The Office of Holly Ryerson Dahlman, MD, FACP

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Green Spring Internal Medicine Dahlman

2360 W. Joppa Road
Suite 210
Lutherville, MD 21093










































































































































Office Policies

Green Spring Medicine, LLCMISSION:  To be a team-based practice that places patients at the center of their own healthcare, connects with family and caregivers, and uses health-information technology to facilitate seamless transitions between healthcare settings.

VISION: To use an evidence-based approach to equip, empower, and engage our patients in their healthcare.

DETAILED PRACTICE DESCRIPTION:  Green Spring Internal Medicine, LLC is an advanced medical practice using health IT and team-based approaches in the Patient-Centered Medical Home Model.  Since 2011, the NCQA has recognized us as a Level 3 PCMH.  We are part of larger initiatives, statewide and nationwide, to improve practice design and to use our technology and personal skills to achieve the Triple Aim:  better outcomes and a lower healthcare costs.

Access to Care
Insurance and Payment Policies
Visit Policies
Prescription Policies
Medical Records Policies
Practice Web Services
Referral Policy
General Policies


Access to Care:

Each patient will be assigned a primary care provider within the practice.

Each patient will have a primary provider assigned within eClinicalWorks, our software system.

The Care Management Team, led by the Care Manager will take responsibility for coordinating visits, labs, diagnostic tests, and communication with other health providers.

eClinicalWorks is the EHR software we use.  We use features to periodically alert our patients, using their preferred mode of communication, as to when labs, visits, tests, and vaccines are due.

Patient visits will be triaged by front office staff, under supervision of our providers, to determine priority.  Clinical protocols guide our decision-making.

Emergency slots and same day visits will be available on the daily schedule and can be scheduled via telephone or Patient Portal.

Every effort is made to return phone calls and web messages in a timely fashion.  Telephone calls that are urgent will be returned within the hour.  Telephone calls that are routine are usually returned on the same business day.  Web messages may be returned on the next business day.

Within reason, we will try to accommodate the patient’s preferred means of communication with us, including language preference.  We will hire a translator on a pre-requested, pre-arranged basis for patients who require this service. 

Telephone calls that are urgent will be returned with the hour.  Telephone calls that are routine will be returned on the same business day.

Patients have 24-hour phone access to staff or providers.  After-hours access is for urgent issues.

Language preference, race, ethnicity, gender and other important identifying information is recorded as demographic information upon the first visit to the practice.  Modifications should be requested in writing.

Prescription education is available through eClinicalWorks in English and Spanish.  Other patient education resources are available online in other languages.

Certain conditions that require an office visit should be scheduled.  For example: ear pain, rashes, minor rectal bleeding, etc.

We will attempt to assist any established patient who lacks insurance or who has insurance we do not accept.  We do charge up-front for out-of-network services.

Existing uninsured patients will be offered a list of resources in writing and via practice website.  We will make a note attesting to our assistance in the chart in eClinicalWorks.

Insurance and Payment Policies:

Patients are expected to provide us with up-to-date insurance information and demographics.  Current insurance cards and ID, preferably driver’s license, are required and must be verified and scanned at every visit if there are any changes.  We request Social Security numbers (SSN) for billing and identity verification purposes.  If a patient requests not to furnish his/her SSN, the patient should provide another form of identification.  Outstanding balances due to incorrect insurance information become the patient's full responsibility.

Payment Policy:  Payment of balance and co-pay and deductibles are required at the time of visit, without exception, unless arrangement has been made with the billing office one week prior to the visit.  A patient who owes a balance to the practice needs to pay the balance in full before being seen by any provider.

Co-pays:  Any co-payment must be paid in full at the time of visit, as per insurance contracts and office policies; otherwise, the appointment will be postponed until payment is received.

Deductibles:  Payment in full is required for services rendered until the insurance deductible has been met.  Patients are responsible for understanding their policies.  Our eligibility verification process is utilized to identify deductibles through insurance carriers.  We have provided resources on our website to help patients understand insurance.

Collections Policy:  We request prompt payment of outstanding bills.  Payments can be phoned in to our office.  After two statements have been sent and a courtesy call, accounts with outstanding balances will be referred to a collection agency.  Patients with accounts referred to a collection agency will be dismissed from the practice with a letter mailed to the address listed in our system. 

Charity Policy:  Our practice offers a self-pay discount.  A payment plan can be arranged prior to collections referral for outstanding balances that are hard to afford.  After collections referral or with a default on a written payment plan, payment plans are no longer available.

Out-of-Network Services:  Our Patient Portal has the up-to-date list of our insurance network participation.  This is also available upon request from the staff.  Payment in full for the visit is required at the time of visit.  Patients will be given an itemized receipt to submit to their insurance companies for direct reimbursement.  The final cost for the visit is subject to change if additional services are rendered, which can be hard to predict prior to the visit.  Patients are responsible for contacting their insurance companies with respect to out-of-network coverage.

Self-pay Patients:  Payment in full is required at the time of service.

**Laboratory bills or bills for outside services not rendered by our practice:  These are solely the responsibility of the patient, and are matters between the patient and the outside entity.  Our practice may provide assistance with additional codes and will make every effort to avoiding tests that are unnecessary or not covered by insurance.**

Visit Policies:

Lateness Policy:  Every effort must be made to start on time.  If a patient arrives more than 15 minutes late for a follow-up visit or more than 20 minutes late for a physical or pre-operative assessment, the appointment may be cancelled or rescheduled for another time. Patients whose appointments are cancelled due to lateness may be subject to the $30 no-show fee. 

“NO-SHOW” Policy:  If a new patient does not show up for his/her first visit, he/she will not be rescheduled with the practice.  Patients who fail to come for an appointment are subject to a $30 no-show fee.  Failure to appear for appointments on more than one occasion may result in dismissal from the practice. 

CANCELLATION Policy:  A patient who does not call to cancel an appointment more than 24 business hours in advance, will be charged a $30 same-day cancellation fee.

Fasting:  Patients planning to have cholesterol tested should fast after dinner the night before their lab appointment.

Vital statistics:  Because of their importance, vitals are recorded at every visit.

We will utilize a CDSS (Clinical Decision Support System) and pre-visit planning huddles to provide important reminders to staff and providers.

We will not administer allergy shots in this practice.

Prescription Policies:

Prescription Refill Policy:  Patients are asked to call the office at least 24 business hours in advance of a request for a prescription refill.  Prescriptions for narcotics and other controlled substances will be handled by the next business day and must be picked up in-person by the patient at the front desk of the office or mailed.  Such prescriptions will not be refilled on weekends except on an emergency basis at the discretion of the provider on call.  Prescriptions for controlled substances will only be written or authorized by the providers.  The practice reserves the right to decline to refill or prescribe a controlled substance.  Chronic narcotic and benzodiazepine use is discouraged for safety reasons and because better alternatives exist.

Prescription Refills When Overdue for Visit:  Any patient on long-term prescription medication should be seen no less than annually.

The prescription list:  This is available to patients via the Patient Portal and will be kept up-to-date at the time of visit or telephone call via review with the staff or provider.

Medical Records Policies:

A signed, completed Medical Records Release Form is required, with the exception of the release of records for the coordination of current medical care.  Medical records will not be released until payment is received. 

Medical records may be faxed by staff members to other doctors’ offices upon request, on a need-to-know basis, particularly when the matter is urgent.  Faxes will be tracked within eClinicalWorks.

eClinicalWorks is our electronic medical records and practice management system. Incoming documents are filed in the chart in a logical and organized manner.

Medical records are viewed by staff members on a need-to-know basis only.

Practice Web Services:

It is the policy of our practice to maintain the highest degree of security with the web products we offer.  We do not correspond with patients via regular e-mail, as the security of e-mail is not fail-safe.  The Patient Portal is the form of e-mail we use, which does require a secure log-in with banking-level security for protection of private information.

Website:  As a service to our patients, we have established the website,, which is for informational purposes.  It will be updated periodically and includes resources suggested by our patients.  Our website 's eLibrary links to interactive health resources to assist patients, families and caregivers in monitoring and self-management of chronic conditions, including educational materials which are multi-lingual.  The eLibrary also features community-based resources.  We also have written materials of a similar nature available.

Patient Portal:  Our practice, upon patient request, grants web access via a unique user ID and password.  The portal allows patients to schedule appointments, see the date of a last appointment, request refills, view lab results, view patient education material and communicate securely with us. radiology requests, etc.  Messages may be sent directly to the provider or staff and should be brief and related to the patient’s own healthcare. .

Interface Labs:  Quest or Labcorp lab results will become available on the portal, once reviewed by the provider.

Healow app:  There is a free smartphone app for Droid and iPhone users.  Healow has all the same features of the Patient Portal and integrates with certain health tracking devices so that patients can keep record and report their data to us.

Facebook: Like us and follow our facebook page for helpful health tips, healthy recipes, articles, and news about the practice.

Twitter:  Follow us at @GreenSpringMed for updates and health posts.

Pinterest:  Follow us @GreenSpringMed for healthy ideas in a more visual format.

Referral Policy:

Requests for Referral:  We require two business days’ advanced notice for referrals, except in the case of urgent consultations.  Urgent referrals will be tracked until we have record of a visit, using the eClinicalWorks referral tracking system to close-the-loop.

Information from Other Providers:  Our office serves as a hub for all of a patient’s medical information; therefore, it is essential that all other providers fax e-Transit or mail consultation notes, lab results, diagnostic test results and any other important health information to us.  Our fax number is 410-583-2891.

General Policies:

Privacy Policy:  Our office follows the guidelines established by HIPAA and HITECH regulations.  Our partners in practice and in business are held to the same standards through Business Associate Agreements.

An electronic registry will be utilized to organize care and may be utilized to report data to insurance companies and public health agencies.  Data generated by the practice for research purposes is confidential, and safeguards are in place to insure proper security.  Upon request in writing, patients may opt out of the PCMH model including participation in the registry.

The security and preservation of data are top priorities.  We will abide by existing statutes which mandate timely reporting of any breach in security.

Patients receive a copy of their note, or may receive an electronic copy of their office visit, at the end of the visit.  Patients are encouraged to keep a hardcopy personal health record (PHR) in safekeeping or, if online, to take precautions to ensure the privacy of their PHR.

Our practice seeks to partner with initiatives that will produce interfaces between medical offices, hospitals, labs and other healthcare facilities with HIPAA safeguards in place.

CRISP and Interfaces:  Our practice participates in Encounter Notification Services (ENS) through Chesapeake Regional Information System exchange (CRISP).  We are notified when any one of our patients is admitted or discharged from a hospital or seen in an emergency department anywhere in Maryland.  We also have access to view information posted to the CRISP Portals on a need-to-know basis for patient care.  Our practice seeks to partner with initiatives that will produce other interfaces between medical offices, hospitals, labs and other healthcare facilities with HIPAA safeguards in place.  We believe such automated connection is of-the-essence for efficiency, excellence and safety in patient care.  patients may opt out of CRISP via this weblink. or by calling 1-877-952-7477

Discretion to Change Providers:  A patient has the right to be seen by the provider of his/her choice and has the freedom to switch providers within our practice or to pursue healthcare outside of our practice with no interference on the part of providers or staff members of Green Spring Internal Medicine.  A patient who has been dismissed by the practice may not be scheduled with any provider in the practice.

Dismissal From the Practice:  Dismissal from the practice does not result in exemption from payment of balances due.  Referral to a collections agency is grounds for dismissal, and we follow Maryland State guidelines with respect to notification of dismissal.

Vaccine Policy:  Vaccinations that are not carried in stock by our practice may be purchased by the patient at a pharmacy and brought back to the office for administration here or may be administered at the pharmacy.  If a pharmacy administers a vaccine, we request notification in writing to update the chart.  Our practice holds the following vaccines in stock:  tetanus toxoid, seasonal influenza, Tdap and pneumovax.  This list is subject to change with changes in insurance coverage.

Samples Policy:  We do not store samples of controlled substances on our premise.  We will comply with Johns Hopkins University policy.

Pharmaceutical Representatives:   The providers of Green Spring Internal Medicine do not accept calls or drop-in visits from pharmaceutical representatives or other vendors except between the hours of 12-1 pm on the 2nd Thursdays of every month on a first come, first-served basis.  We do not host events related to pharmaceutical marketing.  Pharmaceutical marketing materials will not be displayed in our office.

Students:  We have had students from various backgrounds work with the practice at various times and in various capacities including front office work, patient care and research.  We expect our students to abide by our policies as well as a professional code of ethics.  We consider students to be an important part of our healthcare team, enhancing our patient care delivery, and will make every effort to inspire excellence, teamwork and the adoption of evidence-based, state of the art practice.