Patient Financial Responsibility and HIPAA Authorization
PLEASE ALLOW 7-10 DAYS FOR COMPLETION OF EACH FORM.
OBGYN Associates of Hampton will be happy to complete disability forms for patients as needed. However, due to the amount of staff time this absorbs, we do charge a fee of $10 per form.
If possible, give your form to us before delivery or surgery so we can keep it in your chart until the procedure is performed. When you leave the hospital call 722-7401 and ask to speak to your doctor's nurse, and then allow 7-10 days for completion of the form. We may not have all the information from the hospital to complete the form immediately.
You are allowed 6 weeks disability from the date of delivery. Additional disability will only be granted for medical reasons. Thank you for your compliance with this policy in advance.
Below is a link to the US Department of Labor FMLA Guide.
Surgery Cancellation Form
Surgey Cancellation Policy