Full Spectrum Rural Family Practice
We are a rarity. We specialize in providing our families the full range of primary care:
- Caring for newborns at Wyoming County Community Hospital
- Stocking all routine childhood and adult immunizations on site
- Delivering babies
- Offering routine gynecology services including paps and birth control
- Managing high acuity illnesses for all age groups that minimizes your need to travel frequently to distant specialists
- School physicians for Perry and Genesee Country Christian School
- Performing minor office surgeries and other procedures like skin biopsies, vasectomies, joint injections, pulmonary function tests, and sutures
- Saving you from frequent trips to the lab for blood work since our nurses provide skilled phlebotomy on the premises
- Admitting our own patients to WCCH and providing their care throughout their stay
- Serving our disabled, rehabilitating, and declining patients at the Skilled Nursing Facility, at Eastside in Warsaw, and at area ICF and ARC homes
- Coordinating Hospice care and house calls when it becomes necessary
Office Hours - Telephone
Monday through Friday 8:00 a.m. to 5:00 p.m.
Saturday 8:00 a.m. to 10:30 a.m.
Note: It is NOT the policy of this practice to treat illness over the telephone. If you are ill, we would like you to make an appointment so that we may evaluate your problem properly. Most referals require a visit first to evaluate where and how to refer, as well as to initiate preceding testing or treatment that may be necessary. Our referral department can take messages, but please do not leave messages for urgent requests. Emails
or portal messages likewise should only be for non-urgent requests that can be handled by a secretary such as referrals, routine medication refills, or appointment questions.
It is our usual policy to call or portal message you when results are back for tests that we have ordered, even if they are normal. If you have not heard within two weeks, please call us to have us investigate the delay. Please return our calls if we leave a message. It is very important to be able to convey information necessary for your health. The nurse is obligated to continue trying to reach you with results, so it will save us time if you return calls promptly. Please keep your voice mailboxes empty. Vulgarity or excessive rudeness on the phone may be grounds for dismissal from the practice.
Holidays: We are typically closed New Years Day, Memorial Day, Fourth of July, Labor Day, Thanksgiving, and Christmas. The on-call physician is available by phone for emergencies.
Our usual office hours for appointments are:
Monday, Tues., Thurs. 8:00 a.m. to 6:30 p.m.
Wed., Friday 8:00 a.m. to 4:30 p.m.
Saturday 8:00 a.m. to 11:45 a.m.
We offer evening hours especially for the convenience our employed patients.
If you require a same day appointment, we encourage you to call our office early in the morning. We are committed to providing an appointment for illness within three days, but usually it is sooner. When calling for an appointment, please specify if you are booking a visit for evaluation or treatment of a specific problem, or for a wellness visit with physical exam. Consider making a morning appointment if you would like fasting blood work such as a cholesterol panel drawn. An eight hour fast is sufficient; you may drink water and please take your usual medications. Black coffee is permitted.
Please provide the nurse with your reason for scheduling the appointment when you call or email. Tell the nurse who puts you into your exam room all of the issues you would like to address in the visit, because this is how we prioritize the time during the visit. We may not always be able to cover everything in a single visit, particularly if additional questions emerge. It helps to bring your blood glucose log, your home blood pressure readings, and medications an med lists to your appointment.
Every effort is made to see you at the time of your scheduled appointment, however patients with urgent or special problems may take precedence. You may notice patients who arrived after you being called into the exam room ahead of you. These patients are probably seeing another provider. We do our best to stay on schedule.
Cancellations/ Missed Appointments
We discourage missed or no-show appointments.They are an inconvience to our staff and prevent other patients from being seen. Please contact our office as soon as possble if you are unable to come to an appointment. Multiple missed appointments may be grounds for dismissal from the practice.
After Hours/ Weekends
After hours and on weekends and holidays, our office telephone message will instruct you to call the Wyoming County Community Hospital answering service at 786-2233. Urgent messages will be relayed to the physician on call. Please only call for urgent questions. If you have not recieved a response within thirty minutes, please call again. Physicians are taking call from home. For emergencies such as a possible sudden heart attack or stroke, please call 911 or go directly to the emergency department as time may be of the essence. The three physicians rotate call coverage. Saturday morning hours with the on-call doctor are available for weekend illness, but call early.
Prescriptions and Refills
Just as we cannot treat an illness over the telephone, we cannot prescribe medications over the telephone. We encourage you to call your pharmacy for long term medication refills. They can electronically contact us if your renewal is due. Long term medications refills will be handled during regular office hours and ONLY if you are under our care. NO ROUTINE PRESCRIPTIONS WILL BE HANDLED AFTER REGULAR OFFICE HOURS OR ON A WEEKEND.
Chronic conditions such as elevated blood pressure, diabetes, or depression usually require followup appointments every three to six months to reevaluate the prescriptions. If you need long term medication refills, have the name and dosage of the medication and your preferred pharmacy available when you call or come for your appointment.
Scheduled medications such as narcotics, sedatives, and stimulant medications must be sent electronically to the pharmacy. You must give us two days advanced notice to have these refills checked with the NY state database, printed and signed. Thank you for your patience. In accordance with guidelines, we require a Controlled Substance Agreement signed by you in your file, and we require urine Controlled Substance Drug Screen tests every 6 months.
Our controlled substance policies include:
1. No controlled substance prescription requests when the office is closed or on weekends.
2. We do not prescribe new pain medications over the phone.
3. If medications are over-used or sold, you may be asked to find a new doctor.
4. We will not prescribe controlled substances if another medical provider is also prescribing them to you.
5. Protecting your medications is your responsibility. We will not honor requests for replacement prescriptions when the medications are stolen, lost, or inadvertently damaged.
6. Use the same pharmacy for your prescriptions unless there are extenuating circumstances.
7. We may require a drug test at any time for those using controlled medications. We do not prescribe them if we are concerned about the potential for drug abuse. We require regular visits to monitor the ongoing need for these medications.
Our fees are based on regional reimbursement rates. Co-pays are expected at the time of the visit before you are seen. For self-pay patients, we discount our fees for those who pay the full amount on the day of the service because this saves on our billing expenses. Wellness physicals generally do not have co-pays, however most physicals also include evaluation and management of a problem, for which a fee for evaluation and management or co-pay may apply."New patient" codes apply if you have not been seen for three years or more. For plans with deductibles, we will bill your insurance first. Patients who have health insurance must be able to present their insurance card or other proof of insurance (including all identification numbers, covered dependents, and effective date) each time a service is rendered. Notify our office whenever you have a change of insurance. We generally take all area insurances and are pleased to be able to serve medicaid, medicare and workers compensation beneficiaries as well. We see patients reguardless of their insurance. Please recognize that you are ultimately responsible for the contracts, payments and coverage of your insurance. Understanding and communicating with your plan is primarily up to you, though we will often assist you. We do not guarantee coverage of the services, tests, or referrals we provide or recommend.
Patients are responsible for any uncovered charges. Patients will be billed on a monthly basis for any outstanding balance. Payment is due immediatly on receipt of billing statements. Any unpaid balances will be turned over for collection action and you must find another physician. If you are unable to pay your outstanding balance, please contact the billing secretary to make a payment plan.
Form Completion Policy
In response to increasing demands for the completion of medical forms, which require increased administrative time and financial resources, Letchworth Family Medicine has adopted a policy to charge for these services.
In order for us to better serve you, we request that you are aware of the following:
· Submit the form or request well in advance of when they are needed. We will attempt to complete the form(s) as quickly as possible, however, in order to properly address them we need adequate time to review the patient’s records. Turnaround time is usually 7 business days.
· Patient must complete all of their information on the form prior to submitting for completion.
· Payment is required prior to completion of all form(s). If the form is brought in and completed at the time of an office visit, there will be no charge.
· Your insurance company will not be billed as insurance companies do not reimburse for the time and judgment that are required to complete these forms.
The following fees will be assessed:
· $5.00 Simple Form (1 page with no clinical judgment)
· $10.00 Medium Form (camp, school, college, sports, etc.)
· $20.00 Multi-part Form (requires clinical decision and/or patient input, 2 or more pages; disability forms, FMLA, etc.)
· No charge if the form is brought in and completed at the time of an office visit.
How often should I come for routine visits?
- After women reach 40 and men reach 50, yearly physical exams are reasonable. We suggest exams for young healthy adults every 2-5 years. For school-aged children, every 2 years is sufficient, or as dictated by athletic participation. Preschoolers are seen every year.
- The purpose of wellness visits is to:
- Screen for diseases
- Assess risk of future medical problems
- Encourage a healthy lifestyle
- Update vaccinations
- Maintain a relationship with a health care provider in case of an illness
- Routine visits focused on chronic conditions such as hypertension, diabetes and depression, should usually be every 3-6 months.
- Pap smear frequencies are usually every two years up to age thirty, then every three years until age 65.
- Prostate exams usually start at age fifty for men.
- For more specific recommendations for men and women by age group from the NIH/USPTF, see:
- If you have not had a visit in three years, we consider you an "inactive" patient and remove your chart from monitoring for up-to-date health care measures.If we have not seen you in or had contact in 5 years, we will assume you have transferred care to another provider.
Should the gown open in the front or the back?
- Put on gowns so they open in the back. This way your lungs and back moles are accessible when seated.
Should I take off my shoes for my exam?
- Remove your shoes for physicals and diabetes checks. Feet suffer first from many nerve and vascular problems. If your feet are cold you may leave your socks on while waiting for your exam.
Should I take my medicine if I am fasting or am having blood work?
- Please take your regular medications the morning of your visit (except perhaps diabetes pills or short acting insulin if you are fasting).
- Consider making a morning appointment if you would like fasting blood work drawn. An eight hour fast is sufficient.Because non-fasting lipid panels have been shown to be accurate enough, we no longer request or require you to be fasting for cholesterol checks.
Should my work-related injury be reported to work and billed to worker's compensation?
- YES. If you believe your job is primarily responsible for your symptoms, you must open a comp claim. Your work injury will not be covered by your regular insurance. The same goes for motor vehicle accidents; accident incurance must be billed. Please bring your policy information to your appointment.
Will I need any shots?
Is "no news" good news?
- No. It is our usual policy to call you back when the results of tests are in, whether they are negative (normal) or positive (abnormal), or to release them to the patient portal for viewing. If you have not heard or seen the results within two weeks, please call us to have us investigate the delay. Even uncommon tests and biopsy results are usually resulted within two weeks. If your tests were ordered by another provider, you should contact them for the results even if the blood was drawn here.
URINE SAMPLE: Come a little early for physicals, visits for urinary problems, and obstetric appointments and leave a urine sample in a marked cup in the bathroom when you arrive.
PAPS and MAMMOGRAMS: If you have these ordered by another provider, please request that the result be sent to Letchworth Family Medicine as we attempt to track who is in need of these cancer screening tests.
CONSULTANTS: Be sure any consultants know who your primary care doctor is so they can send their reports to your medical record with us. Confirm that they are part of your insurance plan's provider network. Ask us to send copies of blood work results to any consultants you would like at the time your blood is being drawn.
REFILLS: Give two or three days advanced notice for prescriptions, especially for controlled substance scripts to be written. These cannot be faxed.
MED RECONCILIATION: Bring your medications in a bag to visits and your medication list if you are on more than two medications. "The little blue pill" could be many things.
CHANGES: Notify us immediately if your phone, address, health insurance, marital status, name, or email address changes. You should receive a Clinical Visit Summary when you leave. If you see major errors on the form such as in your medication list, please point out the correction to us. If you have a question about a diagnosis on the form, it is usually best to answer that in the context of an appointment.
HEALTH CARE PROXY FORMS: We would like to keep a copy of your health care proxy designations and any advanced directives on your chart. A New York State form is available on the Forms page.
DISCLOSURE PERMISSIONS: If you would like a family member to have permission to recieve medical information about you, including taking messages about your lab results, please sign a Permission to Disclose Information form.
ALLERGY SHOTS: Immunotherapy ordered by your allergist can be given in our office for your convenience, but because life-threatening reactions occur, we insist you remain a full thirty minutes in the office and a physician must be present in the building during that time. They are only given between 8:00 a.m. & 11:00 a.m. or 1:30 p.m. & 4:30 p.m.
Diet to Reduce Blood Pressure
Dosages for Fever in Children