MISSOULA BONE & JOINT PATIENT RESOURCES
Patient Information and Forms
Thank you for selecting Missoula Bone & Joint in Missoula, Montana for your orthopedic and sports medicine care. To schedule an appointment, please call us at (406) 721-4436 or use our online appointment request form.
Below you will find a wealth of helpful information regarding our practice, including patient forms for an orthopedic visit, physical therapy, surgery, and MRI. If you have a question, give us a call and one our friendly representatives will be happy to help.
- To ensure we have your accurate medical history available at your initial orthopedic appointment you can either:
- Print and complete our required New Patient Forms and bring with you to your appointment, OR
- Bring all necessary information with you to accurately complete all your medical and surgical history, and an updated list of all your medications.
- Please check in 15 minutes prior to your scheduled appointment to complete paperwork unless you have done so ahead of time. Remember to bring all forms to your appointment.
- Bring your insurance card to every appointment. You will be asked to pay your insurance co-pay and/or a portion of your bill at each visit.
- Contact your insurance carrier prior to your appointment as some plans require prior approval for services. Patient benefits and eligibility can be confirmed through your insurance plan.
- You may be asked to send all pertinent medical records, X-rays, and/or scans prior to your appointment.
Red Flag Rules: In an effort to comply with federal Identity Theft Laws, Missoula Bone & Joint now requires that patients present photo identification for treatment. Please contact our office with questions regarding this policy. Thank you for helping us to protect you.
Our goal is to minimize your wait time prior to your scheduled appointment. Please understand that emergencies and delays occasionally occur. Patience in these situations is greatly appreciated and we will do our best to keep you informed if such delays do occur.
Once you have made your initial orthopedic appointment it is time to provide us with an accurate medical history.
To ensure we have your accurate medical history available at your initial orthopedic appointment you can either:
- Print and Complete Clinic Forms 1-5 below prior to your visit, OR
- Please bring all necessary information with you to accurately complete all your medical and surgical history, and an updated list of all your medications.
Established patients can update forms online through our patient portal or print and complete Form # 2 below. If you need help setting up or accessing the patient portal, please call our office at (406)721-4436 ext. 5618 and we’ll be happy to help.
If you are scheduled for physical therapy, surgery, or an MRI, please complete the appropriate forms below and bring them with you to your appointment.
Orthopedic Clinic Forms
- Patient Registration Form
- New Patient Health History Intake Form OR Established Patients Intake Form
- Patient Financial Policy
- Notice of Privacy Practices
- MBJ Release of Information
- Consent to Treat Minors Form
- Surrounding Area MRI and X-ray Facilities
For New patients scheduled with Dr. Roster: Please complete the MBJ New Patient Foot & Ankle Form
For New patients scheduled with Dr. Gholson: Please complete the Dr. Gholson New Patient Intake Form
For New patients scheduled with Dr. Woods or Dr. Witte for a back evaluation: Please complete the MBJ New Patient Back Form
Physical Therapy Forms
Surgery Center Forms
Before Surgery: You will be asked to fill out Pre-Surgery forms with the Orthopedic Assistant for your Provider at your clinic visit prior to your surgery.
- Post-Op Instructions Given by Your Surgeon
- Nerve Blocks Information
- Scopolamine Patch Instruction Sheet
Your answers to the questions on the MRI Metal Screening (page 2) will help us determine whether an MRI examination is safe for you based on your history. In addition, we need to determine whether there are any factors that may interfere with your study or may cause difficulty with the scan results.
The Federal Government (Patient Protection and Affordable Healthcare Act, Sections 6409 and 6003 dated March 23, 2010) mandates we provide information on facilities other than those owned by our physicians. You have the right to choose your facility. If you would like to receive services at another facility we will be happy to provide you with a referral. Here is a list of facilities: Surrounding Area MRI and X-ray Facilities
Before Your MRI Appointment
To save time at your MRI appointment, please fill out this MRI Patient History Form, Print Out and Bring With You to your MRI appointment.
If your procedure involves the use of contrast dye, you will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.
Nutrition is Vital
Nutrition is vital to overall health and wellness - the one true medicine that fuels your body and helps it heal. For this reason, following a balanced diet before, during, and after major surgeries is important to your recovery.
Healthy eating and regular physical activity are crucial to adding years to your life and reducing your risk for chronic disease. Nutrient needs change with age and several key foods are important for strong bones and joints, improving memory, and maintaining a healthy body weight. Live your most vibrant years!
Insurance: At Missoula Bone & Joint, we are preferred providers with many insurance companies, including workers’ compensation and Medicare. Please contact your insurance company to verify eligibility and coverage. The following is a list of insurances that we are contracted with as well as preferred provider organizations (PPOs):
- Blue Cross Montana
- Medicare **
- Missoula County
- Pacific Source
** We are NOT contracted with Humana Gold, a Medicare HMO, because of the pre-authorization requirement by your primary care physician for every service item which causes treatment delays as well as non-payment of services. We are sorry for any inconvenience this causes you. We are contracted with BCBS Medicare Advantage and regular Medicare.
Payment: If your insurance plan requires you to pay a co-payment, co-insurance, and/or a deductible, you will need to pay at the time of your visit. For your convenience we accept cash, checks, Visa, MasterCard, Discover, and American Express.
Surgery: If surgery is required, separate statements will be sent to you for each provider of services. You may receive billing from each of the following:
- Surgery Center or Hospital
- Surgical Assistant
- Durable Medical Equipment (DME) Providers
Workers’ Comp: You are required to provide the following information upon scheduling your appointment:
- Work comp carrier and address
- Date of injury
- Claim number
- Employer at time of accident
- Adjustor and contact number
This information will ensure accurate and timely filing of your claims. Without this information we will be unable to submit your claim to your work comp carrier and, therefore, will ask for payment at time of service.
If your claim is denied or not paid within a timely manner, we request that you file a personal claim with your health insurance and pay the charges in full. We recommend you notify your employer should there be any delays in settling your workers’ compensation claim.
Billing: If you have a question related to your bill or insurance, please contact our billing specialists at (406) 532-8779. To pay a bill, call (406) 532-8065 or you may pay your bill online.
When you log in to our secure patient portal, you can view your health information, summaries of your office visits, test results, and patient education. You can also complete online forms, request medication refills and communicate with our clinical staff.
To register for our patient portal, simply provide us with your email address and you will receive an email containing a secure link to complete the registration process. If you do not receive an email, please call our office at (406) 721-4436 ext.5618.
To obtain a copy of your medical records from our office, download and complete our Release of Information form. You can then mail it, fax it to (406) 721-6053, or bring it to our office. Your records will be available within 10 days unless previous arrangements have been made. If you have a question about obtaining your medical records, CALL our medical records department directly at (406)532-8060.
When to call Medical Records Directly: A patient may call us directly when needing their medical records transferred to another provider, a workers compensation, insurance company, or themselves. We can also help with the patient portal. A provider’s office may call us directly especially if they have a patient in the office and need to reach us in a timely manner. An attorney’s/ insurance or workers compensation office can call us directly to check status of a patient’s appointment and/or their request for medical records.
Office Visits: If your insurance is a HMO/managed care plan then you are required to obtain a referral from your primary care physician, the referral must be obtained before you can be seen for an office visit. Please coordinate this with your primary care physician in advance. Appointments can be rescheduled if required referrals are not received in the office by the time of your visit.
Physical Therapy: You will need a referral from your physician or medical provider (primary care doctor, nurse practitioner, orthopedic surgeon, podiatrist, chiropractor, etc.) for insurance to pay for your physical therapy treatment.
Missoula Bone & Joint will accept an initial referral by fax, by phone, or by email from your provider, and we will obtain the needed signed prescription within days of your referral, or you may bring the signed referral form with you to our office.
Refer a Patient: If you are a Provider and would like to refer a patient to Missoula Bone & Joint Clinic or Physical Therapy we have a REFER A PATIENT tab at the bottom of our home page. Please fill in the information and submit the request. Missoula Bone & Joint will call your patient within 1 business day to schedule their appointment with the appropriate provider.
Prescriptions and refills for established patients of Missoula Bone & Joint are routinely handled from 8:30am-4:00pm Monday through Friday. For medication refills, please have your pharmacy fax a refill request to our office at Fax: (406) 721-6053. Please allow at least 24 hours for refill processing.
No refills are issued during the evenings, weekends, or holidays, as the doctors do not have access to your medical records during those times. It is helpful to anticipate your refill needs to avoid an interruption in your medication therapy.
If you need a refill between office visits:
- Please allow at least 24 hours for refill processing.
- Call your pharmacy to request a refill. The Pharmacist will contact our office if necessary. If the request is for a narcotic, per Federal Law these cannot be called or faxed in and prescriptions must be picked up in person.
- Refill requests are handled from 8.30am-4.00pm Monday through Friday.
- Any medication requests after 4.00pm will be addressed the next business day.
- Prescriptions are not refilled after hours, on weekends, or on holidays.
- Narcotic pain medications will not be routinely prescribed for longer than 6 weeks post-operatively. Patients requiring longer term narcotic management will be referred to their primary care provider.
Please contact our office within 24 hours of your scheduled appointment if you need to reschedule or cancel. Every time a patient does not notify us that they will be unable to keep an appointment it prohibits another patient from being able to see one of our providers.
If you do not let us know at least two hours prior to your appointment time that you will be unable to keep your scheduled appointment, you will be assessed with a "no-show." Two "no-shows" within a rolling 24-month period will result in a patient being discharged from our practice and no further appointments will be scheduled for him/her.
Providers at Missoula Bone & Joint have hospital or surgery center affiliations with:
- Community Medical Center, Missoula
- St. Patrick Hospital, Missoula
- Missoula Bone & Joint Ambulatory Surgery Center, Missoula
- St. Joseph Medical Center, Polson
When you are having surgery at either St. Patrick Hospital or Community Medical Center, please contact your surgeon's assistant to discuss arrangements for a pre-registration appointment at the hospital.
During your pre-registration appointment, you may require lab work, X-rays, and an EKG. The hospital will then send the results to your surgeon's office prior to surgery.
If you are scheduled for either a total hip replacement or total knee replacement, specific information is available at each hospital for your review:
Community Medical Center also offers total joint classes during which the physical therapy department and nursing staff are available to meet with you. Please contact your surgeon's assistant to make arrangements to attend one of these classes.
If you are scheduled for a total joint replacement with a physician at Missoula Bone & Joint, please see below for specific information regarding your total hip and total knee procedures.
IMPORTANT: Do not EAT or DRINK anything after MIDNIGHT the night before your surgery.
Generally, you will be asked to arrive at the hospital 2 hours prior to your scheduled surgery time. Please keep in mind road conditions during the winter months and plan appropriately. Also arrange for a responsible adult to drive you home following your surgery and have someone stay with you for 24 hours.
Upon discharge from the hospital, you will be provided with specific instructions given by your surgeon. At that time you will be provided with a post-operative appointment here at Missoula Bone & Joint, or you may be told to contact our office at (406) 721-4436 to schedule a time.
Please contact your surgeon's office at any time regarding questions or concerns.