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Medicaid Ordering, Prescribing or Referring (OPR) and Private Contract
This agreement is between the physician, Pratistha Strong, D.O., of Kathmandu Clinic whose principal place of business is at 10807 Big Bend Blvd., Ste 1, Kirkwood, MO 63122 and you the patient. Dr. Strong is an OPR provider. This means that Dr. Strong does not and will not send claims to Medicaid for the services provided. Please read the following and agree to all of the below.
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Please state your name. *
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Medicaid MO Health Net #: *
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OPR providers do not bill MO HealthNet for the services rendered; they only order, prescribe and/or refer services/supplies for their MO HealthNet patients.
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As an OPR provider, Dr. Strong cannot seek reimbursement for services rendered to Medicaid recipients and cannot submit claims to MO HealthNet.
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As consequence of Dr. Strong being an OPR provider, I, as a patient accept full responsibility for payment of the physician’s charge for all services furnished by the physician.
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