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| New Patient Packet |  |
| Are you a new patient? Get a head start by filling out our New Patient Packet and bring it with you on the day of your visit . Please remember to bring your health insurance cards, picture ID and referral form with you to your appointment. Please do not bring unattended children under the age of 8. Co-pay, deductible and co-insurance are due at the time of service. | |
| Formularios Para Pacientes Nuevos | |
| Es usted un paciente Nuevo? Empiece adelante por llenar nuestro Paquete de Paciente Nuevo y traerlo con usted el día de su visita. Favor de traer indentificacion personal y tarjeta de seguro. Traiga por favor esta forma de la remision a su cita. Por favor de no traer ninos menores de 8 anos porque no peuden estar desantendidos. Copagos, deducibles, coaseguro se cobra al tiempo que los servicios son proveídos. | |
| Medications that contain aspirin |  |
| If you've been scheduled for certain procedures at SDMI, you may have been told by the scheduler not to take any products that contain aspirin on or before the day of the exam. Here's a list of common medications that contain Aspirin. If your medication is not listed and you are unsure if it contains Aspirin, please consult with your pharmacist. | Click here |
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| Minors consent - Invasive | |
| *This form must be notarized This form gives SDMI permission to perform an "invasive" procedure such as a CT exam with IV contrast. A minor is a person under 18 years of age who has never been married and never been declared as an adult by court. Generally, a minor does not have the "legal capacity" to consent to medical treatment. |
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| Minors consent - Non-invasive | |
| This form gives SDMI permission to perform a non-invasive procedure such as a simple X-ray. A minor is a person under 18 years of age who has never been married and never been declared as an adult by court. Generally, a minor does not have the "legal capacity" to consent to medical treatment. If you are not sure which minor consent form you need, please call us at (702) 732-6000 |
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| Accepted Insurance Plans | |
| Here's our current list of accepted insurance plans. Last updated on 08/2010 | |
| Notice of Privacy Practices | |
| This notice describes how medical information about you may be used and disclosed and how you can get access to this information. | Click here |
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| Notice of Privacy Practices (Spanish) | |
| This notice describes how medical information about you may be used and disclosed and how you can get access to this information. | Click here |
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| Consent Form | |
| Patient consent to the use and disclosure of Health Information | |
| Request for Access to Patient's Health Information | |
| As a patient of SDMI, you are entitled under federal law to access your personal protected health information maintained in a "designated record set." In order to process your request for access, please complete this form and submit it to the Privacy Officer, | |
| Request for Correction / Amendment of Health Information | |
| Use this form to request correction on your SDMI Health Information. | |
| Patient Rights & Responsibilities | |
SDMI exists for the purpose of providing high quality care that consistently meets or exceeds the standards of care set forth by the American College of Radiology and the State of Nevada. SDMI believes that every patient regardless of race, color, gender, disability, age, cultural, economic, educational or religious background deserves compassion and respect and has certain rights and responsibilities related to the care he/she receives from our staff and Radiologists.
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| Patient Satisfaction Survey | |
| SDMI is dedicated to providing the highest quality of care. To assist us in maintaining these standards, we would appreciate it if you would please take a moment to complete this survey form. Please Take the opportunity to provide us with your personal comments and please rate our service by checking the appropriate level of service for each item listed. |
Click here |
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| Advance Directives Policy | |
| SDMI has the following notice available for each patient prior to scheduled procedure in order to be in compliance with the Self-Determination Act (PSDA) and State law and rules regarding advance directives. Advance directives are statements that indicate the type of medical treatment wanted or not wanted in the event an individual is unable to make those determinations and who is authorized to make those decisions. The advance directives are made and witnessed prior to serious illness or injury. | Click here |
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For Scheduling call
(702) 732 - 6000
(702) 732 - 6000
For Scheduling call
(702) 732 - 6000
(702) 732 - 6000
For Scheduling call
(702) 732 - 6000
(702) 732 - 6000
