Please be advised that due to the upcoming compliance date of December 31, 2010 for the Red Flags Rule patients of Earl V. Wilkinson, M.D., Earl V Wilkinson, MD, LLC medical practice are subject to comply with policies that the practice uses to identify, detect, and respond to Red Flags. The following is a description of an enforced procedure designed to protect our patients and the practice.
1. When a patient calls to request an appointment, the patient will be asked
to bring the following at the time of the appointment:
a. Driver's license or other photo ID;
b. Current health insurance card; and
c. Utility bills or other correspondence showing current residence if the
photo ID does not show the patient's current address. If the patient is
a minor, the patient's parent or guardian should bring the information
listed above.
Below are links for a Patient Registration form and a
HIPPA Privacy Notice. These files are in PDF format and require an acrobat 7.0 or
later reader to open them. You can download an acrobat reader for FREE by visiting
adobe's website here:
All new patients must fill out a new patient registration form
that applies to them based on age or requiring a legal guardian. The notice of
assignment of benefits to a provider and privacy practices must be completed and
returned to the practice along with the completed new patient registration form.
Please remember to bring cash or check for any required copayments. The practice
does not accept credit cards.
Required:Please select 1 of the 3 New Patient Forms that applies to the patient
New Patient
Adult Registration Form (18 years of age and above)
New Patient
Minor Registration Form (Under 18 years of age)
New Patient
Registration Form (Patient present with Legal Guardian)
Required:Please select the Notice of Assignment of Benefits to a Provider and Privacy Practices
Notice of Assignment of Benefits to a Provider and Privacy Practices Optional: Please select the link below to read about HIPPA Privacy
Optional: Please select the appropriate links regarding record release
Authorization form requesting medical records to be released to Dr. Earl Wilkinson Red Flags Rule Compliance date: December 31, 2010 In November 2007, the Federal Trade Commission (FTC) issued a set of regulations,
known as the "Red Flags Rule," requiring that certain entities develop and implement
written identity theft prevention and detection programs to protect consumers from
identity theft. While the American Medical Association (AMA) is committed to the
protection of patients and physicians, the Red Flags Rule did not specifically
state whether physician practices were subject to the Red Flags requirements.
In response to FTC staff indications that the FTC intends to apply the Rule to
physician practices, the AMA expressed its concerns and successfully delayed
implementation of the Rule until December 31, 2010. The AMA is continuing its
efforts to persuade the FTC that physicians are not "creditors," and therefore
should not be subject to the Red Flags Rule. What is the purpose of the Red Flags Rule? The Red Flags Rule requires certain entities to develop and implement policies
and procedures to protect against identity theft. Identity theft occurs when
someone uses another's personal identifying information (e.g., name, Social
Security number, credit card number, or insurance enrollment or coverage data)
to commit fraud or other crimes. In the case of physician practices, of particular
concern is medical identity theft. Medical identity theft occurs when someone
uses a person's name and sometimes other parts of their identity-such as insurance
information-without that person's knowledge or consent to obtain or make false
claims for medical services or goods. Medical identity theft can also result in
erroneous entries into existing medical records and can involve the creation of
fictitious medical records in the victim's name. Who has to comply with the Red Flags Rule? The Rule applies to any institution considered a "creditor." A creditor
is defined as "any person who regularly extends, renews, or continues credit;
any person who regularly arranges for the extension, renewal, or continuation
of credit; or any assignee of an original creditor who participates in the
decision to extend, renew, or continue credit." The FTC, however, considers
physicians who accept insurance or allow payment plans to be creditors and
therefore subject to the Red Flags Rule. The FTC takes the position that physicians extend credit by allowing deferred
payment until services are rendered and insurance is collected. The AMA does
not believe the FTC interpretation is consistent with the intent or scope of
the enabling legislation and is continuing efforts to avoid application of the
Rule to physician practices. Physician practices who accept insurance or allow
payment plans are covered under the Red Flags Rule and must have adequate policies
and procedures in place by December 31, 2010, or they may face a penalty of up
to $2,500 per "knowing violation." How does the Rule differ from HIPAA privacy and security rules? HIPAA is intended to protect personal health information (PHI) for security
and privacy purposes. PHI as defined by HIPAA is covered by the Red Flags Rule,
but the Rule extends to other sensitive information: What is a "red flag?" A Red Flag is a pattern, practice, or specific account activity that indicates
the possibility of identity theft. The FTC identifies the following as red
flags:Credit card information
Tax identification numbers: Social Security numbers,
business identification numbers and employer identification numbers
Insurance claim information
Background checks for employees and service providers
Alerts, notifications or warnings from a consumer reporting agency
Suspicious documents and/or personal identifying information, such
as an inconsistent address or nonexistent Social Security number
Unusual use of, or suspicious activity relating to, a patient account
Notices of possible identity theft from patients, victims of
identity theft or law enforcement authorities