Basic Visit is $65

 

After Hours Medical Group
9200 Colima Rd.

Ste. 101
Whittier, CA 90605

 

Phone: 562-945-2128

Billing Department: 562-967-3118

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Click on the appropriate form listed below and fill it out in advance of your next scheduled visit to After Hours Medical Group in Whittier, CA. For more information regarding any of the forms listed, please get in touch with us today.

 

AHMG Intake Form
Click on this link and remember to fill out this form before your next scheduled visit with After Hours Medical Group.
AHMG INTAKE FORM.pdf
Adobe Acrobat document [216.4 KB]
AHMG Confidential Patient Information Form
Click on this link and fill out the attached form before your next scheduled visit to After Hours Medical Group.
CONFIDENTIAL PATIENT INFORMATION.pdf
Adobe Acrobat document [106.5 KB]
AHMG Consent to Treat Form
Click on the link below to access the Consent to Treat Form and be sure to fill it out before your next scheduled visit with After Hours Medical Group.
Consent to Treat.pdf
Adobe Acrobat document [22.7 KB]

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

 

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

 

Uses and Disclosure of Protected Health Information

Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any other use required by law.

 

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or manage management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

 

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

 

Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical student, licensing, marketing and fund-raising activities, and conduction or arranging for other business activities. For example, we may disclose your protected health information to medical school students that see patients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

 

We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues as required by law, Communicable Diseases, Health Oversight, Abuse or Neglect, Food and Drug Administration requirements, Legal Proceedings, Law Enforcement, Coroners, Funeral Directors, Organ Donation, Research, Criminal Activity, Military Activity and National Security, Workers’ Compensation, Inmates, Required Uses and Disclosures. Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirement of Section 164.500.

Other permitted and required uses and disclosures will be made only with your consent, authorization or opportunity to object, unless required by law.

 

You may revoke this authorization at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.

 

Your Rights
Following is a statement of your rights with respect to your protected health information.

You have the right to copy your protected health information for the purposes of ongoing medical care. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.

 

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

 

Your physician is not required to agree to a restriction that you may request. If physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.

 

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively, i.e. electronically.

 

You may have the right to have your physician amend your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

 

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. We reserve the right to change the terms of this notice. You then have the right to object or withdraw as provided in this notice.

This notice was published and becomes effective on/or before June 26, 2007.

Legal Statement

 

This is the Legal Statement for After Hours Medical Group web site. The use of After Hours Medical Group web site and all the materials on this web site are subject to the terms and conditions of this Legal Statement.

 

Terms and Conditions

Please read the following terms and conditions carefully, as they contain important limitations on your rights. By accessing the After Hours Medical Group web site, you are accepting these terms and conditions. If you do not agree with these terms and conditions, do not use or access this web site. After Hours Medical Group reserves the right to revise these terms and conditions, in its sole discretion, at any time without notice, and to monitor and restrict any and all use of this web site. You will be bound by any such revisions or modifications and therefore should frequently visit this page and review the current terms and conditions.

 

Restrictions on Use

This site is owned and operated by After Hours Medical Group, LLC., and its affiliates (hereinafter "After Hours Medical Group"). All activity on this site is subject to monitoring by After Hours Medical Group at any time. Anyone who uses this site consents to such monitoring and agrees that After Hours Medical Group may use the results of such monitoring without limitation. No material from any web site owned, operated, licensed, or controlled by After Hours Medical Group or any of its related affiliated companies, including, without limitation, AmericanHealthGroup.com ("After Hours Medical Group Material"), may not be copied, reproduced, republished, uploaded, posted, transmitted, or distributed in any way, without the prior written consent of After Hours Medical Group. Visitors to this site may download one copy of After Hours Medical Group Material on any single computer for your personal, noncommercial home use only, provided you keep intact all copyright, service mark, and other proprietary notices. Modification of After Hours Medical Group Material, or use of After Hours Medical Group Material for any other purpose, is a violation of After Hours Medical Group's copyright, service mark, and other proprietary rights. It is a condition of your use of this web site that you do not restrict or inhibit any other user from using this web site.

 

Disclaimer

Nothing on this web site constitutes professional medical treatment or advice, nor does the information on this web site substitute for medical care rendered by a licensed physician.

 

All information and content on this web site are subject to applicable statutes and regulations and are furnished "as is." After Hours Medical Group disclaims all warranties of any kind, either express or implied, including but not limited to implied warranties of merchantability, fitness for a particular purpose, and noninfringement.

 

Although After Hours Medical Group intends the information contained in this web site to be accurate and reliable, errors may occur. We do not guarantee that the information provided will be accurate and complete, or that this web site will function without interruption, or that the web site and servers are free from viruses or other harmful components. All information, including but not limited to these terms and conditions, is subject to correction or modification without prior notice.

 

To the fullest extent permitted by applicable law, After Hours Medical Group is not liable under any circumstances, including but not limited to negligence, for any direct, special, or consequential damages that may result from the use of or the inability to use this web site, even if we have been advised of the possibility of such damages. After Hours Medical Group is not liable for damages or injury, including but not limited to damages or injury caused by a performance or failure of performance, error, omission, interruption, deletion, defect, delay in operation or transmission, computer virus, communication, theft or destruction, or unauthorized access to, alteration of or use of information contained on this web site, whether resulting in whole or in part from breach of contract, tortuous behavior, negligence, or otherwise.

 

Health care decisions, based on the information contained in this web site, are the sole responsibility of the visitor, and in exchange for using After Hours Medical Group's web site, the visitor agrees to hold After Hours Medical Group harmless against any claims for damages arising from any decisions the visitor makes based on such information.

 

After Hours Medical Group may have provided links and pointers to Internet sites maintained by third parties ("third-party sites") and may from time to time provide third-party materials on this site. Neither After Hours Medical Group nor its related, affiliated companies operate or control in any respect any information, products, or services on these third-party sites. The materials in the third-party sites are provided "as is" and without warranties of any kind, either express or implied. To the fullest extent permissible pursuant to applicable law, After Hours Medical Group disclaims all warranties, express or implied, including but not limited to implied warranties of merchantability and fitness. After Hours Medical Group does not warrant or make any representations regarding the use or the results of the use of the third-party materials in the third-party sites in terms of their accuracy, timeliness, reliability, decency, copyright compliance, or legal compliance.

 

Limitation of Liability

Under no circumstances, including but not limited to negligence, shall After Hours Medical Group or any of its related or affiliated companies be liable for any direct, indirect, incidental, special, consequential, or punitive damages that result from the use of, or the inability to use, After Hours Medical Group Material. You specifically acknowledge and agree that After Hours Medical Group is not liable for any defamatory, offensive, or legal conduct of any user. If you are dissatisfied with any of the After Hours Medical Group Material, or with any of After Hours Medical Group's terms and conditions, your sole and exclusive remedy is to discontinue using this web site.

 

Intellectual Property Rights

After Hours Medical Group maintains all copyright and other intellectual property rights in the text, graphic images and logos contained in this web site. No permission is granted to copy, distribute, modify, post or frame any text, graphics, video, audio, software code, user design interface or logos. Permission is granted to display and navigate this web site with a computer using HTML browser software, solely for personal, noncommercial use. Any commercial or public use of this web site is strictly prohibited. Third-party trademarks and service marks are the property of their respective owners. All other trademarks and service marks are the property of After Hours Medical Group, Inc., and its subsidiaries (collectively "After Hours Medical Group").

The information in this web site is not intended for distribution to or use by any person or entity in any jurisdiction or country where such distribution or use would be contrary to law or regulation or would subject After Hours Medical Group to any registration requirement within such jurisdiction or country.

 

Security Policy

After Hours Medical Group takes the security of the information very seriously and has established security standards and procedures to prevent unauthorized access to customer information. We maintain physical, electronic, and administrative procedural safeguards to protect the integrity and confidentiality of your information. All authorized personnel within After Hours Medical Group who deal with the information must abide by an Employee Confidentiality Agreement. After Hours Medical Group's web site, however, includes links to other web sites, and when you choose to visit those sites, we are not responsible for their privacy policies or how they treat user information. In addition, we may permit third parties to offer registration-based services through our web site. We are not responsible for the actions and policy of these third parties, and you should review the privacy policy of those parties before supplying personally identifiable information to them.

 

Security of Transmissions

Although After Hours Medical Group will use reasonable efforts to safeguard the integrity and confidentiality of your data and information, transmissions made by means of the Internet cannot be made absolutely secure. Electronic mail submitted to this web site, or other information transmitted to or from the web site, may not be secure or confidential. Accordingly, After Hours Medical Group makes no representation whatsoever concerning the security or confidentiality of your e-mail messages, and specifically makes no representation that After Hours Medical Group will receive any e-mail message submitted through this web site. In addition, After Hours Medical Group will have no liability for disclosure of data or information due to errors in transmission or unauthorized acts or breaches of security by third parties.

 

Business Associates

Any Business Associates ("B.A.") of After Hours Medical Group identified in this web site are independent contractors of After Hours Medical Group. Such Business Associates are not joint-venture partners or any other type of partner of After Hours Medical Group. After Hours Medical Group has no control or legal authority over any employee or representative of any Business Associate.

 

Indemnification

You agree to indemnify and hold After Hours Medical Group and its suppliers, information providers, Internet service providers ("ISP"), and the officers, directors, and employees of After Hours Medical Group ("Indemnified Party") harmless against any losses, claims, damages, liabilities, penalty actions, proceedings, or judgments (collectively referred to as "Losses") to which an Indemnified Party may become subject, related to or arising out of any infringement or misappropriation, or alleged infringement or alleged misappropriation, of any United States copyright, trademark, trade secret, or other proprietary right related to your use of this web site, or related to or in connection with this agreement, and will reimburse such Indemnified Party for all legal and other expenses, including reasonable attorneys' fees incurred by such Indemnified Party in connection with investigating, defending, or settling any Loss, whether or not in connection with pending or threatened litigation in which such Indemnified Party is a party.

 

You also agree to indemnify and hold harmless an Indemnified Party against any Losses to which an Indemnified Party may become subject in which Losses arise out of or relate to this agreement, or use of this web site, or your negligent or wrongful conduct, and will reimburse an Indemnified Party for all legal and other expenses, including, without limitation, reasonable attorneys' fees incurred by such Indemnified Party in connection with investigating, defending, or settling any Loss, whether or not in connection with pending or threatened litigation in which such Indemnified Party is a party.

 

Jurisdiction and Governing Law

After Hours Medical Group controls and operates this web site from its corporate headquarters within the State of California. The laws of CAlifornia govern these terms and conditions. After Hours Medical Group does not represent or warrant that any materials on this web site are appropriate or available for use in any other location. If you choose to access this site from another location, you do so at your own risk and are responsible for complying with any and all local laws.

If you take legal action relating to this web site or its terms and conditions, you agree to file such action only in the appropriate state or federal court sitting in Los Angeles County, California, United States of America, and you consent and submit to the personal jurisdiction of such court for the purposes of litigating any such action.

 

Severability

If any term or condition of this agreement shall be held to be invalid or unenforceable by any court, or regulatory or self-regulatory agency or body, such invalidity or unenforceability shall attach only to such term or condition. The validity of the remaining terms and conditions shall not be affected thereby, and this agreement shall be carried out as if any such invalid or unenforceable term or condition were not contained herein.

 

Termination

After Hours Medical Group may, in its sole discretion, terminate or suspend your access to all or any part of this site, including but not limited to any bulletin boards on this site, for any reason, including, without limitation, breach of this agreement. If this agreement is terminated, the restrictions regarding materials appearing on this site, and the representations and warranties, indemnities, and limitations on liability set forth in this agreement, shall survive any such termination. Upon termination, you must destroy all materials obtained from this site and any and all other After Hours Medical Group sites (and all copies thereof), whether made under the terms of this agreement or otherwise.

 

Important Notice About After Hours Medical Group and After Hours Medical Group Networks of Physicians, Hospitals, and Health Care Professionals

 

The physicians, hospitals, and other health care providers that are part of networks organized by After Hours Medical Group are independent contractors who exercise independent medical judgment, and over whom After Hours Medical Group has no control or right of control. They are not agents or employees of After Hours Medical Group. When you or a covered family member select a primary care physician (PCP) or seek care from a physician, specialist, facility, or other health care professional in the network, either directly or by referral from another health care professional, you are seeking care from that health care professional and not from After Hours Medical Group. Your physician and other health care providers exercise independent medical judgment and should discuss treatment options with you, even those options that might not be eligible for benefits under your Certificate of Coverage or Group Plan. The After Hours Medical Group is not responsible for, does not provide, and does not hold itself out as the sole provider of your medical care and disavows all legal responsibility for medical conditions of persons not treated by Physicians at our facility. Any and all content of this site is for purely educational purposes only and not meant to be an alternative to seeking medical advice from a licensed physician.

The After Hours Medical Group is an Urgent Care medical center open after normal business hours to anyone who has a non-life threatening medical condition that requires same day attention. No-appointments are necessary. All patients are seen by Family Practice (Family Medicine) specialists who are trained in Pediatrics, Adult Medicine, Adolescent Medicine, Geriatrics, Dermatology, Gynecology, and other Primary Care related issues.

 

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