Physicians of Rehabilitation, Industrial & Spine Medicine, P.C. values you as an existing patient. We look forward to working with you and doing our best to serve your needs.
If it is not possible for you to keep your scheduled appointment time or you do not know your appointment date/time, please call us immediately.
Please use the links below to find useful information to help make your patient experience as smooth as possible.
How To Have Your Records Sent Elsewhere
How To Renew Your Prescriptions
Disability Form Guidelines
HMO, Managed Care & Medical Assistance Patients
Workers’ Comp & Automobile Accident Insurance
Patient Satisfaction Survey
How To Have Your Records Sent Elsewhere
Please print forms below, complete all sections, sign and date. Return authorization form to our offices. We utilize a weekly copy service to handle these requests. Please note there may be a fee to process your request. The State of Pennsylvania determines the maximum copying fees annually.
Authorization to Use and/or Disclose Health Information:
Complete and submit to the office where you usually are seen:
4310 Londonderry Road, Suite 100
Harrisburg, PA 17109
FAX: 717.561.4903
175 Lancaster Blvd.
Mechanicsburg, PA 17055
FAX: 717.691.3834
How To Renew Your Prescriptions
Please call the office where you are usually seen. Follow the instructions to choose the prescription refill line. Speak clearly when leaving your name, birth date, name of medication, pharmacy and your telephone number. We request 48 business hours to completely process your prescriptions. We will notify you when prescriptions are ready to be picked up or have been sent to your pharmacy. We are sending most prescriptions electronically to your pharmacy, however, there are medications that will require you to personally pick up the prescription in our offices and hand carry it to your pharmacy.
Guidelines for Completion of Disability Forms
Please follow when submitting to PRISM. There is no charge for completion of medical assistance or social security forms.
- Be sure the patient portion is completed and authorizations signed.
- Request copy if needed.
- Patient must be currently under care of PRISM provider.
- Completed forms will not be sent directly to insurance company
- Provide self addressed, stamped envelope or phone number for pick up
- Allow 5-7 business days for completion
- Payment is due prior to completion of forms (Insurance will not cover cost):
- $15 for 1-2 pages
- $25 for 3 or more pages
HMO, Managed Care & Medical Assistance Patients
Your insurance requires proper authorization before we can see you. Our office will make every attempt to obtain the authorization. This action is required even if you have current coverage through workers’ compensation or automobile accident insurance. Managed care companies will not give retroactive referrals.
Workers’ Compensation & Automobile Accident Insurance
We will bill only your workers’ compensation or auto coverage until we have a letter of denial from workers’ compensation or a letter of benefit exhaustion from the auto carrier. Once denied or exhausted, we will bill any unpaid services to your health insurance. Any authorizations from your health insurance will not be used until there is a denial of workers’ compensation or exhaustion of auto benefits. This is your protection against unexpected out of pocket expenses. Our staff will be happy to answer any questions you may have about this process.
Patient Satisfaction Survey
Your opinion is very important to us as we strive to meet the needs of all our patients. We value your input and ask that you take a moment to fill out this questionnaire. Thank you!