Patient Information and Forms
Pre-Visit Information
Thank you for choosing Manchester OB/GYN Associates. To help ensure your visit goes smoothly, we have gathered all the necessary forms and information you will need in one location.
Please make sure to read all the other policies as well.
Disclaimer and Privacy Policies
Your Rights and Protection Against Surprise Medical Bills
Release of Health Information
Manchester Ob/Gyn Associates has partnered with Sharecare to fulfill your requests for records. Manchester Ob/Gyn Associates is committed to protecting your medical information. For information about your rights and the obligations you have regarding the use and disclosure of your medical information, please see our Notice of Privacy Practices.
- If you are our patient and would like to request your medical records, please click on the link below to complete your request for medical records. You will be required to provide a valid email address and a government-issued ID.
Patient Record Request
- If you are an attorney, insurance company, or any other entity requesting records from our facility, please click on the link below to upload your request along with the patient's authorization.
Third Party Record Request
When will my online medical record request be ready?
Your records will be ready in 3-5 business days from the receipt of your electronic request.
How do I check the status of my request?
How do I pay for my records and/or radiology images?
How do I contact Customer Service?
FMLA/Disability Submission for Patients and Requesters
If you are a patient, employer, or disability company requesting an FMLA or Disability form to be completed, please click on the button below to upload your blank form. Once you have submitted your form, Sharecare will contact you within 48 hours to collect payment for processing.
FMLA/Disability Request
What is Sharecare, and what exactly do they do?
Sharecare is a health information management company contracted with Manchester OB/GYN Associates to provide services, including the completion of Disability and FMLA form paperwork.
How do I submit my FMLA or Disability paperwork?
Is there a fee to have my forms completed?
Yes, there is a pre-payment fee of $35 for the first form plus any applicable sales tax.
If I need another form completed to continue my disability claim, will I have to make another payment?
Yes, a pre-payment fee of $35 per form for each consecutive or subsequent FMLA or Disability form regarding the same qualifying condition and claim.
How can I pay for my forms?
Pay Online:
• Suppose you have provided a valid email address on your authorization form. In that case, you will receive an email notification with a payment link that will direct you to pay on the Sharecare payment portal website.
• If you did not provide an email address on your authorization form or cannot locate the email notification, you could pay online. You will need your Request ID to make the payment.
Pay by Phone:
•
Contact the Sharecare Forms Department at 866-273-4039. We like to make it as easy and convenient as possible for you. We accept all major credit cards. We do not accept HSA cards as a payment method.
A Request ID is a unique ID specific to the individual patient and form being completed. Sharecare assigns the ID, and if you are unable to locate it, you can contact Sharecare for assistance at 866- 273-4039.
Do I need to sign an authorization form even if I want the form sent back to me?
Yes, we would like all the patients to fill out a Request for Form Completion document when requesting a form to be completed. This document provides the team with information on where and how to send the form. Also, if a disability insurance company calls, we cannot give any information without consent, thus delaying your claim with your disability company. In addition, this document asks for the patient to identify the treating provider, injury/problem date, and last day worked, which will aid in completing your form.
I do not use email or know my Request ID number. How can I get status updates on the completion of my form?
You can contact the Sharecare Forms Department at 866-273-4039 for the status of your form, as well as the Request ID number associated with your form.
I need to update the information on my FMLA or Disability paperwork. What do I need to do?
We understand that FMLA forms, as well as disability determinations, may require an update of your medical information from your recent doctors' visit. You will need to re-submit the new paperwork to Manchester OB/GYN Associates for Sharecare to complete in such cases. There will be a fee of $35.00 required for any updates requested.
When will I receive my completed forms?
Please allow 48 hours for Sharecare to receive your form from the time you submit it to Manchester OB/GYN Associates. Once payment is received, it may take up to 5-7 business days to complete the forms. It is imperative to submit all information and make the pre- payment as soon as possible; failure to do so will delay the process.
I submitted my paperwork but no longer need it to be completed. How can I cancel it?
You can contact the Sharecare Forms Department at 866-273-4039 for assistance.
Please reach out to our team at Sharecare, and we are happy to discuss any questions you might have. Contact us at 866-273-4039.
When will I receive my completed forms?
Please allow 48 hours for Sharecare to receive your form from the time you submit it to Manchester OB/GYN Associates. Once payment is received, it may take up to 5-7 business days to complete the forms. It is imperative to submit all information and make the pre- payment as soon as possible; failure to do so will delay the process.
Office Policies
- Arrival Policy:
We ask patients to arrive 10-15 minutes prior to the scheduled appointment time. This allows us to check you into the system and verify your information prior to your appointment with the provider.
- Late Policy:
If you arrive more than 10 minutes late for your appointment there is a possibility your appointment may be rescheduled. This will be done in order to keep the appointments following running on time.
- No Show Policy:
Our office requires a 24-hour notice to cancel or reschedule an appointment. At Manchester OB/GYN Associates, we make every effort to schedule your appointment in a timely fashion, while ensuring the appointment length allows time for you to discuss your medical concerns with your provider. A last-minute cancellation or missed appointment will not only delay your care but also prevents us from rescheduling another patient who could have been seen at that time. We do understand that sometimes unforeseen emergency situations arise; however, we ask that you provide us with the courtesy of canceling or rescheduling your appointment at least 24 hours prior to your scheduled appointment. Please be aware that we do charge $50 for each appointment that is missed or rescheduled with less than 24 hours notice. If you have more than two last-minute rescheduled or missed appointments you may be discharged from our practice.
Epic Electronic Medical Records
We use Epic for our electronic medical records (EMR). This is the same system used at Elliot Hospital. Your records from our office are completely integrated with Elliot providers. Much of your health information, from both our office and the Elliot, will be available to you in one convenient location by signing up for MyEChart.
Proud Member of the U.S. Women's Health Alliance
The U.S. Women’s Health Alliance is a network of the most experienced, knowledgeable and passionate women healthcare providers across the nation. This organization was founded in 2012 based on one important Mission: to deliver the highest quality and most affordable healthcare to women. Check out their patient page
here.
Humana/Tricare
We are grateful to members of the armed forces who protect and serve our country. We are committed to providing quality care to military families. We proudly accept Humana/Tricare patients. Thank you for your service! Call us today for an appointment!
Laboratory Services
We send the majority of blood work and pathology samples to the Elliot Medical Lab (EML). This will generate a separate cytology bill from the lab. A second bill
from Pathology Specialists of NH will also occur for all pathology samples. If you would like to have your labs and pathology go to an independent laboratory please notify your medical assistant the day of your visit.
If you do not inform the staff of which lab to use the day of your service it will be sent to Elliot Medical Lab automatically. Any questions please contact your health insurance directly prior to your visit.