Patient Information Patient Forms Insurance Billing Patient Portal Medication Refills FAQ News Our Providers Careers On Line Bill Pay MAIN OFFICE 112 Helen Street Sauk City, WI 53583 WOMEN'S HEALTH CENTER 250 26th Street, Suite 100 Prairie du Sac, WI 53578 Patient Information Notice of Privacy Practices Forms Physical Forms Male history Form (Male Physical) Female history Form (Female Physical - except Dr. Schad) Privacy Forms Please read Prairie Clinic's Notice of Privacy Practices first. To use the forms print, complete, sign, date and send the form(s) to: Prairie Clinic S.C., 112 Helen Street, Sauk City, WI 53583. Form Purpose Example Communication Authorization Authorization for Prairie Clinic to discuss my condition with designated individual(s). If you want your provider to be able to discuss your health with your spouse, adult child, caregiver or other person(s). Confidential Communication To request alternate (confidential) communication with the clinic. If you want the clinic to call you on your cell phone instead of your home phone for sensitive lab results. Information Release To request copies of your medical record. If you are moving and want to transfer your medical records to another clinic. Information Release Revocation Revocation of the Authorization for Prairie Clinic to send your medical record. If you were sharing health information for a court case or don't want additional medical records sent. Information Amendment To amend your medical record. If you want to request a change to your medical record. Other Forms Authorization for Prairie Clinic to discuss my condition with designated individual(s). Form Purpose Example Advanced Directives Advanced directives in case you are incapacitated. If you do not want to be resuscitated. Job Application Employment application. If you would like to work at Prairie Clinic. Insurance Coverage Prairie Clinic is able to file the majority of insurance claims directly with your insurance company if we have received all the necessary information. When you have a change in insurance coverage, our office needs to know before services are provided, in order to file your claim more efficiently. When you check in for an appointment, please let the receptionist know of any changes. Please bring your insurance card with you. It is your responsibility to be aware of the coverage of your insurance plan. If you are a member of an HMO plan, Prairie Clinic must be selected as your primary care provider for you to be seen here. Workmen's Compensation It is the responsibility of the employee with a work-related injury or illness to inform the Clinic when the appointment is made or at the time of service. The Clinic will complete the form and forward it directly to the patient's employer or insurance company. For questions, ask for the Workmen's Compensation Specialist. Medicare All services provided by the Clinic Physicians are filed automatically with Medicare. Please let your doctor or nurse know if this is your first physical with Medicare, so we can process your claim properly. We accept assignment. For questions, ask for the Insurance Department. Insurance Coverage Includes: Alliance Anthem Blue Cross/Blue Shield Care Wisconsin Cigna Dean Gold Dean Health Care (We are not part of FOCUS network) DHP Administrators Great West Group Health Cooperative SCW Health EOS Humana Interplan Health Group Medicare Physicians Plus Quartz Insurance WEA WPS BILLING Billing Phone: 608-644-2419 On Line Bill Pay: https://pay.instamed.com/PRAIRIE Charges Our fees are comparable to surrounding communities. Our charges for service including office visits and procedures are based upon the severity and complexity of your injury or illness; as well as the time needed treating you. If you have any questions, please feel free to discuss them with us. We would appreciate your efforts to pay for your medical services as you receive them. All co-pays are due at the time of service We maintain one account per family with a running total balance due. This account has notations by our office, i.e. dates of service, patient seen, type of service, payments and adjustments made by you or your insurance. Statements Statements are mailed every 4 weeks. The statement you receive is an exact copy of your account. You will not receive a statement if we are waiting for payment from your insurance company. After insurance pays on that date of service, you will receive a statement. We try to send everything to your insurance company as soon as possible, although your insurance company can take up to 6 weeks to pay on your claim. Other Questions Other questions regarding your account should be directed to our Billing Office. Please Notify us upon registration of any insurance or address changes. My Patient Portal/ NextMD Web Portal Prairie Clinic uses NextMD (also known as the NextGen Patient Portal) as our patient portal service. A patient portal allows our patients on-line access to their physician's office for secure messages, medication refill requests, records requests and even look up health information. Requests are typically answered with 2 business days. If you feel a life threatening situation exists, immediately call 911. NextMD offers a secure way to send messages, using 128-bit encryption, firewalls and secured systems. Once you sign up for NextMD, you'll use a username and password and a confirmation question to access your on-line account. When we send you information, you'll receive a notification e-mail, but you need to log onto the secure website (https://www.nextmd.com) to read your confidential information. How to Sign-Up If you are a Prairie Clinic patient interested in signing up for NextMD, please ask at the front desk when checking in at your next appointment. My Patient Portal For a handy guide to using NextMD, click here. Medication Refills We are happy to order medication refills prescribed by your provider when appropriate. To refill your prescription, please call your pharmacy and ask them to fax us the request for a prescription refill. We receive many requests for refills each day, and the process takes time, (especially when your provider is not in the office). Please allow 48 hours for your request to be processed. Refill requests are processed Monday through Friday between 8:00 am and 4:00 pm. Medication refill requests made on Saturday will be processed on Monday An office visit may be required (to monitor your overall health and condition) prior to refilling your medication. An office visit may be required prior to filling or refilling an antibiotic prescription. We are not able to refill medications we have not prescribed. There are some programs available to assist patients in paying for medications you need: SeniorCare A description of the SeniorCare Program is available at: http://www.dhfs.state.wi.us/seniorcare. An application is available at: http://dhfs.wisconsin.gov/SeniorCare/app-instruc-info.htm Medicare Information about Medicare's Prescription Drug and other assistance programs is available at: http://www.medicare.gov/A MAIN OFFICE Address: 112 Helen Street, Sauk City, WI 53583 GET DIRECTIONS BUSINESS HOURS Mon - Thu 7:00 am - 7:00 pm Friday 7:00 am - 5:00 pm Saturday 8:00 am - 12:00 pm Sunday Closed contact numbers Appointment Desk: 608-644-2400 Billing Questions: 608-644-2419 Referral Questions: 608-643-3351 Medical Records Fax: 608-643-8162 WOMEN'S HEALTH CENTER (WHC) Address: 250 26th Street, Suite 100, Prairie du Sac, WI 53578 GET DIRECTIONS EXPRESS HOURS (Main Office Only) At this time we do not have our Express / Walk-In Clinic due to COVID. Mon - Sun Closed Content, including images, displayed on this website is protected by copyright laws. Downloading, republication, retransmission or reproduction of content on this website is strictly prohibited. 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