PAHCOM - Central Jersey Chapter

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Central Jersey PAHCOM
P.O. Box 321
South Plainfield, NJ 07080
Email us here

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Helpful Practice Information

The following are useful forms and policies donated by fellow members of the Central Jersey Chapter of Pahcom. If you would like to contribute any documents for this page, please contact a member of the executive board.

This is a sample of this Members Only page. As a member or corporate sponsor, you would have access to these valuable shared forms. If you have a valid member ID, please click here to signon.

Financial Forms

Financial Hardship Sliding Scale - 2005
Financial Hardship Sliding Scale - 2006
Patient Refund Request Form
Truth in Lending Monthly Payment Form

General

2007 Exam Room Workweek Calendar
2008 Exam Room Workweek Calendar
90 Day Global Date for Surgery Calendar - 2007
90 Day Global Date for Surgery Calendar - 2008
HSS/CDC Pandemic Planning Checklist
Patient Incident Report

HIPAA

HIPAA Release Form
Medical Records Release - Inbound
Patient Contact Permission Form
Privacy Policy - (Short)
Privacy Policy - English
Privacy Policy - Spanish

Insurance Company

2008 Secure Horizons Card Descriptions
Legislative Report - Horizon Seminar
Managed Care Contract Checklist
Prompt Pay Law Letter - Non Participating
Prompt Pay Law Letter - Participating

Legistative

Health Claims Auth, Processing and Payment Act

Medicare

Medicare COB - Patient Notification
Medicare Coordination of Benefits Information
Medicare Overpayment Refund Form (May 06)
Medicare Overpayment Refund Instructions
Medicare Site Navigation Tool

Patient Forms

Influenze Vaccine Consent Form
Medical History Form
Medication History Form
Out of Network Patient Confirmation Form
Patient History Form 1
Patient History Form 2
Patient Satisfaction Form (Bi-Lingual)

Seminar Handouts

Medicare 2008 - Internet Guide
Medicare 2008 - Presentation Slides
Medicare 2008 - Update

Staff Administration

Employee Internet Use Policy
Employee Late/Absence Notice
Medical Assistance Externship Policy
Patient Service Standards
Staff Guidelines
Staff HIPAA Confidentiality Agreement
Time Off Request

Additional practice forms and policies are also available on the members only section of the National PAHCOM website - WWW.PAHCOM.COM - under 'Shared Resources'.

Only 11 days until our next chapter event.
Practice Diagnosis : An 8 Step Program to Creating a Healthy Practice
Presented by J.H. COHN LLP
May 28, 2008
See our Events Page for more details.

April 2008 Newsletter

Vendors

Are you interested in becoming a corporate sponsor? Please click here.

Attention all Members

Our executive board meets on the second Thursday of each month (except July and August). If you are interested in volunteering for a committee, please contact Barbara Geoghegan or any member of the executive board.

Barbara Geoghegan CMM
President

Jayne Mott RN
Secretary

Jean Parente CMM
Treasurer

Patricia Urban CMM
Membership

Angel Kenvin CMM
Meeting Facilitator

Betty Maloney CPC, CMM
Legislation

Lee Dalfonzo Office Manager
Corporate Sponsors

JoAnn DeJesus Office Manager
Shared Resources