Picture 2 | Bonomo Periodontics

Patient Information

Find resources, both new and current patient information is listed below. Just click on the heading to learn more.

First Visit

Welcome to our office
Your initial appointment will consist of an examination in which Dr. Bonomo will review your medical and dental histories, your presenting symptoms and treatment options which are appropriate for treatment.

Please assist us by providing the following information at the time of your examination:

  • Your referral slip and x-rays if applicable.
  • A list of all medications which you are presently taking.
  • Your dental insurance card/information.
Providing this information at the time of your initial visit will save time and assist us in the processing of your claims.

PLEASE NOTE: All minors (under the age of 18 years of age) must be accompanied by a parent or legal guardian at the examination appointment.

Please inform the office if you have a medical condition that may be of concern prior to surgery. Such conditions may include:

  • Diabetes
  • High or low blood pressure
  • Heart disease, artificial heart valves and joints
  • Asthma

Please notify the office if you are taking the following medications:

  • Heart medications
  • Aspirin or anticoagulant therapy
  • Fosamax, Actonel or Zometa

Scheduling

The office of Raymond Bonomo Periodontics is open on weekdays by appointment only. The following are the usual and customary hours of operation:

Monday 9:00 a.m. - 5:00 p.m.
Tuesday 8:30 a.m. - 6:00 p.m.
Thursday 8:30 a.m. - 6:00 p.m.
Friday 8:00 a.m. - 1:00 p.m.

Our staff will make every effort to schedule your appointment as promptly as possible.

At our office we try our best to stay on schedule to minimize your waiting. Due to the fact Dr. Bonomo provides surgical services, various circumstances may lengthen the time allocated for a procedure. Emergency cases can also arise and cause delays. We very much appreciate your understanding and patience.

EMERGENCY CONTACT NUMBER: (513) 383-3615

PLEASE NOTE: On Wednesdays the office is closed, but in the event of a true dental emergency our patients of record can reach Dr. Bonomo on our after hours number.

Please contact us with any questions or to schedule an appointment.

X-rays

If your dentist or physician has taken x-rays, please request that they be forwarded to our office prior to your first visit. If there is not enough time additional x-rays may be taken at our office during your visit.

Insurance Info

At the office of Raymond Bonomo Periodontics, we make every effort to provide you the finest care and most convenient financial options. To accomplish this goal, our administrative staff will work hand in hand with you to maximize your insurance reimbursement for covered procedures.

Please remember that not all of our specialty services are covered under your insurance benefits.

We accept and are specialty providers for the following dental Insurance plans:

  • Metlife
  • Dental Care Plus
We also work closely with CareCredit in providing our patients the best financial options available.

Financial Info

We strive to provide exceptional patient care with the convenience of multiple payment options. Our fees are based on the type and extent of treatment you require. In an effort to maximize savings to you, we ask that your portion of payment be made at the time of your visit. We accept cash, checks, MasterCard, Visa, and the Discover Card. We also work with CareCredit to help our patients make treatment affordable. Please bring your most current insurance information to your visit, as this will save us time and allow us to process your insurance claims in a timely manner.

Sedation Checklist

Please Read You have scheduled a procedure to be performed under I.V. Sedation and the following are guidelines which must be followed on the day of/before your appointment.

1. You may eat a small meal 1 to 2 hours prior to appointment. (DO NOT OVERLOAD YOUR STOMACH) If you have medications that must be taken, you may do so with small amounts of water or clear liquids.
2. Most medications should be taken regularly prior to your procedure. If you are a diabetic and use insulin, you should not take your insulin until after the procedure has been performed, unless you have discussed your blood sugar management with Dr. Bonomo or your primary care physician. PLEASE NOTIFY DR. BONOMO OF ANY MEDICATIONS THAT YOU ARE TAKING TO PREVENT ANY INTERACTION WITH THE SEDATION AGENTS.
3. You must be accompanied by a driver who is at least 18 years of age and is capable of taking post-operative instructions and can fill your prescriptions. The driver must have permission to make decisions about your treatment while you are sedated.
4. If you wear contact lenses please remove them before your appointment or wear glasses to the office.
5. You cannot return to work after the procedure is over. You must return home and rest/sleep as the sedation agents will require several hours before they are completely metabolized.
6. You cannot operate a vehicle or machinery for the remainder of the day.
7. Wear a short sleeve shirt or a thin long sleeve shirt, which will not impede the blood pressure cuff reading.
8. Remove fingernail polish on at least the thumb and the forefinger of both hands. These items can prevent the monitoring of oxygen saturation in the blood.
9. Wear something comfortable and do not wear high heeled shoes.
10. If you have any questions regarding these instructions please feel free to contact our office. (513) 671-0222 After hours: (513) 383-3615

Conscious Sedation

Please Read

1. Please eat a small meal 2 hours prior to scheduled appointment time. Take entire contents of packet 1 hour prior to appointment.
2. You must be accompanied by a driver who is 18 years of age and is capable of taking post-operative instructions. Your driver must have authority to make treatment decisions on your behalf while you are under the influence of the prescription medications. Please discuss this with your driver prior to treatment.
3. You cannot return to work after the procedure. You must return home and rest/sleep as the sedation medication will require several hours before it is completely metabolized.
4. You cannot operate a vehicle or machinery for the remainder of the day.
5. Wear something comfortable and do not wear high heeled shoes.
6. If you have any questions regarding these instructions please feel free to contact our office. (513) 671-0222 After hours (513) 383-3615.

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.

OUR LEGAL DUTY
Federal and state law requires us to maintain the privacy of your health information. That law also requires us to give you this notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices we describe in this notice while it is in effect. This notice takes effect April 14, 2003, and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided such applicable law permits the changes. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request.
You may request a copy of our notice at any time. For more information about our privacy practices or for additional copies of this notice please contact us using the information listed at the end of this notice.

USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment, and health care operations. For example:

  • Treatment: We may use your health information for treatment or disclose it to a dentist, physician or other health care provider providing treatment to you.
  • Payment: We may use and disclose your health information to obtain payment for services we provide to you. We may also disclose your health information to another health care provider or entity that is subject to the federal Privacy Rules for its payment activities.
  • Health Care Operations: We may use and disclose your health information for our health care operations. Health care operations include quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, conduction training programs, accreditation, certification, licensing or credentialing activities. We may disclose your health information to another health care provider or organization that is subject to the federal privacy rules and that has a relationship with you to support some of their health care operations. We may disclose your information to help these organizations conduct quality assessment and improvement activities, review the competence or qualifications of health care professionals, or detect or prevent health care fraud and abuse.
  • On Your Authorization: You may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any uses or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those describe in this notice.
  • To Your Family and Friends: We may disclose your health information to a family member, friend or other person to the extent necessary to help with your health care or with payment for your health care. Before we disclose your health information to these people, we will provide you with an opportunity to object to our use or disclosure. If you are not present, or in the event of your incapacity or an emergency, we will disclose your medical information based on our professional judgment of whether the disclosure would be in your best interest. We may use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information. We may use or disclose information about you to notify or assist in notifying a person involved in your care, of your location and general condition.
  • Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voice mail messages, postcards, or letters.)
  • Disaster Relief: We may use or disclose your health information to a public or private entity authorized by law or by it charter to assist in disaster relief efforts.
  • Public Benefit: We may use or disclose your medical information as authorized by law for the following purposes deemed to be in the public interest or benefit:
    • As required by law
    • For public health activities, including disease and vital statistic reporting, child abuse reporting, FDA oversight, and to employers regarding work-related illness or injury
    • To report adult abuse, neglect, or domestic violence
    • To health oversight agencies
    • In response to court and administrative orders and other lawful processes
    • To law enforcement officials pursuant to subpoenas and other lawful processes, concerning crime victims, suspicious deaths, crimes on our premises, reporting crimes in emergencies, and for purposes of identifying or locating a suspect or other person
    • To coroners, medical examiners, and funeral directors
    • To an organ procurement organizations
    • To avert a serious threat to health or safety
    • In connection with certain research activities
    • To the military and to federal officials for lawful intelligence, counterintelligence, and national security activities; To correctional institutions regarding inmates
    • As authorized by state worker's compensation laws.

PATIENT RIGHTS

Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must make a request in writing to obtain access to your health information. You may request access by sending us a letter to the address at the end of this notice. If you request copies, we will charge you a reasonable cost-based fee that may include labor, copying costs, and postage. If you request an alternative format, we will charge a cost-based fee for providing your health information in that format. If you prefer, we may but are not required to prepare a summary or an explanation of your health information for a fee. Contact us using in the information listed at the end of this notice for more information about fees.

Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information over the last six years (but not before April 14th 2003). That list will not include disclosures for treatment, payment, health care operations, as authorized by you, and for certain other activities. If you request this accounting more than once in a 12 month period, we may charge you a reasonable, cost based fee for responding to these additional requests. Contact us using the information listed at the end of this notice for more information about fees.

Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). Any agreement we may make to request for additional restrictions must be in writing signed by a person authorized to make such an agreement on our behalf. Your request is not binding unless our agreement in is in writing.

Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. You must make your request in writing. You must specify in your request the alternative means, or location, and provide satisfactory explanation how you will handle payment under the alternative means or location you request.

Amendment: You have the right to request that we amend your health information. Your request must be in writing, and it must explain why we should amend the information. We may deny your request under certain circumstances.


Questions and Complaints If you want more information about our privacy practices or have questions or concerns, please contact us.

If you believe that:

  • We may have violated your privacy rights
  • We made a decision about access to your health information incorrectly
  • Our response to a request you made to amend or restrict the use or disclosure of your health information was incorrect
  • We should communicate with you by alternative means or at alternate locations.

You may contact us at our office or you may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

 

Cincinnati Office

York Haven Professional Plaza
Phone: (513) 671-0222
Fax: (513) 671-0222
424 Ray Norrish Dr
Cincinnati, OH 45246
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Springboro Office

Ledgestone Professional Park
Phone: (937) 886-9940
Fax: (937) 886-9945
34 Remick Blvd
Springboro, OH 45066
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