Lindner Center of HOPE Professional Associates (LCOHPA)
Consent to Treatment-LCOHPA
NOPP- Notice of Privacy Practice Handout
HIPAA- Acknowledgement of Receipt of Notice of Privacy Practice
Outpatient Practice Policy Guidelines
Financial Responsibility Agreement-Self-Pay-LCOHPA (based upon insurance)
Medicaid Waiver-LCOHPA (based upon insurance)
MDCR (ABN) Advance Beneficiary Notice
Brett C. Plyler, M.D.
Paul E. Keck, MD
Chris J. Tuell, EdD, LPCC-S, LICDC-CS
Megan T. Schrantz, Ed.D., LPCC
Peter White, M.A., LPCC, LICDC
Nutrition Services
Consent to Treatment-LCOHPA
NOPP- Notice of Privacy Practice Handout
HIPAA- Acknowledgement of Receipt of Notice of Privacy Practice
Outpatient Practice Policy Guidelines
Verbal Release of Information
Authorization to Release-Documents
Financial Responsibility Agreement-Self-Pay-LCOHPA
Medicaid Waiver-LCOHPA
MDCR (ABN) Advance Beneficiary Notice
Brett C. Plyler, M.D.
Paul E. Keck, MD
Chris J. Tuell, EdD, LPCC-S, LICDC-CS
Megan T. Schrantz, Ed.D., LPCC
Peter White, M.A., LPCC, LICDC
Nutrition Services
Behavioral Health (BH) Financial Responsibility Agreement
Collection & Bad Debt Policy-LCOHPA
Late Cancellation No Show Waiver Request-LCOHPA
If you need assistance, please call:
Hospital Main Line: 513-536-HOPE
Lobby Registration Direct Line: 513-536-0560
If you are not using the online form completion option, completed documents may be sent by
Mail to:
Lindner Center of HOPE Registration
4075 Old Western Row Rd.
Mason, OH 45040
Lobby Registration Fax Line: 513-536-0648
Registration Email: [email protected]