• ADSCI

    ADSCI

    28049 Smyth Dr, Valencia, CA 91355 | 15477 Ventura Blvd, Suite 100, Sherman Oaks, CA 91403 | 435 N Roxbury Dr, Suite 315, Beverly Hills, CA 90210 | 2100 North Solar Dr, Suite 202, Oxnard, CA 93036 | 2659 Townsgate Rd, Suite 215, Westlake Village, CA 91361 | 8341 Westminster Blvd, Suite 101, Westminster, CA 92683 | 18501 Gale Ave, Suite 150, City of Industry, CA 91748 | 1510 S. Central Ave, Suite 120, Glendale, CA 91204
  • Dear Patient:

    The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) created several guidelines for doctors to follow to encourage Electronic Patient Communication. A new requirement is the creation of a patient portal for doctor's offices to communicate safely and securely following Health Insurance Portability and Accountability Act of 1996 (HIPAA) guidelines.

    Our office has an advanced Electronic Health Record (EHR) system that provides a patient portal called Patient Ally.

    Please provide your email below so that we can send you an invite link to create an account.

    Thank you for assisting us in fulfilling this important MACRA requirement.

    Sincerely,

    Dr. Lin

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  • PATIENT INFORMATION

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  • Pharmacy Information

  • Allergies

  • Medications

  • MEDICAL QUESTIONNAIRE

  • PAYMENT POLICY

  • Thank you for choosing our medical practice. We are committed to providing you the best possible medical care. The following information is provided to avoid any confusion regarding payment for professional medical services. OurInsurance Billing Department will work with you to see that your claim is filed accurately and promptly.

    • All Copayments and Deductibles must be collected in full at the time of service if applicable.
    • If we are in-network with your insurance plan, we will not discount our services by any further amount after your insurance company has processed your claim and informed us of your responsibility.
    • If we are not a contracted provider for your insurance company, we will bill them, as a courtesy, on your behalf.
    • If your acount is overdue for more than 180 days after your insurnace has paid, it will be referred to a collection agency. This is done reluctantly, as a last resort, after we have exhausted all efforts for voluntary payment.
    • New patients, and those who have no insurance, are required to pay at the time of service with either a credit card or cash. We do not accept personal checks.
  • Acknowledgement and Authorization

    I have read, understood, and agreed to abide by the above payment policy. I understand that charges not covered by insurance company, as well as copayment, deductibles and coinsurances, are my responsibility.

    By signing below, you agree to the Terms and Conditions of Advanced Dermatology and Skin Cancer Institute's Payment Policies

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  • Office Policy for No Show Patients

  • No Show Policy:

    Please notify our office 48 hours in advance if you are unable to keep your scheduled appointment. If you do not notify us and miss your appointment by not showing up at all, we will require that you pay a $100.00 Missed Appointment Fee before any future appointments.

    By signing below, I have read and understood the full Office Policy for No Show Patients.

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  • ACKNOWLEDGMENT: RECEIPT OF NOTICE OF PRIVACY PRACTICES

    Our office has copies of the HIPAA Notice of Privacy Practices available. Please feel free to get a copy or ask a staff member to hand one to you. I have read/understand the full Notice of Privacy Practices.

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  • NOTICE TO PATIENTS

    Medical doctors are licensed and regulated by the Medical Board of California. To check up on a license or to file a complaint, go to www.mbc.ca.gov, email: licensecheck@mbc.ca.gov, or call 800-633-2322. By signing below, I acknowledge this notice about the role of the Board.

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  • OPEN PAYMENTS DATABASE

    The Open Payments Database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at openpaymentsdata.cms.gov. By signing below, I acknowledge this notice about the Open Payments Database.

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