PATIENT INFORMATION

Forms, Links & Documentation

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Bruce Banias, MD, LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. 


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Bruce Banias, MD, LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.  Bruce Banias, MD, LLC does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.


  Bruce Banias, MD, LLC:


  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:

  ○ Qualified sign language interpreters

  ○     Written information in other formats (large print, audio, accessible electronic formats, other formats)

  • Provides free language services to people whose primary language is not English, such as:

  ○ Qualified interpreters

  ○ Information written in other languages

 

If you need these services, contact Tracy Zerba, RN, MS, MBA; Office Manager and Civil Rights Coordinator.


If you believe that Bruce Banias, MD, LLC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: 

Tracy Zerba, Office Manager and Civil Rights Coordinator

3075 Governor’s Place Blvd, STE 210, Dayton, Ohio 45409

P: (937) 424-5921

F: (937) 424-5925

Email:  tracy@genesisobgynonline.com



You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance Tracy Zerba, RN, MS, MBA; Office Manager and Civil Rights Coordinator is available to you. 

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201 

1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. 




Patient Forms:


The below forms are in PDF format and designed for you to be able to download them, print them, fill them out and bring them into the office.  We do not recommend nor advocate emailing them or  sending them through this site.

PATIENT PAMPHLET

PATIENT INFORMATION SHEET

PATIENTS RIGHTS & RESPONSIBILITIES

RELEASE OF MEDICAL INFORMATION

HIPPA FACT SHEET

POLICIES & PROCEDURES

 

Calculating Your Due Date


Your due date, an estimated date of when the baby will be born, is based on the length of an average pregnancy — 280 days, or 40 weeks from the first day of your last period.

Using this method of calculation, and assuming that you conceived on the 14th day of 280 days, you weren't officially pregnant during the first two weeks of your pregnancy. You may also be surprised to learn that you're very unlikely to give birth on your exact due date. In fact, the chances of this happening are only 5 percent! You are, however, extremely likely to have your baby within two weeks on either side of this date, because a normal pregnancy can last between 37 and 42 weeks.


A Handy Due Date Formula:


Start with the first day of your last period and count backward three months to get the month in which you will deliver. Add seven to the day of the month in which your last period began to get the due date. For example, if your last period began on August 20, you would count backwards three months to May, then add seven to 20 to get a due date of May 27. 

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