PAHCOM - Central Jersey Chapter

To access the members only sections of this site, please enter your member id.

If you have forgotten your Member Id, please click here.

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

For more information about an affordable, professional website for your organization, medical practice or small business, please click here
WWW.TRI-G-WEB.COM.

Visitors

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 submit and share any of your office forms or policies for this page, please email as an attachment to president@pahcomnj.com or mail the hard copy to:

Central Jersey Pahcom
Attn: Form Submit
PO Box 321
South Plainfield, NJ
07080.

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 41 days until our next event.
Branding Your Practice
Presented by: JH Cohn
September 8, 2010
See our Events Page for more details.

Vendors

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

If you would like to add your business card to our Chapter Rolodex, please click here.

Attention all Members

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

Lee Dalfonzo Office Manager
Immediate Past President

Debbie Silver Practice Manager
Treasurer

Betty Maloney CPC, CMM
Secretary

Jayne Mott RN
Parliamentarian

Patricia Urban CMM
Membership

JoAnn DeJesus Office Manager
Awards

Beverlyjean Jenkin LA, CMM
Legislation Chair