{"id":946,"date":"2021-02-17T22:43:05","date_gmt":"2021-02-17T22:43:05","guid":{"rendered":"https:\/\/www.icnarelief.org\/dallas-clinic\/?page_id=946"},"modified":"2024-06-22T13:21:49","modified_gmt":"2024-06-22T18:21:49","slug":"make-an-appointment","status":"publish","type":"page","link":"https:\/\/www.icnarelief.org\/dallas-clinic\/make-an-appointment\/","title":{"rendered":"Make An Appointment"},"content":{"rendered":"<section class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Make An Appointment&#8221; use_theme_fonts=&#8221;yes&#8221;][vc_separator][vc_column_text]<span style=\"color: #000000\">Thank you for your interest in ICNA Relief Medical Clinic Dallas. Before making an appointment, please read through our Eligibility Requirements and HIPAA &amp; Privacy Policy. We look forward to serving you.<\/span>[\/vc_column_text][vc_empty_space height=&#8221;15px&#8221;][vc_row_inner][vc_column_inner width=&#8221;1\/3&#8243;][vc_custom_heading text=&#8221;Patient Intake Form&#8221; font_container=&#8221;tag:h2|font_size:30|text_align:center&#8221; use_theme_fonts=&#8221;yes&#8221;][vc_custom_heading text=&#8221;Please fill out this form if you are a NEW patient&#8221; font_container=&#8221;tag:h3|font_size:16|text_align:center&#8221; use_theme_fonts=&#8221;yes&#8221; css_animation=&#8221;none&#8221;][vc_single_image image=&#8221;949&#8243; img_size=&#8221;large&#8221;][vc_btn title=&#8221;Click Here&#8221; color=&#8221;warning&#8221; size=&#8221;lg&#8221; align=&#8221;center&#8221; css_animation=&#8221;none&#8221; link=&#8221;url:https%3A%2F%2Fintakeq.com%2Fnew%2Ffyei65&#8243;][\/vc_column_inner][vc_column_inner width=&#8221;1\/3&#8243;][vc_custom_heading text=&#8221;General Appointment Form&#8221; font_container=&#8221;tag:h2|font_size:30|text_align:center&#8221; use_theme_fonts=&#8221;yes&#8221;][vc_custom_heading text=&#8221;Please fill out the Patient Intake Form if you are a NEW patient&#8221; font_container=&#8221;tag:h3|font_size:16|text_align:center&#8221; use_theme_fonts=&#8221;yes&#8221; link=&#8221;url:https%3A%2F%2Fintakeq.com%2Fnew%2Ffyei65&#8243;][vc_single_image image=&#8221;134&#8243; img_size=&#8221;large&#8221;][vc_btn title=&#8221;Click Here&#8221; color=&#8221;success&#8221; size=&#8221;lg&#8221; align=&#8221;center&#8221; css_animation=&#8221;none&#8221; link=&#8221;url:https%3A%2F%2Fintakeq.com%2Fnew%2F3jezut&#8221;][\/vc_column_inner][vc_column_inner width=&#8221;1\/3&#8243;][vc_custom_heading text=&#8221;Psychiatrist Intake Form&#8221; font_container=&#8221;tag:h2|font_size:30|text_align:center&#8221; use_theme_fonts=&#8221;yes&#8221;][vc_empty_space height=&#8221;20px&#8221;][vc_single_image image=&#8221;947&#8243; img_size=&#8221;large&#8221;][vc_btn title=&#8221;Click Here&#8221; color=&#8221;warning&#8221; size=&#8221;lg&#8221; align=&#8221;center&#8221; css_animation=&#8221;none&#8221; link=&#8221;url:https%3A%2F%2Fintakeq.com%2Fnew%2FVDsK0f&#8221;][\/vc_column_inner][\/vc_row_inner][vc_tta_accordion c_icon=&#8221;chevron&#8221; active_section=&#8221;0&#8243; collapsible_all=&#8221;true&#8221;][vc_tta_section title=&#8221;Eligibility Requirements&#8221; tab_id=&#8221;1616438240244-06f13f7f-3217&#8243;][vc_column_text]<span style=\"font-weight: 400;color: #000000\">You will have to complete the new patient clinic application (attached below) and meet our eligibility requirements prior to scheduling an appointment with a doctor.<\/span><\/p>\n<p><span style=\"color: #000000\"><b>Eligibility Requirements (you must):<\/b><\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400;color: #000000\">Be between the ages 18 \u2013 64<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400;color: #000000\">Have no health insurance<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400;color: #000000\">Have an income level that falls within 250% of the Federal Poverty Level based on the number of people in your household<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\"><b>Required Documents<\/b><\/span><\/p>\n<ol>\n<li><span style=\"color: #000000\"><b><i> Identification Documents (any one of the following):<\/i><\/b><\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400;color: #000000\">Driver\u2019s license<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400;color: #000000\">DMV ID card<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400;color: #000000\">Passport<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400;color: #000000\">Green Card<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\"><b><i>Chart for income guidelines<\/i><\/b><\/span>[\/vc_column_text][vc_single_image image=&#8221;1036&#8243; img_size=&#8221;large&#8221;][vc_column_text]<span style=\"color: #000000\">Our address is: 10874 Plano Rd #A, Dallas, TX 75238<\/span><\/p>\n<p><span style=\"color: #000000\">Our fax number is: 214-602-3510<\/span><\/p>\n<p><span style=\"color: #000000\">If you have any questions feel free to call us at 469-291-7411<\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;HIPAA &amp; Privacy Policy&#8221; tab_id=&#8221;1616438240282-8229601d-4163&#8243;][vc_column_text]<\/p>\n<div class=\"vc_row wpb_row vc_row-fluid\">\n<div class=\"wpb_column vc_column_container vc_col-sm-12\">\n<div class=\"vc_column-inner\">\n<div class=\"wpb_wrapper\">\n<h2 class=\"vc_custom_heading\"><span style=\"color: #000000\">Summary HIPAA Notice of Privacy Practices<\/span><\/h2>\n<div class=\"vc_empty_space\"><\/div>\n<div class=\"wpb_text_column wpb_content_element \">\n<div class=\"wpb_wrapper\">\n<p><span style=\"color: #000000\">The ICNA Relief Medical Clinic complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).\u00a0 The ICNA Relief Medical Clinic protects confidential health care information, known as \u201cProtected Health Information\u201d (PHI).<\/span><\/p>\n<p><span style=\"color: #000000\">Below is a summary of your privacy rights under HIPAA.<\/span><\/p>\n<p><span style=\"color: #000000\">Please see the attached details.<\/span><\/p>\n<p><span style=\"color: #000000\">The ICNA Relief Medical Clinic legal duties and privacy practices regarding your PHI are also included in this Summary Notice.<\/span><\/p>\n<\/div>\n<\/div>\n<div class=\"vc_empty_space\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"vc_row wpb_row vc_row-fluid\">\n<div class=\"wpb_column vc_column_container vc_col-sm-12\">\n<div class=\"vc_column-inner\">\n<div class=\"wpb_wrapper\">\n<h2 class=\"vc_custom_heading\"><span style=\"color: #000000\">Summary of Your Privacy Rights<\/span><\/h2>\n<div class=\"vc_empty_space\"><\/div>\n<div class=\"wpb_text_column wpb_content_element \">\n<div class=\"wpb_wrapper\">\n<p><span style=\"color: #000000\">ICNA Relief Medical Clinic may use and give your health information to:<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000\">Treat you<\/span><\/li>\n<li><span style=\"color: #000000\">Operate health care services<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\">The ICNA Relief Medical Clinic may use and give your health information for:<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000\">Law enforcement requests<\/span><\/li>\n<li><span style=\"color: #000000\">Judicial and administrative proceedings related to legal actions<\/span><\/li>\n<li><span style=\"color: #000000\">Healthcare fraud and abuse detection or compliance with the law<\/span><\/li>\n<li><span style=\"color: #000000\">Use by another healthcare provider treating you<\/span><\/li>\n<li><span style=\"color: #000000\">Government health oversight activities<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\">Reports required by law related to births, deaths or diseases<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000\">Reports required by law related to neglect and abuse, or domestic violence<\/span><\/li>\n<li><span style=\"color: #000000\">Notifying a party about exposure to a possible communicable disease<\/span><\/li>\n<li><span style=\"color: #000000\">Military, national defense and security or other governmental functions<\/span><\/li>\n<li><span style=\"color: #000000\">Workers\u2019 compensation purposes and in compliance with related laws<\/span><\/li>\n<li><span style=\"color: #000000\">Averting a serious threat to public health and safety<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\">You have the right to:<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000\">Inspect or get a copy of your medical record<\/span><\/li>\n<li><span style=\"color: #000000\">Change information on your medical record if you think it is incorrect<\/span><\/li>\n<li><span style=\"color: #000000\">Get a list of persons whom The ICNA Relief Clinic shared your PHI<\/span><\/li>\n<li><span style=\"color: #000000\">Ask The ICNA Relief Medical Clinic to limit the information it shares<\/span><\/li>\n<li><span style=\"color: #000000\">Ask for a copy of your privacy notice<\/span><\/li>\n<li><span style=\"color: #000000\">Write a letter of complaint to The ICNA Relief Medical Clinic or the federal government<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>[\/vc_column_text][\/vc_tta_section][\/vc_tta_accordion][\/vc_column][\/vc_row]<\/p>\n<\/section>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Make An Appointment&#8221; use_theme_fonts=&#8221;yes&#8221;][vc_separator][vc_column_text]Thank you for your interest in ICNA Relief Medical Clinic Dallas. Before making an appointment, please read through our Eligibility Requirements and HIPAA &amp; Privacy Policy. We look forward to serving you.[\/vc_column_text][vc_empty_space height=&#8221;15px&#8221;][vc_row_inner][vc_column_inner width=&#8221;1\/3&#8243;][vc_custom_heading text=&#8221;Patient Intake Form&#8221; font_container=&#8221;tag:h2|font_size:30|text_align:center&#8221; use_theme_fonts=&#8221;yes&#8221;][vc_custom_heading text=&#8221;Please fill out this form if you are a NEW patient&#8221; font_container=&#8221;tag:h3|font_size:16|text_align:center&#8221; [&hellip;]<\/p>\n","protected":false},"author":17,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-946","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.icnarelief.org\/dallas-clinic\/wp-json\/wp\/v2\/pages\/946","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.icnarelief.org\/dallas-clinic\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.icnarelief.org\/dallas-clinic\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.icnarelief.org\/dallas-clinic\/wp-json\/wp\/v2\/users\/17"}],"replies":[{"embeddable":true,"href":"https:\/\/www.icnarelief.org\/dallas-clinic\/wp-json\/wp\/v2\/comments?post=946"}],"version-history":[{"count":21,"href":"https:\/\/www.icnarelief.org\/dallas-clinic\/wp-json\/wp\/v2\/pages\/946\/revisions"}],"predecessor-version":[{"id":1343,"href":"https:\/\/www.icnarelief.org\/dallas-clinic\/wp-json\/wp\/v2\/pages\/946\/revisions\/1343"}],"wp:attachment":[{"href":"https:\/\/www.icnarelief.org\/dallas-clinic\/wp-json\/wp\/v2\/media?parent=946"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}