Our Policies

Patient Financial Responsibility Policy

It is important for patients to understand the costs of their health care before deciding on services. Calculating all costs beforehand can be a confusing process. Clear Lake Specialties’ Patient Financial Policy helps explain this process. The following information is provided by Clear Lake Specialties to help answer questions you may have related to your visit may be reviewed on Patient Portal

Patient Forms
Assignment of Benefits – English

Assignment of Benefits – Spanish

 

Patient Authorization Form (HIPAA)

Authorization to Disclose Health Information

 

CLS Compliance Program and Reporting

Resources

CLS Compliance Hotline

CLS Patient Complaints and Concerns

Please complete the CLS Compliance Incident Report Form to submit your report.

Protect Yourself from Covid-19 Health Care Fraud

Clear Lake Specialties (CLS), its Governing Board, and its administration are committed to quality and efficient patient care; high standards of ethical and professional conduct; and full compliance with all applicable federal and state laws affecting the delivery or payment of health care, including those that prohibit fraud, abuse or waste of health care resources. We have developed a Compliance Program to ensure that everyone associated with CLS adheres to all applicable laws, rules, and regulations. It provides employees with information and training to ensure a culture of accountability and responsibility. CLS Compliance Department monitors all compliance-related issues through ongoing auditing and reporting mechanisms. The purpose of the program is to prevent any inadvertent or intentional wrongdoing. CLS employees and independent contractors have an obligation to become familiar with the CLS Compliance Program and to certify that they have read and understood the CLS Code of Conduct and the CLS Compliance Program.

The key objective of the CLS Compliance Program is to develop and implement a corporate compliance program on an ongoing basis to enable CLS to operate its business in compliance with federal, state, and local laws and regulations and avoid wrongdoing, whether by mistake, through inadvertence, or intentional.

CLS employees and independent contractors have an obligation to become familiar with the CLS Compliance Program and to certify that they have read and understood the CLS Code of Conduct and the CLS Compliance Program. Any such employee or contractor who does not understand any provision of the CLS Code of Conduct or the CLS Compliance Program shall seek clarification from the CLS Compliance Officer about such provision.

CLS Employees, patients, and contractors should report any activity that is believed to be inconsistent with CLS’s policies, governing laws, or the tenants of ethics to CLS’s Compliance Officer. The reporter can choose to be completely anonymous or provide his or her name. Either way, the report will be handled with full confidentiality.