All patients are asked to complete the online registration to fill out any health history forms that are not completed 100%. Please make sure to check in prior to your visit to follow any instructions left for you to complete for your visit. You will often find that we have left personalized instructions for you due to complete prior to your upcoming visit. Please take time to complete this information and if there is anything that you do not understand, please leave blank.
You may upload your photo, insurance cards, medical record or anything pertaining to your visit in order to expedite the process of checking in. If you are not able to complete the requested information online we ask that you arrive 10 minutes early to ensure we have time to gather the necessary information before seeing the provider. Please make sure to present your insurance card at every office visit, as this is required by your insurance company. For your convenience we have updated information about the practice below. Please make sure to read the the new patient information prior to arriving for your appointment as it includes information in regards to the following:
- FINANCIAL POLICY
- PARTICIPATING HEALTH PLANS
- FEES NOT COVERED BY INSURANCE
- RELEASE OF INFORMATION
- ASSIGNMENT OF BENEFITS & CONSENT FOR TREATMENT
- HEALTH CARE EXCHANGE INFORMATION REGARDING CONNECTION WITH CAP and HealtheConnections*
- NOTICE OF PRIVACY PRACTICES (HIPAA)
*We ask that all patients review & authorize the above consents annually. All policies listed above are available to pick up at the office in paper form upon request.
IMPORTANT INFORMATION FROM ITHACAMED
NOTICE: MEDICARE PATIENTS ACO NOTIFICATION
NOTICE: INCLEMENT WEATHER ALERT
NOTICE: NON-DISCRIMINATION STATEMENT
HOW TO PREPARE FOR SPECIFIC TYPES OF OFFICE VISITS
MVA/No-Fault: If you have been injured in an automobile accident and have an upcoming appointment, you will need to complete the no fault paperwork required by the insurance covering the claim. These forms must be completed before you are seen. Please complete and return to the office on the day of your first visit (automobile related). If this information is not received, your appointment may be delayed, or you may become responsible for the balance due. Under no circumstances can your automobile accident related appointment be billed to your medical insurance plan. Thank you.
Medicare Annual Wellness Visit: We ask that you complete an online health risk assessment. This assessment requires less than 10 minutes to complete. You will be ask you about problems and concern. You should select the first option: “Short Health Check-Up” and Choose “Continue without a sponsor” or select a sponsoring organization. You will not have to provide any identifying information. It is best to complete when you do not have a deadline, usually a few days before a medical office visit. Once complete, you will be able to print the assessment and have a copy sent to the office. Please make sure to send a copy to: firstname.lastname@example.org. If you wish to complete the paper form, or if time permits you may complete in the office.
Cornell Program for Healthy Living Annual Wellness Exam: How does CPHL plan work?: CPHL patients are asked to have an enhanced wellness exam annually at no cost to them. In order to complete the exam, we suggest that you complete the Questionnaire chosen by your company before your appointment with IthacaMed. With the data from the questionnaire along with lab work results your provider will have a better view of your general health status as well as your current lifestyle choices. The provider will then recommend a plan for making lifestyle changes. This may include-more exercise, a better diet, or management of chronic conditions that you may have, etc.
REQUEST FORM: Providers may send a consult request to IthacaMed via direct messaging to IthacaMed, via CCD. You are not required to complete the consult form, however if information has not been provided it will create a delay in contacting the patient. If you cannot send a CCD, we ask that you send by fax (607-277-3242) either a letter requesting a consultation consult request, medical notes including the request to see Dr. Law for an endocrine condition, along with supporting medical information/ investigations pertaining to the diagnosis, insurance information and complete demographics. This request must come from providers. We can process the request within 72 hours providing all information requested has been received.
RELEASE OF HEALTH CARE INFORMATION REQUEST FORMS
Authorization allowing IthacaMed to send, receive records to a physician/organization of your choice or discuss health care with individuals
Authorization allowing IthacaMed to release/receive confidential healthcare information regarding HIV/AIDS Diagnosis Alcohol/Drug Treatment and/or Mental Health Treatment
You may complete the form and fax to the office at: 607-277-3242 or E-Mail: email@example.com
You may also drop it off to us or mail to IthacaMed ATTN: Medical Records 404 N. Cayuga Street Ithaca, NY 14850 -4219
FORMS TO KEEP ON FILE WITH YOUR PHYSICIAN & LOCAL HOSPITAL
What should I do if I find myself losing Insurance coverage?
What if I cannot afford transportation or I do not have reliable transportation? Please see the resources available in our community and express this concern so that we can work with you.
The following are useful links to professionally sound and well-balanced, up-to-date information and education materials for patients with various endocrine and metabolic disorders:
Thyroid Cancer Survivor Association:
Created and is maintained by thyroid cancer survivors. A network of services that link thyroid cancer survivors and health care professionals around the world. Here you will find current information about thyroid cancer and support services available to people at any stage of testing, treatment, or lifelong monitoring for thyroid cancer, as well as their caregivers. It receives ongoing input and review from numerous thyroid cancer specialists. This site also serves as a resource for anyone interested in thyroid cancer survivors’ issues.
Founded in 1916, the Endocrine Society is the world’s oldest, largest, and most active organization devoted to research on hormones and the clinical practice of endocrinology. The Society works to foster a greater understanding of endocrinology among the general public and practitioners of complementary medical disciplines, and to promote the interests of all endocrinologists at the international and national scientific research and health policy levels of government.
The National Comprehensive Cancer Network®
NCCN aims to provide people with cancer and the general public with state-of-the-art cancer treatment information in easy-to-understand language. The NCCN Guidelines for Patients®, translations of the NCCN clinical guidelines, are meant to help patients with cancer talk with their physicians about the best treatment options for their disease. NCCN Guidelines for Patients® do not replace the expertise and clinical judgment of the physician.
As the Public Education Affiliate of the Endocrine Society, the Hormone Foundation is dedicated to serving as a web-based resource for the public by promoting the understanding, prevention, treatment and cure of hormone-related conditions.
There are over 120 very detailed but easy to understand pages on endocrine diseases, conditions, hormone problems and treatment options tailored for patients and their families. There is also detailed information on endocrine surgery such as thyroid, parathyroid, and adrenal surgery. All Endocrine Disorders included are: Acromegaly, Addison’s Disease, Adrenal Cancer, Adrenal Disorders, Anaplastic Thyroid Cancer, Cushing’s Syndrome, De Quervain’s Thyroiditis, Diabetes, Follicular Thyroid Cancer, Gestational Diabetes, Goiters, Graves’ Disease, Growth Disorders, Growth Hormone Deficiency, Hashimoto’s Thyroiditis,
Hurthle Cell Thyroid Cancer, Hyperglycemia, Hyperparathyroidism, Hyperthyroidism, Hypoglycemia, Hypoparathyroidism, Hypothyroidism, Low Testosterone, Medullary Thyroid Cancer, MEN 1, MEN 2A, MEN 2B, Menopause, Obesity, Osteoporosis, Papillary Thyroid Cancer, Parathyroid Diseases, Pheochromocytoma, Pituitary Disorders, Pituitary Tumors, Polycystic Ovary Syndrome, Prediabetes, Reproduction, Silent Thyroiditis, Thyroid Cancer, Thyroid Diseases, Thyroid Nodules, Thyroiditis, Turner Syndrome, Type 1 Diabetes, Type 2 Diabetes
An international professional organization for physicians and scientists dedicated to better understanding and treatment of thyroid diseases. The web provides extensive patient resources and up-to-date information, including Web Brochures and FAQs on all types of thyroid disorders.
An organization for both patients and health care professionals devoted to providing diabetes research, information and advocacy. The site contains valuable information for patients on diabetes, nutrition and recipes, weight loss and exercise, diabetes prevention as well as updates on diabetes research.
Pituitary Network Association
An international organization for patients with pituitary tumors and disorders, their families, loved ones, and health care providers who treat them. The site promotes public awareness and provides education on pituitary diseases, including pituitary FAQs, glossary and clinical trials.
A patient-based organization dedicated to providing support, information and education to individuals having Addison’s disease as well as other diseases of the adrenal glands. The site provides the facts you need to know if you are suffer from Addison’s disease, Cushing’s syndrome, hyperaldosteronism (Conn’s syndrome), or congenital adrenal hyperplasia (CAH).
An organization for both patients and health professionals committed to the prevention and treatment of osteoporosis. The site contains up-to-date information on the causes, prevention, detection and treatment of osteoporosis.
The impetus behind AACE’s efforts has always been quality and cost-effective patient care for those with endocrine diseases and disorders.
This website by the American Association of Clinical Endocrinologists provides educational resources on thyroid diseases for the public. It will help you understand the role of your thyroid gland and illustrate how you and your doctor can partner to identify your risk for thyroid disease, how to best treat your condition if you are diagnosed, and how to live an active and fulfilling life by keeping your thyroid in balance.