University of California San Francisco
Medical Center
Carol Franc Buck Breast Care Center
1600 Divisadero, Second Floor
San Francisco, CA 94115
415 353 7027



Date: Wed, 6 Oct 2004 13:37:37 -0700

08 02 04 60 04100601




Ms. Mildred A. Buck
1158 St. Mathew Place #103
Concord, Ca 94518
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Subject:   Schedule 2nd Opinion Breast Cancer IBC

Dear Millie,

And how are you today? Having read the below from you, I will attach the letter explaining 'self pay'. I'm not surprised Kaiser wouldn't pay for a consult here. That is really common with my other Kaiser patients.
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I can get you in with one of our oncologists on 10-15-04...appointments are not the issue at the moment.,...getting your records are. I am also attaching a checklist of documents needed in case I had not sent it before. Keep me informed if you'd like to proceed with the appoint. I wanted to be sure you understood the University's criteria for self pay first.
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  1. Self pay letter.doc

  2. What to bring.doc

  3. Oncology Checklist.doc
Sincerely,



Sheridan L. Tinker
New Patient Coordinator
Admissions






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University of California San Francisco
UCSF Comprehensive Cancer Center
Carol Franc Buck Breast Care Center
A Program of the National Center of Excellence
& Women's Health
1600 Divsadaro Street
San Francisco, CA 94115
415 353 700



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Subject:   Self-pay Notice

Dear Breast Care Center Patient:

We wanted to take a moment to bring to your attention important information about how UCSF charges for services, so you are prepared and can ask questions along the way. If you are a self-pay patient, meaning you do not have insurance or you are choosing not to use your insurance, a deposit of $602 will be collected from you when you check in to see the doctor for your first visit at the Breast Care Center. This fee only covers your exam and conversation with the physician. If the physician performs any tests or does any procedures, you will be billed for those additional services.
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If you are coming here for a second opinion, it is very common for the physician to request that any pertinent previous pathology slides and radiology films be reviewed here at UCSF. If your doctor suggests this as their plan, please be aware that charges for these evaluations can range from $400 to $2500. If you want an estimate prior to either the Department of Pathology or the Department of Radiology performing their review, please call (415) 353-1269 or (415) 353-1609 for Pathology and (415) 353-1236 for Radiology. You may be asked to make a deposit for these reviews in advance. Unfortunately, the staff in the Breast Care Center do not have access to how the pricing is determined by these other departments and are unable to provide you with an accurate quote.
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If during your appointment, the doctor recommends a procedure to be done the same day, such as a biopsy, there will be an additional charge by the doctor performing the biopsy and the Department of Pathology, who will be processing and reviewing the specimen. These services can range from $1500 to $10,000, so please discuss pricing in advance. If at any time you would like to speak to a financial counselor to see if any special arrangements can be made, please fax (415) 885-3505 or call (415) 885-7803.
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Sincerely,

Breast Care Center Staff







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Subject:   What to Bring

WELCOME TO THE UCSF CAROL FRANC BUCK BREAST CARE CENTER

Our goal is to provide you with quality and expert care, in a respectful and supportive environment. Each of us is committed to you and looks forward to assisting you through the evaluation and, perhaps, treatment process. Your medical care is part of a team effort and you and your loved ones are very important players. We urge you to take an active role in your treatment, to ask questions and to voice any concerns you may have.
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We are located in the UCSF Mount Zion Comprehensive Cancer Center at 1600 Divisadero (between Post and Sutter), on the 2nd Floor. Our phone numbers are: (415) 353-7070 for appointments, Our New Patient fax number is (415) 353-7050.
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PREPARATION FOR YOUR FIRST APPOINTMENT

YOUR FIRST CLINIC VISIT: You may first be seen by a Fellow, Resident, or Nurse Practitioner who will take a detailed history and perform a physical exam. Your case will then be presented to the faculty physician who will review your history and medical records. The faculty physician will then examine you and consult with you and your family The physician's findings and recommendations will be reviewed with you, and together, a plan will be designed for your care. You should plan to spend two to three hours at the BCC for your appointment.
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MEDICAL RECORDS:

The review of your medical records is a vital part of your evaluation at the Breast Care Center. Your medical records must be received one day before your appointment. If we do not receive your records, we will need to re-schedule your appointment.
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PATIENT FORMS:

Before your first visit, you will need to fill out a couple of forms. In order to save you time, you may print and fill these out at home and bring them to your appointment. Alternatively, you can also fax the completed paperwork to us at (415) 353-7021. Please enclose a cover page with your name and the date and time of your upcoming appointment. Please click here to go to our Patient Forms section.
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http://ucsfbreastcarecenter.org/patientforms.html


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PLEASE PROVIDE: LOCATION & DIRECTIONS
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The Breast Care Center is located within the UCSF Comprehensive Cancer Center (Building D on map).

OUR ADDRESS

UCSF Carol Franc Buck Breast Care Center 1600 Divisadero Street, 2nd Floor San Francisco, CA 94115


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DIRECTIONS TO THE UCSF Comprehensive Cancer Center TRAVELING BY CAR FROM MARIN COUNTY

From the Golden Gate Bridge, take the Downtown exit to Lombard Street. Turn right on Divisadero Street. Continue to the 1600 block of Divisadero at Sutter Street.
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FROM THE EAST BAY (80)

From I-80 after crossing the Bay Bridge, stay in the second lane from the right. Follow the signs for "Mission St." and exit on Mission St. Get in the middle lanes and turn left on S. Van Ness Ave. After 7 blocks, turn left on Turk St. After 1 mile, turn right on Divisadero St. and continue to UCSF Medical Center at Mount Zion.
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FROM THE PENINSULA (101, 280)

From 101 North take the Mission Street/Fell Street exit. Go up Fell Street and turn right on Divisadero. Continue to the 1600 block of Divisadero at Sutter Street.
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TRAVELING BY MUNI

UCSF/Mount Zion is easily accessible via Muni bus routes No. 2 (wheelchair accessible on weekends), 38 (wheelchair accessible daily), 4 and 24. The No. 1 California stop at California and Divisadero is three blocks north of the hospital.
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PARKING

There are several public parking lots within walking distance of the hospital: San Francisco Medical Center Garage 1635 Divisadero St.
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On Divisadero, between Sutter and Broderick . $1.50/20 minutes $15 daily maximum (415) 441-5408 2186 Geary Boulevard
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On Geary, between Scott and Divisadero. $2/half hour $13 daily (415) 441-2486 1515 Scott Street Parking
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Auto Parking 8 - 6 p.m. On corner of Scott and Geary. $1.75/half hour $12 daily maximum (415) 567-4656 1701 Divisadero Medical Office Garage
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On corner of Sutter and Divisadero. $2/half hour $16 daily maximum. 2300 Sutter Street Building Parking On Scott, near corner of Scott and Sutter. $2/hour
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Note that much of the street parking around the hospital is limited to two hours. Also pay attention to street cleaning times, as you will be ticketed for parking during these times.







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ONCOLOGY NEW PATIENT
RECORDS CHECKLIST

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(APPOINTMENT WILL NEED TO BE RESCHEDULED IF ALL RECORDS HAVE NOT BEEN RECEIVED 24 HOURS IN ADVANCE) ..
COPY OF INSURANCE CARD(S) FRONT AND BACK