No surprises act letter

Can anyone share the letter they give to self pay patients in regards to the NSA?
I’m not sure if anything was ever posted on soapm? I am a member but maybe I missed it?
@SKB ?

This was posted on SOAPM last week:

From the SOAPM EC, we’d like to give thanks to the SOAPM GFE Committee

  • Amber Griffin

  • Melissa Schwartz

  • Karla Swatski

They have worked hard to get Sample GFE Documents that we can reference as templates for our office.

They have been uploaded to the

SOAPM Collaboration Site:

While you are there, peruse all the other great sources of information we have for you.

  • Past Webinars
  • CARES Act Information
  • Vaccine Storage
  • Visual Gallery of Office Design Spaces

and much more.

Hiral Lavania, MD, IBCLC, FAAP

One Family Pediatrics

2575 Peachtree Parkway | Suite 301

Cumming | Ga 30041

678.962.PEDS (7337)

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Thank you!!!

I have made a template that fits on 1 page. :slight_smile:
Cannot paste it here. I can email it to you if you’d like.


Can you email me a copy please?

Please email to me

Me too, please.

I would love this as well. Thanks.



Would like to see this as well :wink:

THANKS! This template is greatly appreciated.

Could you also email to:

Thank you!

Would love to see it:
Thanks so much!

I’ve sent to everyone requested. FYI, I made it base it off what Dr. Berman said in Chip & Paulie’s webinar but it’s not the SOAPM template Dr. Lavania mentioned above.

Would you be able to send me one too?
Thank you SO MUCH!

Could you send one to me as well Thank you!

Can you please send me copy also
Thank You