Patient or Responsible party or Medical POA (Power of Attorney) voluntary consent to the medical treatment/ wound care treatment by Kelechi (Kay) Blanton, Nurse Practitioner, her associate, and/or assistants. Treatment for the wound management may include physical exam, debridement (removal of unhealthy and dead tissue from wound base to promote healing,), biopsies, laboratory assessment, diagnostic studies and procedures, imaging and/or prescription of medications appropriate for the patient. Patient agrees that the risks, benefits, treatments, and services have been discussed and explained to the patient and patient consent to treatment.
It is a policy of Kelechi (Kay) Blanton, Nurse Practitioner office to release personal information only to individuals who have been authorized by the patient and/or legal guardian to receive such information for purposes of treatment,payment, and operation. The office will share all necessary information with other professional providers,insurer(s), payor(s), governmental entities (such as Medicare, etc.) and their representative involved in the billing process (including, but not limited to claims representative, data warehouses, billing companies, and collection (HIPAA). Any information about you and/or your family will be held in the strictest of confidence by all employees. No discussions about you outside of the patient care framework will be allowed, and anyconversation between staff members that pertain to delivering you quality care will be held in a confidentialand professional manner.