Patient Information

Plan you first visit, download forms, and find other important information you need to know.

Planning Your First Visit to Diagnostic Clinic

Arrive 45 minutes before your scheduled appointment time. If the patient is under the age of 18, a parent needs to accompany them to their appointment. Parking information for Largo patients.

Should you need to cancel or reschedule your appointment, please call 727-585-3797. We require 24 advanced notice for cancelling appointments.

A checklist of what to bring to your appointment

  • Insurance Information: Please bring your insurance card or necessary insurance information. If your insurance carrier requires a referral, bring referral numbers and forms. If your treatment is covered by Workers' Compensation, bring a letter of authorization from your insurance carrier.
  • Patient Information Form: Please print and complete the patient information form before arriving for your appointment and bring it with you.
  • Medical Records: Please have your medical records from previous physicians transferred to the office of your scheduled appointment.
  • X-Rays and/or Scans: If appropriate to your visit, please bring any available X-rays or scans or have them sent to arrive by the time of your appointment.
  • A List of All Medications: Please bring a list of all medications you currently are taking or have taken recently, whether over-the-counter or prescription. Include the strength and dosage of each medication.
  • A List of Personal Health Questions or Concerns: Sometimes we forget all the things we wanted to tell or ask the doctor, so make a list of your symptoms, questions or concerns before you come to your appointment.
  • Patients’ Bill Of Rights

    SUMMARY OF THE FLORIDA PATIENTS’ BILL OF RIGHTS AND RESPONSIBILITIES

    Patient Rights

    A patient has the right to:

    • Be treated with courtesy and respect, with appreciation of his/her individual dignity, and with the protection of his/her need for privacy.
    • Receive a prompt and reasonable response to questions and requests.
    • Know who is providing medical services and who is responsible for his/her care.
    • Know what member support services are available, including whether an interpreter is available if his/her does not speak English.
    • Know what rules are regulations apply to his/her conduct.
    • Express grievances regarding any violation of his/her rights, as stated in Florida law. Through the grievance procedure of health care provider and health care facility which served him/her and to the appropriate state licensing agency.
    • Be give, by his/her health care provider, information concerning diagnosis, planned course of treatment, alternatives, risks and prognosis.
    • Refuse any treatment, except as otherwise provided by Law.
    • Be given, upon request, full information and necessary counseling on the availability of known financial resources for his/her care.
    • Receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
    • Receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
    • Impartial access to medical treatment and accommodations, regardless of race, national origin, religion, physical handicap, or source payment.
    • Treatment for any emergency medical condition that shall deteriorate from failure to provide treatment.
    • Know if medical treatment if for purposes of experimental research and to give his/her consent or refusal to participate in such experimental research.
    • Be provided with a description of and a link to the performance outcome and financial data published by the Agency for Health Care Administration.
    • A member who is eligible for Medicare has the right to know, upon request and in advance of treatment; whether the health care provider or health care facility accepts the Medicare assignment rate.
    Member Responsibilities

    A member is responsible for:

    • Providing to his/her health care provider to the best of his/her knowledge, accurate and complete information about present complaints, part illnesses, hospitalizations, medication and other matters relating to his/her health.
    • Reporting unexpected changes to his/her condition to his/her health care provider.
    • Reporting to his/her health care provider whether he/she comprehends a contemplated course of action and what is expected of him/her.
    • Following the treatment plan recommended by his/her health care provider.
    • Their actions if they refuse treatment or do not follow the health care provider’s instructions.
    • Assuring that the financial obligations of his/her health care are fulfilled as promptly as possible.
    • Following health care facility rules and regulations affecting member care and conduct.
    • For keeping appointments and, when he/she is unable to do so for any reason, for notifying the health care provider or health care facility.
  • Notice of Privacy Practices

    NOTICE OF PRIVACY PRATICES FOR DIAGNOSTIC CLINIC MEDICAL GROUP, INC.

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

    This Notice describes the privacy policies of the Provider, and applies to the physicians, health care professionals, employees, staff and other personnel who provide services at the Provider. The people and organizations to which this notice applies (referred to as “we,” “our,” and “us”) have agreed to abide by the terms of this notice. We may share your information with each other for purposes of treatment, and as necessary for payment and operations activities as described below.

    This notice applies to any information in our possession that would allow someone to identify you and learn something about your health. It is intended to describe the policies that protect medical information relating to your past, present and future medical conditions, health care treatment and payment for that treatment (called “Protected Health Information” or “PHI”). It does not apply to information that could not reasonably be used to identify you.

    OUR LEGAL DUTIES
    • We are required by law to maintain the privacy of your health information.
    • We are required to provide this notice of our privacy practices to anyone who asks for it.
    • We are required to abide by the terms of this notice until we officially adopt a new notice.
    HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION.

    We may use your PHI, or disclose your PHI to others, for a number of different reasons. This notice describes the categories of reasons for using or disclosing your information. For each category, we have provided a brief explanation, and in many cases have provided examples. The examples given do not include all of the specific ways we may use or disclose your PHI. However, any time we use or disclose your PHI, it will be for one of the categories of listed below.

    Treatment.

    We will use your health information to provide you with medical care and services. This means that our employees and staff and others who work under our direct control may read your health information to learn about your medical condition and use it to make decisions about your care. For instance, a medical assistant may read your medical chart in order to care for you properly. We will also give your information to others who need it in order to provide you with medical treatment or services. For instance, we may send your doctor the results of laboratory tests or x‐rays we perform.

    Payment.

    We will use your health information, and disclose it to others, as necessary to obtain payment for the services we provide to you. For instance, an employee in our business office may use your health information to prepare a bill. And we may send that bill, and any health information it contains, to your insurance company. We may also disclose some of your health information to companies with whom we contract for payment‐related services. We may give information about you to a health plan that pays for your benefits. We will not use or disclose more information for payment purposes than is necessary.

    Health Care Operations.

    We may use your health information for activities that are necessary to operate this organization. This includes reading your health information to review the performance of our Staff. We may also use your information and the information of other patients to plan what services we need to provide, expand, or reduce. For example, we may disclose your health information to a company that assists us with quality assurance. We may disclose your health information as necessary to others who we contract with to provide administrative services. This includes our lawyers, auditors, accreditation services, and consultants, for instance.

    To Business Associates.

    The Provider may hire third parties that may need your PHI to perform certain services on behalf of the Provider. These third parties are “Business Associates” of the Provider. Business Associates must protect any PHI they receive from, or create and maintain on behalf of, the Provider.

    Family and Friends.

    We may disclose your health information to a member of your family or to someone else who is involved in your medical care or payment for care. We may notify family or friends if you are in the hospital, and tell them your general condition. In the event of a disaster, we may provide information about you to a disaster relief organization so they can notify your family of your condition and location. We will not disclose your information to family or friends if you object. We may also disclose to your personal representatives who have authority to act on your behalf (for example, to parents of minors or to someone with a power of attorney).

    Public Health Oversight.

    We may disclose your health information to a public health oversight agency for oversight activities authorized by law. This includes uses or disclosures in civil, administrative or criminal investigations; licensure or disciplinary actions (for example, to investigate complaints against health care providers); inspections; and other activities necessary for appropriate oversight of government programs (for example, to investigate Medicaid fraud).

    To Report Abuse.

    We may disclose your health information when the information relates to a victim of abuse, neglect or domestic violence. We will make this report only in accordance with laws that require or allow such reporting, or with your permission.

    YOUR RIGHTS
    Authorization.

    We will ask for your written authorization if we plan to use or disclose your health information for reasons not covered in this notice, including but not limited to uses and disclosures relating to psychotherapy notes, marketing activities, and any sale of your PHI. If you authorize us to use or disclose your health information, you have the right to revoke the authorization at any time. If you want to revoke an authorization, send a written notice to the Privacy Official listed at the end of this notice. You may not revoke an authorization to the extent that we have already given out your information or taken other action in reliance on the authorization. If the authorization is to permit disclosure of your information to an insurance company, as a condition of obtaining coverage, other laws may allow the insurer to continue to use your information to contest claims or your coverage, even after you have revoked the authorization.

    Request Restrictions.

    You have the right to ask us to restrict how we use or disclose your health information. You must make this request in writing. We will consider your request, but we are not required to agree. If we do agree, we will comply with the request unless the information is needed to provide you with emergency treatment. We cannot agree to restrict disclosures that are required by law.

  • Vendor Policy

    Information for All Corporate Representatives and Vendors Who Wish to Schedule a Visit at Diagnostic Clinic

    Diagnostic Clinic seeks to serve its patients with compassion, skill, and integrity. In keeping with this mission, access and activities of all non-patients who desire to enter the Diagnostic Clinic building will be managed in order to maintain:

    • security
    • patient privacy
    • delivery of excellent service
    • operations consistent with our mission and business strategies

    All corporate representatives, vendors, pharmaceutical representatives, representatives of other medical or non-medical business entities, and/or physicians and providers whose visits are unrelated to the active care of an individual Diagnostic Clinic patient will follow the follow process to schedule visits. Unscheduled visits are not permitted. Scheduling of visitors is at the sole discretion of Diagnostic Clinic.

    Visits That Do Not Involve the Delivery or Consumption of Food:
    • Contact Diagnostic Clinic’s Patient Service Center at 727-584-7706.
    • Provide your name, the name of your organization or company, the reason for visit, and the provider or pod of providers you wish to visit.
    • Depending on provider / pod preference, the Patient Service Center may either schedule the corporate representative into pre-designated appointment times or task the appointment request to the individual provider / pod requested.
    • If the provider / pod prefers to be tasked, the representative or vendor requesting an appointment will later be contacted directly by the provider office to officially schedule the visit (PSC will have included contact information within the task).
    • Practices may also request and schedule a visit on an as needed basis by calling and scheduling the particular vendor or representative.
    Visits Involving the Delivery or Consumption of Food
    • Contact Executive Administrative Assistant at 727-584-6555, ext. 2015 or email lfrain@dcmail.org
    • Scheduling will be on a 1st come first serve basis.
    • Note that no food is permitted anywhere outside of the 4th floor employee lounge area.
    • Meetings are limited only to those invited.
    Conducting a Visit
    • Register at the Ground Floor Information Desk upon arrival.
    • Information Desk will verify a scheduled appointment.
    • Unscheduled visits are not recommended. They will be referred to the PSC to make an appointment.
    • Information Desk will issue a visitor’s badge indicating the date, location, and duration of the visit.
    • Visitors must wear and visibly display the visitors badge.
    • All visitors will be granted access only to the location in the building for which they have been scheduled.
    • Upon arrival to the area scheduled for a visit, the visitor will notify local.
    • Patient Registration check out personnel who will who in turn notify the staff of their visitor’s appointment.
    • Visitors are not permitted to wait in the hallways of clinical care areas (visitors may only wait in reception area or a provider’s personal office).
    • At the conclusion of a scheduled visit, visitors will go directly to the Information Desk to sign out and return their visitor badge.
    • Food may not be delivered or consumed anywhere within Largo Diagnostic Clinic except the employee lounge and all events in that area must be pre-scheduled.
    • The only participants in food related meetings are those from the department for which the meeting was scheduled and invited guests.
    • A list of invited guests will be placed at the entry to the meeting.
    • Pharmaceutical samples or other types of samples should be delivered at the time of scheduled visits, either in the provider’s office, or during events in the employee lounge.
    Failure to Follow Policy
    • Visitors who do not follow this policy will be educated, escorted from the building, and may be temporarily or permanently banned from non-patient related entry.
    • Repeat violation of this policy will result in all individuals from the same organization being banned altogether.

    Diagnostic Clinic seeks to serve its patients with compassion, skill, and integrity. In keeping with this mission, access and activities of all non-patients who desire to enter the Diagnostic Clinic building will be managed in order to maintain:

    • security
    • patient privacy
    • delivery of excellent service
    • operations consistent with our mission and business strategies

    All corporate representatives, vendors, pharmaceutical representatives, representatives of other medical or non-medical business entities, and/or physicians and providers whose visits are unrelated to the active care of an individual Diagnostic Clinic patient will follow the follow process to schedule visits. Unscheduled visits are not permitted. Scheduling of visitors is at the sole discretion of Diagnostic Clinic.

    Visits That Do Not Involve the Delivery or Consumption of Food:

    • Contact Diagnostic Clinic’s Patient Service Center at 727-584-7706.
    • Provide your name, the name of your organization or company, the reason for visit, and the provider or pod of providers you wish to visit.
    • Depending on provider / pod preference, the Patient Service Center may either schedule the corporate representative into pre-designated appointment times or task the appointment request to the individual provider / pod requested.
    • If the provider / pod prefers to be tasked, the representative or vendor requesting an appointment will later be contacted directly by the provider office to officially schedule the visit (PSC will have included contact information within the task).
    • Practices may also request and schedule a visit on an as needed basis by calling and scheduling the particular vendor or representative.
    Visits Involving the Delivery or Consumption of Food
    • Contact Executive Administrative Assistant at 727-584-6555, ext. 2015 or email lfrain@dcmail.org
    • Scheduling will be on a 1st come first serve basis.
    • Note that no food is permitted anywhere outside of the 4th floor employee lounge area.
    • Meetings are limited only to those invited.
    Conducting a Visit
    • Register at the Ground Floor Information Desk upon arrival.
    • Information Desk will verify a scheduled appointment.
    • Unscheduled visits are not recommended. They will be referred to the PSC to make an appointment.
    • Information Desk will issue a visitor’s badge indicating the date, location, and duration of the visit.
    • Visitors must wear and visibly display the visitors badge.
    • All visitors will be granted access only to the location in the building for which they have been scheduled.
    • Upon arrival to the area scheduled for a visit, the visitor will notify local.
    • Patient Registration check out personnel who will who in turn notify the staff of their visitor’s appointment.
    • Visitors are not permitted to wait in the hallways of clinical care areas (visitors may only wait in reception area or a provider’s personal office).
    • At the conclusion of a scheduled visit, visitors will go directly to the Information Desk to sign out and return their visitor badge.
    • Food may not be delivered or consumed anywhere within Largo Diagnostic Clinic except the employee lounge and all events in that area must be pre-scheduled.
    • The only participants in food related meetings are those from the department for which the meeting was scheduled and invited guests.
    • A list of invited guests will be placed at the entry to the meeting.
    • Pharmaceutical samples or other types of samples should be delivered at the time of scheduled visits, either in the provider’s office, or during events in the employee lounge.
    Failure to Follow Policy
    • Visitors who do not follow this policy will be educated, escorted from the building, and may be temporarily or permanently banned from non-patient related entry.
    • Repeat violation of this policy will result in all individuals from the same organization being banned altogether.
GWDCM 001 NF 102015