UNC Specialty Care at Chatham

Forms

Acknowledgement of Receipt of Notice of Privacy Practices

Authorization for Release of Medical Information

Financial Assistance Policy

Política de Asistencia Financiera

General Consent for Treatment

Consentimiento General para el Tratamiento

Limited Release of Health Information: Friends and Family

New Patient Medical History

Notice of Privacy Practices Brochure

Notice of Separate Billing

Patient Information (Demographics)

Formulario de Información del Paciente

Appointments

To make an appointment, please call 919-799-4050.

Insurance Plans

To ensure you can get the care you need, UNC Physician Network practices participate in a wide range of health plans and accepts most major insurance providers; however, it is important that you contact your insurance provider before receiving treatment to verify that you have full coverage. You should also determine your individual plan requirements regarding referrals, authorizations and co-pay/deductible amounts. View a list of our health plans accepted.

Prescriptions

You can request prescription refills or submit questions to your physician regarding your medication by using our online patient portal. If you do not have a My UNC Chart account and you need a refill, contact your pharmacist before your supply runs out. This allows ample time for the pharmacist to obtain approval from the physician to prepare your medication. Refills are not handled after hours or on weekends. If you have any questions about your medication, or if you're experiencing difficulty taking your medications, bring it to the attention of your pharmacist and our clinic.