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Patient Policy

NorthShore Patient Privacy Policy

Notice of Privacy Practices

NorthShore Health Centers Continuous Quality Improvement

Authorization and Disclosure of Protected Health Information

As a Patient Centered Medical Home, we work together with our patients to help improve their quality of care. We encourage our patients to stay on top of their healthcare outcomes with fast, easy access to their patient portal or ability to request your medical records online.

NorthShore Payment Policy/Cost of Services

The Health Centers are open to the public.

  • Self pay discounts for health care are determined on a sliding scale according to the responsible party’s income. Click here to view sliding scale. ​Patients can print the sliding fee scale application to fill out prior to their visit, or NorthShore staff has copies available at all of our locations.
  • Cash payments and private insurance are accepted.
  • All clients must pay a minimum fee for each office visit.
  • Medicaid and Hoosier Healthwise payments are accepted.
  • Discounts for dental work are assessed based on the services provided and sliding scale.
  • Payments must be made at the time services are rendered.

NorthShore Health Centers will assess each patient’s insurance plan and financial status prior to rendering services. It is the responsible party’s obligation to furnish all financial documents requested by NorthShore Health Centers.

While we provide a wide range of services, we sometimes refer patients to specialists and others not affiliated with NorthShore Health Centers. Those fees must be negotiated directly by the patient with the provider. NorthShore Health Centers is not involved in these negotiations, and is not responsible for paying such fees.

The new Healthy Indiana Plan (or “HIP 2.0”), www.hip.in.gov, is an affordable health insurance program from the State of Indiana for uninsured adult Hoosiers. The Healthy Indiana Plan helps pays for medical expenses and provides incentives for members to be more health conscious. The Healthy Indiana Plan provides coverage for qualified low-income Hoosiers ages 19 to 64, who are interested in participating in a low-cost, consumer-driven health care program.

NorthShore is also an enrollment site for Hoosier Healthwise which provides Medicaid for pregnant women & children. Visit Indiana Medicaid www.indianamedicaid.com for more information.

NorthShore Dental Policies

To provide our dental patients with the best possible care in a timely manner, the following policies related to patient walk-ins, broken appointments and overall dental procedures have been created. Please click on the links below to read through the policy pertaining to your dental needs.

Dental Walk-In Policy

Dental Broken Appointment Policy

Dental Procedures

Minor Consent Form

NorthShore Health Centers’ policy is that a parent/guardian must fill out a consent form giving permission for another adult to accompany their child to the child’s medical, dental or vision appointments. For the protection of your child, we are no longer accepting written permission letters or verbal consent over the phone as acceptable documentation of minor consent. Please print out the Minor Consent Form below and return to any NorthShore Health Centers’ location or stop by one of our locations for a copy of the form. Once you complete the form, it will be documented in the child’s chart and referenced for all future appointments.

Minor Consent Form – Permission to Accompany a Minor