Policies

After Hours Policy

Please make every effort to contact us during regular clinic hours with questions. For non-urgent issues, please use your patient portal access to send messages to our provider sand staff. We usually respond to portal messages with 48 hours.

For established patients with urgent issues that cannot wait until we reopen, our phone message system includes an option to be transferred to the “Provider on Call”. You will likely be asked to leave a message so that the provider can hear the issue, access your records and therefore be ready to help you when they return the call. Calls should be returned within an hour.

Please understand that we generally do not prescribe controlled substances (e.g. narcotics, stimulants, sedatives) as the result of an after-hours call. These prescriptions require a visit with one of our providers. We also typically do not prescribe antibiotics without office visits, especially for respiratory symptoms as an exam is needed to determine the severity of such an infection.

For medical emergencies patients should dial 911.

No-Show & Late Policy

We work hard to run on time and do not double-book appointments so we take our no-show and late arrival policy seriously. Missed appointments and late arrivals cause time when a provider could not see another patient. It is also highly likely that another patient was previously told that they could not be seen at that time. Therefore, out of respect for all of our patients and the value of our time, we ask patients to agree to the following:

• Missed appointments will be assessed a $50 no-show fee.
• Arrival more than 10 minutes after the time of your appointment will be treated as a no-show and assessed the $50 fee unless circumstances allow us to work a patient back into the schedule that day.
• Repeated missed appointments or late arrivals will cause us to ask a patient to establish care at another practice.
• We understand that mistakes happen and circumstances beyond a patient’s control occur. Therefore, established patients who do not have a history of missing appointments or arriving late will generally benefit from a one-time waiving of the $50 no-show fee.
• We remind all of our patients that they signed an acknowledgement of these policies when they established care with us.

Controlled Substance Policy

The following is now Ponce Primary Care’s policy for the following categories of medications:

1. Opioid prescriptions for pain: Ponce Primary Care recognizes the value of these pain medications for the treatment of short-term pain from a specific cause (e.g. a broken bone or surgical wound). When appropriate, our providers will prescribe a limited supply of opioids for such treatment. However, we will no longer prescribe opioids for regular use for chronic (long-term) pain. There are medical situations in which this use is appropriate, but this should be managed by a pain specialist so we will when appropriate refer for specialist evaluation.
2. Stimulants for ADD/ADHD treatment: We will continue to prescribe appropriately dosed stimulants for the treatment of diagnosed ADD/ADHD. Patients receiving these medications will need to have an appointment with one of our providers every 3 months. We now offer virtual (i.e. telemedicine) visits which are can be appropriate for these visits. However, one in-office visit each year is required in order to assess for unintended effects of chronic stimulant use (e.g. hypertension). Patients who have not previously been diagnosed with ADD/ADHD will require a specialist consultation to establish the diagnosis prior to starting a stimulant medication.
3. Benzodiazepines (e.g. Xanax, Ativan, Klonopin etc.): While this class of anti-anxiety medications is appropriate for infrequent treatment of acute anxiety, the risk of chronic use is significant and outweighs the benefits in the vast majority of situations. Therefore, Ponce Primary Care will not prescribe benzodiazepines for daily or frequent use. Prescriptions for limited numbers of benzodiazepines may be provided at the discretion of your provider, but patients should assume that if they are needing this class of medication more than 1-2 times per week, a discussion will be initiated regarding better ways to treat/manage anxiety. Many patients also use benzodiazepines as a sleep aid. Ponce Primary Care providers will not prescribe this class of medication as a sleep aid except in unusual circumstances for short-term use.
4. Sedative hypnotics for sleep (e.g. Ambien, Lunesta, Sonata). The medical evidence supports the use of these medications in appropriate circumstances for short-term sleep disturbance. In most cases, long-term regular use is not supported by the evidence and risks of adverse outcomes is significant. We will continue to emphasize non-medication approaches to improved sleep and limit the use of these prescriptions.

Please understand that these policies have been established to ensure the safety of our patients and are supported by current medical evidence. If you have questions regarding your current medication regimen and how it is affected by these policies, please make an appointment to discuss with your medical provider. You are also welcome to send a portal message to the practice requesting that we review any concerns.

Patient Behavior & Communication Expectation

Patients should expect to be treated with respect by our team. In return, we expect patients to treat us respectfully. Threats to health certainly raise anxiety and occasionally angry emotions, but we cannot tolerate behavior that is in any way threatening or abusive. If a patient has a concern, we ask them to ask our staff to communicate the concern with either Dr. Kristina Lemene or Dr. Chad Costley and allow a 24 hour “cooling off” period before expecting to discuss the issue. Obviously, if the issue involves an immediate threat to one’s health, we will engage on it immediately, but in our experience waiting 24 hours makes respectful interaction and therefore problem resolution more likely.

Form Completion

Short forms can be completed without an additional fee at the time of a visit in our office. Completion of forms at other times can be completed but require a standard fee of $25. We may ask for an additional fee in certain circumstances (e.g. Peace Corps, Foreign Service and Adoption forms which can be quite time-consuming). We also charge a $35 fee for printed copies of medical records. There is no charge for sending electronic copies of medical records to another practice.