office.  Louisiana Heart Medical Group has contracts with a number of managed care organizations.  

Louisiana Heart Medical Group Managed Care Contracts

  • AETNA
  • American Lifecare
  • Bayou Medical Management
  • Diagnostic Management Affiliates
  • Beechstreet
  • Blue Cross Blue Shield
  • CIGNA
  • Coventry Health Care of Louisiana
  • Difinity Health
  • Galaxy Health
  • GEHA
  • Humana
  • Integrated Health Plan
  • Louisiana Medicare
  • Mississippi Medicare
  • Multi-Plan
  • National Preferred Provider Network
  • PlanCare America
  • People’s Health
  • PPO Plus
  • Private Healthcare Systems
  • Stratose
  • Three Rivers
  • Tricare 
  • United Healthcare
  • USA Managed Care
  • Vantage Health Plan
  • Verity Health Net
  • Viant
  • Wellcare of Louisiana

Some plans may require prior authorization and patients are responsible for helping to arrange for authorizations through their insurers.

Payments

Your insurance may require an office co-payment. If so, you will be asked to make your co-payment in full at your visit. If your visit is not covered by a health plan or insurance, you will be asked to pay for your visit on arrival. For your convenience, we accept cash, checks, and credit cards. We also accept payments made through your health savings account.

Prescription Refills

May be requested through your Patient Portal.  You may also call your pharmacy to request a prescription refill. Your pharmacy will call your physician. The prescription request and your medical record will be reviewed. Please allow 48 hours for your prescription to be refilled.

Lab and Diagnostic Tests

It is best that any lab work or diagnostic studies be performed prior to your physician appointment. This will ensure the results will be ready for your physician to review with you at the time of your appointment. We will make every effort to complete your lab work or diagnostic test prior to your appointment time. When this is not possible, your nurse will notify you of your test results by telephone or mail. If you have not received your test results within five business days of the date performed, please call the clinic and ask to speak with the nurse.

After Hours 

Calls after 5:00 pm will be handled by our answering service. The answering service will direct your call to the appropriate physician. Please leave your telephone number where you may be reached. If you have a medical emergency, you should go to the nearest emergency room. If necessary, the Emergency Services will contact the appropriate physician.