Jackson Regional Women’s Center provides a unique medical practice. We spend the necessary time to get to know each patient. Our patients know our physicians and staff, and feel comfortable and secure in the quality of care they are receiving. Jackson Regional Women’s Center uses Jackson-Madison County General Hospital.
If you are a new patient, or if you have not been to our clinic for more than three years, please print, fill out and bring the completed forms with you to your appointment. It is important to fill out every form.
- Patient History
- Patient Consent
- Health Information Release
- HIPAA Release
- Advanced Directives
- Common Interest Disclosure
- Procedure for Completion of FMLA and Insurance Forms
Insurance and Financial Forms: Please look over the following forms and fill out the ones pertinent to your situation.
- Clinic Financial Policies
- Patient Financial Responsibilities
- Insurance Authorization
- Self Pay Agreement
- No Show and Collections Notice
- Insurance Fraud TennCare Letter
While you are a patient of Jackson Regional Women’s Center, the care you receive depends partially on you. To fulfill our responsibilities, we ask that you:
- Provide information about past illnesses, hospitalizations, medications, and other matters related to your health.
- Request additional information or clarification about your health status or treatment when you do not fully understand information or instructions.
- Provide JRWC with a copy of your written Advance Directive, Living Will, Durable Power of Attorney for Healthcare, and Advance Care Plan.
- Respect the rules and regulations of the clinic, and the rights of other patients and clinic personnel.
- Follow instructions of those rendering service. Also, work with the clinic in making timely financial arrangements.
- Keep track of personal belongings.
- If children attend your appointment with you, please make sure they are attended at all times and not allowed to move freely throughout the clinic.
- Allow us the opportunity to discuss any questions or concerns regarding service or care.
- Discuss your treatment with staff and doctors.
While you are a patient at JRWC, your rights include the following:
- You have the right to privacy and confidentiality regarding your office visits and records.
- You have the right to adequate education and counseling regarding your medical condition.
- You have the right to have all procedures, risks, benefits, and alternatives explained and your questions answered in lay language.
- You have the right to have medications’ effectiveness and possible side effects explained to you.
- You have the right to see results of tests and have the meaning of tests explained to you.
- You have the right to refuse treatment to the extent permitted by law and the right to receive information on alternatives and consequences of refused treatment.
- You have the right to review your medical records in the presence of your physician and have them explained to you.
- You have the right to decide whether to participate in clinical research studies.
- You have the right to voice any complaints and concerns regarding your care and treatment received at our facility. Complaints and concerns may be relayed to the office manager or health care provider.
- You have the right to know if this office has relationships with outside parties that may influence your treatment of care, such as educational institutions, other health care providers or insurers.
- Please pre-register at the hospital of your choice before the day of your surgery. Remember to bring all insurance information.
- Do not have anything to eat or drink after midnight prior to your surgery.
- Please be free of all make up products, and remove all nail polish.
- Please leave all jewelry and valuables at home, and remove all piercings.
- Please bring a list of all current medications.
- You must have a designated driver to drive you home upon discharge from the hospital..
- Be 10 minutes early for your appointment. If you are late, you will be rescheduled.
- Have a FULL bladder (unless told otherwise.) See instructions below.
- No children under the age of 10; no exceptions.
- Only two or three family members, maximum, are permitted in the room.
- No videotaping.
- Please turn off all cellphones and pagers duing your ultrasound.
- You will be given pictures of the baby when possible.
With all of our ultrasounds, we will do our best to see you at your scheduled appointment time.
If you are having a Pelvic Ultrasound, you do need a FULL bladder. This is to image a non-pregnant uterus and ovaries. Please drink 20 ounces of a non-carbonated, caffeine-free beverage one hour before your appointment time. Do not go to the bathroom! Your bladder should be full when you arrive for your appointment.
If you are having a Transvaginal Ultrasound, you do not need a full bladder. This ultrasound will be done internally/vaginally with a vaginal probe. If you are having a transvaginal ultrasound for an IUD or SIS procedure, you do not need a full bldder. Ifyou are unsure of which appointment type you have, come with a full bladder and, if it is not neeeded, you will be able to empty your bladder beforehand.
If you are less than eight weeks pregnant , you do not need to have to have a full bladder unless you are told otherwise. Your ultrasound will be done internally with a vaginal transducer to image the early pregnancy.
If you are pregnant and between eight and 24 weeks, you do need a full bladder. Please drink 20 ounces of a non-carbonated, caffeine-free beverage (preferably water) one hour before your appointment time. Your bladder should be full when you arrive for your appointment.
If you are pregnant and past 24 weeks, you still need a full bladder, but your bladder does not need to be completely full. (as long as it’s not empty). If you are pregnant and need to leave a urine specimen, this will need to be done after your ultrasound! You will need to know the first day of your lsat cylce when you come in for your ultrasound.