BEFORE YOUR VISIT

Please fill out our Patient Demographics form and bring it to your appointment to expedite your visit.

Notice of Privacy Practices & Medicare Supplier Standards:
Please click here to view our Privacy Practices and Medicare Supplier Standards.  
We will have you sign as proof we have shown you these required documents on your next visit to our facility.

Financial Responsibility:
Our office staff will verify your insurance benefits and bill your insurance company as a courtesy; however verification
of benefits is not a guarantee of payment.
Please click here to view the Financial Responsibility Notice
Click here to view the Financial Responsibility Notice in Spanish

Advance Beneficiary Notice of Non-Coverage:
In the even that your physician has prescribed you a device that we know to be non-covered by your insurance or we
believe may be non-covered, you will be asked to sign an
Advance Beneficiary Notice.  This notice states that we
informed you that we believe the device you are getting is not covered by your insurance, but you have decided to
receive the device regardless of coverage.  For those patients in a Skilled Nursing Facility receiving non-covered
devices from us they will be asked to sign the
Skilled Nursing Facility Advance Beneficiary Notice.

Financial Assistance:
For patients that do not have insurance and cannot pay out of pocket for the device that the doctor has recommend
for them, you can apply for financial assistance through UNC Healthcare.  
Click here for the hospital's Charity Care
brochure for more information.  In some cases we may be willing to establish a payment plan, please review our
Purchase Option Agreement for more information.



AFTER YOUR VISIT

Warranty:
Devices are warranted for 90 days following delivery.  This includes repairs and adjustments, except for those
resulting from physiologic change or from abuse of the device.  Some components, such as feet and knees, may have
additional manufacturer's warranties.


Follow up:
You should return for follow up if you see any redness or skin irritation lasting longer than 20 minutes after device
removal, or if you have any concerns about a change in structural integrity of the device.
If you have an emergency call 911.


Patient Satisfaction Survey:
Your feedback is important to us!  Please print and fill out our patient survey and mail it back to us at:

UNCH Prosthetics
200 Timberhill Place, Suite 203
Chapel Hill, NC 27514

Click here to print the Patient Satisfaction Survey


Patient Complaints & Procedures:
You have the right to make a complaint concerning our HIPPA policies and procedures to our compliance with these
policies and procedures.  Please call us at 919-945-0215 to speak to a manager or owner, or please print and fill out
a complaint form and mail it to us at:

Click here to print the Patient Complaint Form

UNCH Prosthetics
200 Timberhill Place, Suite 203
Chapel Hill, NC 27514
Prosthetic Liner Care:
Prosthetic liners should be cleaned once a day following removal.  Wash with an antibacterial soap, and rinse
thoroughly.  Ensure that your liner is completely dry before you put it on again.
Atlantic Prosthetics & Orthotics- For Our Patients
Care and Use Instructions for your device:
Click on the device you received for instructions on the care and use of your device.