Medical Record / HIPAA
We document all visits and always respect your privacy. Medical records can be sent to a specialist or agency at your request for no charge. Records requested for transfer to another physician, personal use, or sent directly to you will incur a charge, which must be paid before the records are processed. To request records, a medical record release must be submitted. Turn around time is within 3 business days. Urgent request will incur an additional fee.

Insurance / Financial Policy
We are contracted with many insurance companies. Claims will be submitted to all insurance companies we are contracted with. In the event that the insurance carrier pends the claim while requesting information from the insured, we will provide a maximum of 30 days to resolve issues with your insurance company. If you are unable to resolve the issue, or you do not respond to your insurance carrier, then the charges will be transferred to your responsibility for payment.

Copays and a minimum of 50% of all deductibles/coinsurances are due at the time of service. If you need to arrange a payment plan, please contact our billing department prior to your visit to the office. Please be aware of your plans benefits and limitations. Although we will file many insurance carriers, you are responsible for any portion not covered by your plan. Statements are mailed monthly and payment is due upon receipt. Extended payments require contacting our billing manager. Please bring a copy of your insurance card to every visit. Payment is due at the time of service for patients without insurance. Ask us about the VFC program for immunizations. We accept cash, personal checks, money orders, Visa, Mastercard, Discover, and Amex.

Forms
All children receiving vaccines will be given an updated 3231 immunization form. The office provides this 3231 form free of charge on the day that the patient receives immunizations. Any request for 3231 (immunization) or 3300 (hearing, vision, dental) forms beyond the time of service will be subject to a fee for form completion. Sports, school, and camp forms are all subject to a fee. Most forms require a physical exam within 1 year. If your child has not had an exam, please schedule one before asking us to fill out the form. Due to the increased volume and enormous amount of staff time, beginning January 1, 2009 we will charge a fee of $2-$20 for every form, including sports, school, camp, 3231, 3300, medication forms, utility letters and insurance forms. The fee is due at the time of the request. Turn around time is 2-3 business days. An additional fee of $10.00 will be charged for all urgent requests. When completed, forms can be faxed, mailed, or picked up.

Scheduling Appointments
We schedule well checkups, rechecks and consultations in advance. Sick appointments can be made the day your child is ill. You can make a same day sick appointment by calling as early as 8:30 AM. During times of peak illness if a nurse will triage your call. Please call our office during normal business hours. If your childs condition changes before your appointment time please call us, or call 911 for a true emergency.
We accept walk-ins when we can accommodate them. All walk in patients will be triaged and given an appointment time. To avoid waiting, call first. For life threatening emergencies call 911.

Pease help us stay on time by arriving on time for your appointment. If you are more than 15 minutes late you may be rescheduled for the next available appointment
Please call with 24 hours notice to cancel an appointment. If a cancellation call is not received by 8:30 am on the day of the appointment a fee may be charged; missed appointment charges are not covered by insurance plans. A pattern of missed appointments may result in dismissal from the practice.

Referrals
We often refer to a variety of talented, mostly pediatric specialists in the area for things that need specialty care. We will almost always suggest you start with an appointment with us, although at times and for certain conditions we will make suggestions by phone. It is your responsibility to check with your insurance company and with the specialist to be sure your visit will be covered. If a referral is needed, call our office and leave all the required information. Please be sure you call in advance of your appointment to allow time to process the referral. Other than for emergencies, there is a 2-3 day turn around time for referrals.

Phone Calls
Our front office staff are generally available to answers all calls between 8:30 am and 12:00pm and from 1:00pm until 5:00 pm. Please be as clear as possible with information such as your childs name, date of birth, and the reason you are calling. Be very clear if you think you have an urgent medical situation. You can ask to be transferred to the form line to leave information about a form you need, the referral line as outlined above, the prescription refill line, or the nurse advice line. If you want to schedule an appointment for a sick visit, call the day your child is sick for a same day appointment. Call in advance for well visits, rechecks, and consults as we may not be able to accommodate same day appointments for these visits. Our Clinical Triage Staff are generally available Monday Friday to answer baby care questions, medication questions and refills, or to help you decide if your child needs to be seen. If you wish to speak to the doctor, non-emergency calls are generally answered at the end of the afternoon and, as time permits, between appointments. For some problems, the physician may request that you schedule an appointment. When calling about a sick child, always the number of your pharmacy ready. As we have limited staff on Saturday, please hold all routine calls until the weekdays.

After Hours
A physician is available after hours for urgent and emergent medical needs by calling the main number. For calls that are not urgent, please call during regular office hours. We recommend that all parents learn CPR and keep emergency numbers handy.

Rx refills
We refill prescriptions during regular office hours. Call and leave a message, or have your pharmacy call or fax a request. Refills are done within 48 hours, unless authorization is required. We will notify you if there are any problems. You may be asked to leave this information on voice mail of the clinical staff. When calling, please specify dose, time given, and quantity desired.

Please help us keep our office clean so each visit can be an enjoyable experience for all:

• No Food Allowed, other than breastfeeding and formula for infants
• No cell phone use in exam rooms and hallways except for emergencies
• No smoking on the premises
• Dirty diapers must be taken out of the office 

THANK YOU FOR YOUR COOPERATION