IMPORTANT FORMS, ANSWERS
AND INFORMATION

Our staff and expert practitioners are here to help. On your first visit, bring any requested paperwork and insurance information. If additional procedures are needed, we will provide an outline for what you need to do and what to expect before, during and after your procedure. We welcome questions about treatment for your condition and will address any concerns.

Our physicians have a track record of excellence in serving our patients. Learn more about our providers on the PHYSICIANS page.

If possible, please print and complete the patient registration form prior to your visit. Access the form by clicking HERE. You will need Adobe Acrobat to access the form. You may bring the form to your appointment or fax it to 865-588-2126.

Learn more about your procedure and create a checklist to prepare for your exam. Coming in for your procedure in the next few days? Use this section of the site to learn more about your procedure below. You may also download a PDF of patient registration medical information you’ll be asked prior to your procedure. If you have an appointment, please download PDF preparation instructions for the SuPrep Kit, SuTab Kit, SuFlave Kit or Miralax Kit procedures.

We have partnered with Gifthealth Pharmacy to provide your colonoscopy prep. Our goal is to give you the most dependable and affordable source to obtain your prep. A representative from Gifthealth will reach out to you via text and phone call, apply any discounts or coupons available, and will ship the prep and instructions directly to your home. Our partnership with Gifthealth has proven to offer considerable cost savings for our patients. Please do not hesitate to reach out to Gifthealth with questions regarding your colonoscopy prep at (833) 614-4438.
https://www.gifthealth.com/gastrointestinal-associates

Capsule Endoscopy (Pillcam)

Capsule endoscopy allows the examination of the lining of the small intestine (the middle part of the gastrointestinal tract, including the duodenum, jejunum, ileum). A pill-sized/shaped video capsule, which has its own miniature lens and light source, is used to provide photographs of the lining of the small intestine, which are electronically transmitted and can be viewed on a video monitor.

Colonoscopy/Polypectomy

Screening colonoscopy is an endoscopic procedure using a long, flexible tube about the thickness of a finger to view the entire colon. It is performed by a gastroenterologist trained and skilled in the procedure to carefully examine the lining of the colon and for the detection and removal of precancerous colon polyps, if present. The test is performed under sedation to essentially eliminate any discomfort.

EGD

An EGD endoscope is a long, flexible tube about the size of your little finger. During the procedure, you are sedated and the EGD scope is passed through the mouth and back of the throat into the upper digestive tract, allowing the physician to examine the lining of the esophagus, stomach and duodenum (the first portion of the small intestine).

ERCP

A long, flexible tube, slightly thinner than a pen, is passed through the mouth and back of the throat into the duodenum (the first portion of the small intestine). The opening from the bile duct and pancreatic duct into the duodenum is identified.

Endoscopic Ultrasound (EUS)

Endoscopic ultrasound (EUS) is a procedure that looks at your digestive system from the inside. It can be done for either your upper or lower digestive tract. A thin, flexible tube, called an endoscope, with a tiny camera at the end, is gently guided into your digestive system.

Colonoscope

A colonoscope is a long flexible tube that is about the thickness of a finger. It is inserted through the rectum into the large intestine (colon) and allows the physician to carefully examine the lining of the colon. Abnormalities such as polyps can be found and even removed during a colonoscopy.

Sigmoidoscopy

The test is performed with a slim, flexible fiber-optic instrument that is inserted along the curves of the rectum and colon. The fiber optics create the instrument flexibility while allowing excellent visualization.

Our commitment is to provide the best
health care for our patients.

The responsibility for payment of fees for any services at Gastrointestinal Associates is the direct obligation of the patient. Please be prepared to pay for routine office visits and co-payments when the service is rendered.

Any financial payment a patient may receive from private insurance or government agencies is strictly between the patient and the insurance carrier or government agency. Our physicians are participating Medicare physicians, and any deductible or co-payment is the patient’s responsibility. The same responsibility exists for HMOs or PPOs that our physicians participate in.

Our receptionists and billing department will assist with questions about insurance and fees. Please bring financial concerns to our attention, and we will make every effort to find a solution.
Extra administrative work such as insurance forms or letters to lawyers may incur additional fees.

• To receive treatment without discrimination as to race, color, religion, sex, national origin, disability or source of payment.
• To be treated with respect, consideration and dignity in receiving care, treatment, procedures, surgery and/or services.
• To be provided privacy and security of self and belongings during the delivery of patient care service.
• To receive information from his/her physician about his/her illness, his/her course of treatment and his/her prospects for recovery in terms that he/she can understand.
• To receive as much information about any proposed treatment or procedures as he/she may need in order to give informed consent prior to the start of any procedure or treatment.
• When it is medically inadvisable to give such information to a patient, the information is provided to a person designated by the patient or to a legally authorized person.
• To make decisions regarding the health plan that is recommended by the physician. Accordingly, the patient may accept or refuse any recommended medical treatment. If treatment is refused, the patient has the right to be told what effect this may have on their health, and the reason shall be reported to the physician and documented in the medical record.
• To be free from mental and physical abuse, free from exploitation, and free from use of restraints. Drugs and other medications shall not be used for discipline of patients or for convenience of facility personnel.
• Full consideration of privacy concerning his/her medical care program. Case discussion, consultation, examination and treatment are confidential and shall be conducted discreetly.
• Confidential treatment of all communications and records pertaining to his/her care and his/her stay in the facility. His/her written permission shall be obtained before his/her medical records can be made available to anyone not directly concerned with his/her care.
• The facility has established policies to govern access and duplication of patient records.
• To leave the facility even against the advice of his/her physician.
• Reasonable continuity of care and to know in advance the time and location of appointment, as well as the physician providing the care.
• To be informed by his/her physician or a delegate of his/her physician of the continuing health care requirements following his/her discharge from the facility.
• To know the identity and professional status of individuals providing services to them, and to know the name of the physician who is primarily responsible for coordination of his/her care.
• To know which facility rules and policies apply to his/her conduct while a patient.
• To have all patient’s rights apply to the person who may have legal responsibility to make decisions regarding medical care on behalf of the patient. All personnel shall observe these patient’s rights.
• To be informed of any research or experimental treatment or drugs and to refuse participation without compromise to the patient’s usual care. The patient’s written consent for participation in research shall be obtained and retained in his/her patient record.
• To examine and receive an explanation of his/her bill regardless of source of payment.
• To receive appropriate assessment and management of pain.

Patient Responsibilities:

• To provide accurate past and present medical history, present complaints, past illnesses, hospitalizations, surgeries, existence of advance directives, medication and other pertinent data.
• To ask questions when they do not understand something regarding their care or treatment.
• To assure that the financial obligations for health care rendered are paid in a timely manner.
• For their actions if they should refuse a treatment or procedure, or if they do not follow or understand the instructions given them by the physician or Center employee.
• For keeping their procedure appointment. If they anticipate a delay or must cancel, they will notify the Center as soon as possible.
• For the disposition of their valuables, as the Center does not assume this responsibility.
• For showing respect and consideration to other people and property.

The Center regards the doctor-patient relationship to be sacred requiring trust, mutual respect and confidentiality. To that end, if you have any comment, grievance or complaint regarding the care you received by this facility or a physician or employee of this facility, please voice your concern by letter or telephone call to:

David M. Harano, Chief Executive Officer
1311 Dowell Springs Blvd
Knoxville, TN 37909

(865) 588-5121

The Center will not discriminate or use any form of reprisal against you for taking action to solve a problem or voice a concern.

Discrimination is Against the Law

Gastrointestinal Associates, P.C., complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.

Gastrointestinal Associates, P.C., does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.

Gastrointestinal Associates, P.C.:

• Provides free aid and services to people with disabilities to communicate effectively with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats)
• Provides free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages

If you need these services, contact Michelle Maves, Section 1557 coordinator.

If you believe that Gastrointestinal Associates, P.C., has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with:

Michelle Maves, Section 1557 Coordinator
1311 Dowell Springs Blvd.
Knoxville, TN 37909
865-588-5121
Fax: 865-558-8950
Email: MMaves@gihealthcare.com

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Michelle Maves, Section 1557 coordinator, is available to help you.

You also can file a civil rights complaint with the U.S. Department of Health & Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at:

https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf

Or by mail or phone at:

U.S. Department of Health & Human Services
200 Independence Ave. SW., Room 509F,
HHH Building
Washington, D.C. 20201
1-800-868-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Source: HHS Office for Civil Rights

LANGUAGE ASSISTANCE SERVICES are available to you at Gastrointestinal Associates, P.C., free of charge.  To obtain services, call 865-588-5121.