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RECORDS RELEASE

If you need a medical record released, please complete the Records Release Form and mail to the address below or drop off.
We cannot accept forms sent over e-mail.

DaVita Medical Group Records Office:
1625 Medical Center Point, Suite 105
Colorado Springs, CO 80907
Phone: 719-265-3073

Get Directions


PATIENT FORMS

Below you will find paperwork that will need to be completed before your appointment.

 

When you arrive for your appointment, please:

  • Bring your completed New Patient History form
  • Any other form related to the specialty or provider you are seeing, i.e., Review of Symptoms form
  • Have your insurance card available
  • Plan to arrive 20 minutes before your appointment with your completed forms or plan to arrive 30 minutes before your appointment if you are not able to print and complete the forms so that we can get your information processed prior to your visit with your provider
  • Be prepared to make any necessary copayment or $125 payment toward your deductible

Should you need to change or cancel your appointment, please contact us at least 24 hours in advance so that we may use that time to serve another patient.

We look forward to seeing you and partnering with you to address your medical needs.  

 

Allergy

Download New Patient Allergy Forms

Dermatology

Download New Patient Dermatology Forms

Primary Care

Download Primary New Patient Forms

Download Pediatrics New Patient Forms

Neurology

Download New Patient Neurology Forms

Orthopedics

Download New Patient Orthopedics Forms

Podiatry

Download New Patient Podiatry Forms

Pulmonology

Download FEMALE New Patient Pulmonology Forms

Download MALE New Patient Pulmonology Forms

Urology

Download New Patient Urology Forms

Download Urology Male Over 50 Forms

 Otolaryngology

Download New Patient Otolaryngology Forms

     

 


MEDICARE



Aging In (Turning 65) To Medicare Meetings
There is a lot of information our patients are faced with when turning 65, which is why CSHP hosts bi-monthly no-cost educational meetings for our patients who are looking at soon being eligible for Medicare. Patients can expect to learn the basics about Medicare and Medicare Advantage, and have a chance to ask questions from CSHP professionals and the different Medicare Advantage representatives for the plans we accept.

Below is a list of upcoming events: 

 

TYPE DATE TIME LOCATION RSVP
Turning 65 Medicare Meetings Hosted by Local Agent/Broker Saturday, August 19 10:00am - 11:00am  Monument Office NO REGISTRATION NEEDED 
Turning 65 Medicare Meetings Hosted by Local Agent/Broker Saturday, September 9 10:00am - 11:00am  Monument Office NO REGISTRATION NEEDED  
New to Medicare: Turning 65 Thursday, September 28 3:00pm - 4:00pm Medical Center Point CLICK HERE TO RSVP


Open Enrollment  & Educational Open Houses

The 2016 Medicare Open Enrollment period has closed.

2017 Medicare Open Enrollment is October 15 - December 7. DaVita Medical Group will host another series of educational open houses that are NO COST and open to the public at convenient locations throughout the Pikes Peak Region. Please visit this site closer to the 2017 Medicare Open Enrollment period for a list of open house dates and times.

If you or someone you know has questions about Medicare and/or Medicare Advantage Plans, DaVita Medical Group will host a series of educational open houses and meetings over the course of the 2017 year. Please check this site regularly as more information about upcoming sessions will be posted here. This is a great opportunity to ask questions about your Medicare options.

To request more information, call 719-538-2900 or email seniorrelations@davita.com


Medicare: Frequently Asked Questions

What is a Medicare Advantage Plan?
Medicare Part C, usually known as Medicare Advantage, is offered by private health care organizations. These plans cover all services under Parts A & B and usually offer prescription drug coverage and may offer extra coverage like vision, hearing, dental and other health and wellness programs.

What is a Medicare Supplement?
Sold by private companies, Medicare supplemental insurance plans are also known as Medigap plans. Medicare supplemental insurance plans fill in coverage gaps (such as cost sharing or additional benefits) found in Original Medicare (Parts A and B). Medigap plans allow you to choose any Medicare-certified doctor or hospital regardless of network.

When do I have to enroll in Medicare?
Contact Social Security 4 to 6 months prior to turning 65 years of age at 1-800-772-1213 (toll free), or visit your local Social Security office to confirm your eligibility for Medicare and to determine the earliest date when you can request your Medicare card.

Will I still be able to see my DaVita Medical Group doctor?
Yes, current DaVita Medical Group patients can continue to see their current primary care physician.

I have TRICARE For Life (TFL), how does that work with Medicare?
When you have Medicare Parts A and B, you can use TRICARE For Life (TFL). Medicare is your primary insurance, TFL is the secondary payer, so your out-of-pocket expenses are less. TFL benefits include covering Medicare’s coinsurance and deductible.


Plans DaVita Medical Group Participates In



DaVita Medical Group is happy to assist you in getting the information you need about your Medicare options. If you have questions about Medicare, Medicare Advantage or Medicare Advantage Special Needs Plans designed for people with certain chronic illnesses or special needs, please contact us.
719-329-7035  seniorrelations@davita.com

Helpful Resources
Medicare: www.medicare.gov  1-800-633-4227
Social Security Administration: www.ssa.gov  1-800-772-1213
Local State Health Insurance Assistance Program (SHIP) office: 719-471-2096

Sources: www.medicare.gov, www.tricare.mil


INSURANCE

Tax ID 47-2218380

DaVita Medical Group is dedicated to making access to our care as convenient as possible for as many patients as possible. For that reason, we participate (contract) with most insurance plans offering a wide range of benefits. This summary is offered as a general guide, and lists plans that DaVita Medical Group accepts, plans accepted with limitations, or plans not accepted. DaVita Medical Group also offers an “Easy Claim” program. This list is not all inclusive, and changes may occur between updates. Please contact our Patient Advocate at 866-6575 with questions regarding participation in a particular plan.

 

The following plans are accepted at DaVita Medical Group:

  • Aetna/Cofinity
  • Aetna Medicare Advantage
  • Anthem (Blue Cross/Blue Shield)
  • Cigna/Great West
  • Colorado Choice
  • First Health
  • Humana
  • Humana Medicare Advantage
  • Kaiser
  • Kaiser Senior Plan
  • Multiplan (PHCS)
  • Rocky Mountain Health Plan
  • Rocky Mountain Senior Plan
  • Secure Horizons Medicare Advantage
  • Sterling Health
  • United Healthcare
  • Worker's Compensation and Motor Vehicle

The following plans are accepted with limited availability, or as special circumstances may apply.
Please contact our Patient Advocate at 866-6575 with questions about your coverage with these plans:

  • Medicare
  • Tricare (Standard and Prime)

The following plans are not accepted at DaVita Medical Group:

  • Any private Medicare plan not listed above
  • Colorado Access
  • Child Health Plan Plus (CHP+)
  • Medical Network

DaVita Medical Group will bill non-contracted insurance companies as a courtesy one time through the Easy Claim Program. Ask the office Patient Service Rep. at your physician’s office for details.


CPC+ PARTICIPATION

DaVita Medical Group is one of more than 2,900 primary care practices nationwide participating in Comprehensive Primary Care Plus (CPC+), a partnership between payer partners from the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies, commercial health plans, self-insured businesses, and primary care providers. This partnership is designed to provide improved access to quality health care at lower costs. Read more in our letter here.


PREVENTIVE CARE

It's time for your annual wellness check! What exactly does that mean for most patients?

Preventive/Wellness Care May Include (but is not limited to):

  • Annual wellness check or physical exam
  • Annual lab work
  • Colonoscopy
  • Mammogram (women)
  • PAP smear (women)
  • Prostate exam (men)
  • Immunizations
 

Examples of services generally NOT covered by most insurance benefit plans at your annual wellness exam include:

  • Acute illness care (coughs, colds, sore throats, etc.)
  • Acute orthopedic issues (back pain, sore shoulder, etc.)
  • Specific health conditions that have already been diagnosed (high cholesterol, diabetes, review of labs, etc.)


Insurance benefits differ regarding what services are covered under the terms "preventive care" or "wellness exam". We highly recommend that you contact your insurance company if you have any questions regarding what your specific plan covers.

Thank you for choosing DaVita Medical Group as your health care provider!