EFTA00477833.pdf

From: Lesley Groff To: Jefffrey Epstein <jeevacation@gmail.com> Subject: Fwd: Appointment with Dr. Rodriguez-Wed. July 11th at 9am (arrive 8:45am) Date: Mon, 09 Jul 2018 18:24:08 +0000 Attachments: New_AdulUrev_03.22.18).pdf; Patient_Informational_Forms_(11.1.17).pdf Inline-Images: image001.png -Dr. Rodriguez cancellation policy is 24 hours (1 business day) prior to your appointment. Failure to notify may result in a cancelation fee. Your appt is at 9am this Wed. July I 1 th (arrive 8:45am) -I have printed the paper work and will fill out as much as I can then scan and email to you. Begin forwarded message: From: NYU Plastic Surgery a> Subject: Appointment with Dr. Rodriguez Date: July 9, 2018 at 1:05:57 PM EDT To: Good Afternoon, You have been scheduled to see Dr. Rodriguez on Wednesday July 11th at 9:00am. The address is 305 E 33rd Street New York, NY 10016. Attached is the new patient paperwork as well as informational forms to fu a llotice of Privacy Practices, and the HIE Factsheet. The completed paperwork can be faxed to r emailed to NYUPlasticSurgery@syumc.org. The forms should be completed in their entirety prior to your visit with us. This will enable your appointment to proceed most efficiently. Please take the time to review this information and let us know if you have any questions. A Few Reminders: • Please bring your insurance card and photo ID. • Please arrive 15 minutes before your appointment time. • If your insurance has a copay, coinsurance, or deductible, please be prepared to pay it on the date of service. Also, if your insurance requires a referral, it is your responsibility to obtain one and provide it before your office visit to ensure insurance coverage for your visit. • Personal checks exceeding $1,000 and CareCredit are not accepted as forms of payment Please note that we do have a cancelation/rescheduling policy that requires you to provide us with a 24 hour (1 business day) notice for any changes to your existing appointment Should you wish to make any changes to your existing appointment, please call our office at Failure to notify us in time may result in a cancelation fee being accessed to your account. Please also be on the lookout for a separate email prompting you to activate your MyChart account with us. It will come frommychart.donotreply@syumc.org and the activation link enclosed will only be valid for 24 hours. MyChart at NYU Langone allows you to securely send messages to our office, view your test results, request renewals for your existing prescriptions, view/cancel appointments, and more! It also has a downloadable app for Android and iPhone. Should the link expire, below are instructions enabling you to securely create your online medical record. We do require that you check in online and verify/update your demographics as well as your medical history prior to coming in for your appointment. Once we see that you are active, we will send you a message for you to reply ensuring complete activation. EFTA00477833 How Do I Sign Up? 1. In your Internet browser, go to http://nyulmc.org&-nychart-activation 2. Complete the MyChart Account Verification Form and click Submit. 3. An activation link will be sent to the e-mail we have on file. 4. Open the e-mail you receive from donotreply_@Dyumc.org_with subject: NYU Langone Account Activation. 5. Click the link in the email (MyChart at NYU Langone). 6. Verify your date of birth and e-mail on file with NYU. 7. Create a MyChart at NYU Langone Username. This will be your MyChart at NYU Langone login ID and cannot be changed, so think of one that is secure and easy to remember. 8. Create a MyChart at NYU Langone Password. You can change your password at any time. 9. Enter your Security Question and Answer. This can be used at a later time if you forget your password. 10. Click Submit. 11. Your account will be created. You will also receive a confirmation e-mail. Additional Information If you have questions, please call to talk to our MyChart at NYU Langone staff. Remember, MyChart at NYU Langone is NOT to be used for urgent needs. For medical emergencies, dial 911. Rochelle-Anne Campbell, MPA Front Desk Supervisor NYU Faculty Group Practice ja artment of Plastic Surgery New York, NY 10016 A CONFIDENTIALITY Nona: This message is for the sole use of the intended recipent(s) and may contain conf4eroal, proprietary, and/or protected health Information. Under the Federal Law (HIPAA) or other conf4eroality protections, the intended recipient is obligated to keep this inforrnaoon secure and corthdenual, and may only use or disclose it in a manner permitted under HIPAA or other protectons. If you are not a desgnated recipient, you may not review, copy, or dartute this message. If you receve this in error, please notify the sender by reply email and delete this message. Thank you. Please do not print this e-mail unless necessary. This email message, including any attachments, is for the sole use of the intended recipient(s) and may contain information that is proprietary, confidential, and exempt from disclosure under applicable law. Any unauthorized review, use, disclosure, or distribution is prohibited. If you have received this email in error please notify the sender by return email and delete the original message. Please note, the recipient should check this email and any attachments for the presence of viruses. The organization accepts no liability for any damage caused by any virus transmitted by this email. EFTA00477834