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New Patient Information

Records, Registration, Payment Policy 

Letter to Clients
January 23, 2023

 Appointments available for all ages, with locations at:

        28 Executive Drive, Norwalk, Ohio 44857; phone (419) 668-1652 ext. 241

        392 East Howard Street, Willard, Ohio 44890; phone (419) 935-0213 

New-Patient Forms

HIPAA Form (English)

HIPAA Form (en Español)

Consent to Treat a Minor without Parent/Guardian

Select the form below to complete a form for consent for the Health Center of Huron County to treat a minor without a parent/guardian. 

                                     *Note: A new, completed and signed form is required at every visit.

New Patient Forms
Registration, Records, and Payment Policy

Registration- During your first visit, specific information must be recorded to create a permanent medical history for you. Huron County Public Health and the Health Center of Huron County use a computer system to store this information, to keep records of past visits, and to schedule appointments. This does save time for you, but please allow sufficient time for this interview, especially for a first visit or when updating your file on following visits.   We must also take a copy of the patient’s or the patient’s guardian’s photo identification. It is important that you keep your medical files updated. Any changes of address, telephone, household income or insurance coverage needs to be reported as soon as possible to the clerk at the reception desk. By helping us keep this information current, we can serve you more quickly and efficiently.

Records- Your medical record is held in strictest confidence by Huron County Public Health and the Health Center of Huron County. In order to assure this confidentiality is maintained, your medical record will not be released to anyone unless you have given your written consent. If you need a copy of your medical record sent to another physician, you should ask the receptionist for a Medical Records Release Form. After you have completed the form, your record will be copied and mailed. Records are copied and mailed within 7 business days.

In keeping with records retention guidelines, your medical record will be retained for no more than three years beyond the last date you saw a provider at the District. In the case of treatment of a minor, the record will be retained for seven years beyond the age of majority (typically age 21 years).

Payment Policy- Payment is due at the time of service for self-pay clients and copays are due at the time of visit. All services are delivered on a sliding fee scale based on household income. If you wish to pay your bill with a debit or credit card, a credit card fee will also be charged.  

We now accept patients with or without insurance, including Medicare/Medicaid. Patients are seen by appointment only.

Billing- You will pay your bill at the time of service. This enables us to keep fees manageable.  To avoid any misunderstandings, please discuss your financial concerns or problems early. Our staff will be happy to discuss your charges and payments with you.

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