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Stonegate Pharmacy

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Pharmacist Consultation Disclaimer

At Stonegate Pharmacy, it’s important for us to make sure you receive the best care possible. As part of that, counseling is not only an essential service but also required by state law. This means that when you pick up a new prescription or if your treatment plan changes, we’re required to review your medications with you to ensure they're safe and effective for your specific situation.

As pharmacists, we’re trained and licensed to provide this level of care, and it falls within our scope of practice to offer expert advice on medication management, potential side effects, and how to get the best results from your treatment. This service helps ensure you're fully informed about your medications and how they fit into your overall healthcare.

We’ll also be billing your medical insurance for these consultations, just like any other healthcare provider would for similar services. If you have any questions about this process or how it works, feel free to ask. We're here to help.

*** Acknowledgement for Medical Billing***

I acknowledge and authorize Stonegate Pharmacy and its pharmacists (the "Provider") to bill my medical insurance for healthcare services provided during my visit. These services may include consultations, diagnostic tests, treatments, and any other medically necessary services.

I understand that I am responsible for any co-payments, deductibles, or non-covered services as determined by my insurance plan. I am aware that my insurance will be billed based on the medical necessity and coverage eligibility of the services provided.

By signing this form, I confirm that I have provided accurate and current insurance information to the Provider. I understand that I am responsible for any remaining balance not covered by my insurance and agree to pay any such amounts in accordance with the Provider’s payment terms.

I have been given the opportunity to ask questions about the billing process, and I am satisfied with the explanations provided. I consent to the billing of my medical insurance and accept responsibility for any balance owed.
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