New Patients


 

New Patient Information and Forms


SCHEDULING AN APPOINTMENT
To schedule an appointment please call 360-385-4843.

To schedule an Introductory Consultation or Second Opinion 100 please e-mail Staff@opas.us These are brief Telemedicine/Telephone introductory consultations. Fee is $100.


INTAKE FORMS: please see below for links to forms that can be faxed securely to us, mailed or simply brought in. Once we have your email address we can also send them to you in a HIPPA secure way.

NOTICE to Potential Patients who have state administered insurance: Medicare, Medicaid, Apple Health, Basic Health, L&I, etc. lease click the following link: Memo about Medicare and Washington State plans.


YOUR FIRST VISIT
After the physician listens to your medical history and provides a pertinent physical exam, he/she can advise you of your health care choices. We expect new patients to feel well listened to. Our plans for pain management and addictions are intended to be practical and workable. For your first visit expect to be at the office for at least an hour. Please do not expect to have prescriptions for controlled substances filled during the first consultative visit.


PAYMENTS AND INSURANCE
Please follow the Link to the Memo Describing Policies Regarding Commercial Insurance Coverage. We do continue to bill third parties but with specific caveats.

Payment by cash, checks, or credit card is expected at the time of the visit unless other arrangements have been made. While we are prepared to help bill third parties we do not have any formal agreements with private insurers. Medicare is the only third party carrier we have a routine agreement with.


AFTER HOURS CARE
A physician is available by phone, generally within 24 hours, for established patients encountering concerns regarding their treatment plan. Please call the office number 360-385-4843 for instructions on how best to contact our physician.


FORMS RELATED TO YOUR FIRST VISIT
These forms can be printed out and then completed and returned via mail, fax, or in person. If reading skills or other issues preclude one's ability to complete these forms please let the receptionist/scheduler know. The forms marked with a "*" are especially helpful to be completed or reviewed prior to your first visit.


* NEW PATIENT PACKET - May be downloaded and is set up to be printed on two sides.
Includes:
Welcome Memo
Demographics - Intake form
Payment Policies
Out of Network third party issues
Brief Medical History Questionnaire


OTHER HELPFUL FORMS AND HANDOUTS
OPAS Introductory Memo for Patients who are interested in specialized medical care for pain management and substance use disorders. [These are administratively required forms and handouts.]

Notice of Privacy Practices (Please Read and sign acknowledgement form at end)

Release of Healthcare Information (useful for records to be sent from one provider to another)

OPAS Policies regarding prescription refills and prior authorizations

Out of Network Insurance Related Issues


QUESTIONNAIRES
The following are some questionnaires we often provide to new patients who are being see for pain management or addictive disorders:
Pain and Activity Questionnaire
Patient Health Questionnaire (PHQ)
AUDIT Alcohol use screener
GAD-7 Anxiety Screener


AGREEMENTS AND CONSENT FORMS
The following two forms are the agreements/consents related to the use of prescribed controlled substances. If you are considering having us prescribe you any controlled substance, please review and be prepared to sign the agreement. If you are wanting to be prescribed an opioid such as buprenorphine, morphine, oxycodone, tramadol, etc. please also review and be prepared to sign the opioid use agreement:
OMS Controlled Substance Use Agreement
General Opiate/Opioid Information Sheet & Consent

Location
J. Kimber Rotchford, MD
1136 Water Street, Suite 107
Port Townsend, WA 98368
Phone: 360-385-4843
Office Hours

Get in touch

360-385-4843