Manchester Community Health Center is a primary care clinic committed
to serving you and your family.
As part of our contract with you, we pledge to provide:
• Services available as you need them, appropriately triaged by a trained
nurse.
• Emergency coverage and availability of a physician on call 24 hours a
day, 7 days a week by calling our office number (626-9500).
• Every effort will be made to refer you to the appropriate consultant(s)
if we cannot provide the services you need.
• Timely care, as much as possible, in a health clinic where emergency
and unexpected patient needs are a daily and unpredictable reality.
• Confidentiality about all your health problems except where we are
obligated to report certain types of information (e.g. contagious diseases).
• Disclosure and honesty in communicating your health condition.
• Qualified and caring health providers and a courteous and conscientious
staff who are customer-service oriented.
• Financial assistance on a sliding-fee scale based on income.
In return, we must expect from you:
• Co-payments and deductibles which are due at the time of service.
If you are unable to pay these, a payment plan will be developed with you.
• To be honest and open with your caregiver. We cannot provide
appropriate care without knowing the true details of your health history.
• To develop a treatment plan with your caregiver and follow it to the
best of your ability; and to be honest about what you have been able
to do (or not do) when seen in follow-up. If you are unable to follow a
treatment plan we will do our best to help you find out why, and change
the plan or correct the problem if possible.
• To be on time for all scheduled appointments. If you are unable to keep
your appointment, call as soon as possible, preferably 24 hours prior, so
that we can give your appointment time to others needing urgent care.
Our providers may ask you to reschedule if you are more than
10 minutes late for your appointment. If you miss an appointment due
to lateness, it is still considered a missed (or broken) appointment.
If you miss your first new patient appointment, you will be denied
services for six months . The second offense will last for 1 year of
denied services, and the third offense will last for 2 years of denied
services.
• If you miss 3 appointments in a calendar year, we must assume that you
do not wish to receive care at this facility. Your name may be removed
from our active patient files. If that occurs, we may contact you by
Certified Mail asking you to find another caregiver within 30 days.
You may not access care again for six months as a minimum, the second
offense will last for 1 year of denied services, and the third offense will
last for 2 years of denied services.
• To be truthful in disclosing the number of family members and family
income in application for sliding-fee scale. This is a federal requirement.
Failure to provide truthful data, or to notify us of changes, is considered
fraud for which you could be held liable.
• You are responsible for renewing your Medical Assistance Card
before it expires. You will be unable to access discounted care or
vouchers until your card is renewed. If you do not have a discount
and have an outstanding balance of $100 or more for more than
90 days, and are not compliant with a payment plan, you will be
discharged from the practice and cannot re-access care for six
months. If that should happen, you remain responsible for any
outstanding balance on your account.
• A willingness to work with us in developing an appropriate payment
plan so that account balances can be effectively managed.
If you have any difficulty with these expectations, please speak to the
Business Office manager. If you are unable to fulfill these expectations,
we will work with you to find a solution. Otherwise we will not be able
to continue serving you, and we may suggest you seek care elsewhere.
We look forward to a caring relationship that maximizes your good health.
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