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Referral requests: Please allow 3 business days for referral preparation. We understand that from time to time  referrals may be needed more urgently and we will attempt to satisfy those requests as soon as possible. When calling for referrals please have full name of physician, office contact information and the reason for the evaluation.
Medication refill request: We currently use e-prescribing software to refill medications. We will try to refill requests with in 24 hours during the business week. At times there may be issues with the pharmacy or insurance plan concerning authorization for certain medications. This process can sometimes take several days or longer . We will process our part in less than 48 hours but are then dependent on pharmacy/Insurance response which may take considerably longer .
We will not routinely refill medications ordered by another physician.  There may at times be exceptions to this rule after full discussion between physician and patient.
Billiing request: Please refer all billing inquiries to Cathy Hill. It is the responsibility of the patient to present any changes in insurance status or billing address. We are happy to submit claims to your insurance carrier however we need accurate and current information to do it properly. Ultimately the patient is responsible for payment if there is a discrepancy.
Appointment request/Cancellation:We will make every attempt to schedule urgent appointments on a same day basis or make arrangements for referral to emergency care if needed. All nonurgent requests will be seen in a timely manner depending on the urgency of the situation.
New patient appointments will be scheduled as soon as possible .However new patient appointments are limited and at times not available.  If the patients current situation warrants more urgent attention than can be reasonably accomodated then the patient will be referred elsewhere.
We currently use Televox which is an electronic reminder device that contacts the patient 48 prior to a scheduled appointment. If you need to cancel for any reason we ask that you notify the office immediately. If a patient recurrently cancels without proper notice we reserve the right to no longer schedule that patient.
After Hours Care:
We have 24 hour, 7 day a week on call coverage.
You can reach Dr Downing or Dr Ramirez or covering physician by calling office number and the answering service will connect you to physician.
Please understand that this service is intended to offer advice and direction for issues that can not wait for office hours. It is not intended to be a substitute for a face to face evaluation of a problem.
In case of emergency please call 911 or go to nearest emergency room.
Laboratory Issues:
We do not do lab testing in office other than dipstick urinalysis and PT/INR for coumadin testing.
We refer patients to outpatient labs in the area. We do not have an affiliation with any particular lab . Lab choice should be determined by insurance coverage and patient preference.
We do have direct electronic communication with Quest labs and Lab Corp Labs which facilitates entry into our Electronic Medical record however lab choice should still be primarily driven by insurance and patient preference.
Please be advised that Medicare and some insurance companies may not cover all ordered tests. This is frequently an issue with some screening tests but may also be an issue with some routine labs as well. . Our physicians are ordering what they feel is needed for adequate patient care .It is the sole responsibility of the patient to ascertain if the tests are a covered or non covered service and proceed per there discretion. Payment for any non covered services is the sole responsibility of the patient.  
Lab LInks: